Varicose Veins

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Woman with varicose veins in the legs

Varicose veins are enlarged, swollen, and twisting veins, frequently linked to faulty valves in the vein and usually blue or dark purple in colour. They usually develop in the legs.

Veins have pairs of leaflet valves to prevent blood from flowing backwards. Leg muscles pump the veins to return blood to the heart against the effects of gravity.

When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. Blood cannot flow back up to the heart. This allows blood to pool in the lower leg veins.

This condition is most frequently seen in the legs and feet, since standing and walking naturally forces blood down into your lower legs due to the effects of gravity. However, varicose veins may also occur elsewhere. Typical symptoms are cramping pain and heavy limbs, leg swelling, venous eczema, skin thickening and ulceration.

To treat a case of varicose veins, doctors may recommend a program of home based self care. If the problem is exceptionally serious, they may suggest one of a number of available procedures to remove the problem veins.

Varicose veins should not be  confused with deep vein thrombosis (DVT), which is a distinct (and much more serious) condition. DVT involves the development of blood clots in the veins of the lower leg.

Spider veins is another condition frequently confused with varicose veins. Individuals with spider veins tend to have red or blue veins (instead of dark blue or purple). Spider veins also tend to be superficial veins that are closer to the skin. Additionally, spider veins can sometimes also occur on the face, unlike varicose veins.

Causes Of Varicose Veins

As we have summarized above, this condition is a result of the development of defects in the valves of the lower leg blood vessels. To return the blood in the lower legs to the heart, the leg muscles must force the blood up through the veins against the force of gravity.

However, in the case of someone with varicose veins,  the lower leg veins have defective valves that will not open easily. As a result, the blood will be unable to return to the heart and will instead pool in the lower leg veins. This results in enlargement and twisting of those veins.

Risk Factors

The following factors can increase the risk of an individual developing varicose veins:

  • Increasing age, since this increases the wear and tear of your lower leg blood vessel veins;
  • Gender, as women are more likely to experience this problem. This may be a result of the fact that female hormones tend to reduce the tension in vein walls. Some types of birth control pills are hormone based, and may therefore also contribute to the risk;
  • Being pregnant, which increases the volume of blood in the body and enlarges the veins. Additionally, pregnancy itself can cause bodily hormonal changes that could reduce vein wall tension. The more babies a woman has had, the greater the risk of developing varicose veins. The varicose veins tend to appear or get worse during  pregnancy, but improve after childbirth;
  • Genetics, as the risk of developing varicose veins appears to be higher among those with family members who already have the condition;
  • Body weight (in women, but not in men), as obesity causes extra pressure on the body’s veins and increases the wear and tear suffered by blood vessel valves;
  • If your job requires you to sit or stand for long periods, this (can) is thought to inhibit blood circulation and increase the varicose veins risk. However, there is only limited scientific evidence to support this theory;
  • A previous blood clot (deep vein thrombosis), due to damage to the valves when the veins recanalise.

Symptoms Of Varicose Veins

Most people with varicose veins actually do not have any symptoms. However, occasionally, people with varicose veins tend to experience the following symptoms:

  • Twisted and/or bulging veins that may also appear to be blue or purple in colour;
  • Discoloration of the skin adjacent to varicose veins;
  • Achiness or heaviness in the legs, especially after prolonged standing
  • Pain, swelling and sometimes muscle cramping in the lower legs. This pain may increase after a long period of standing or sitting;
  • Itching of the lower legs, usually around the site of the varicose veins.

Treating Varicose Veins

LifeStyle Changes

Moderate cases of varicose veins can be treated by making lifestyle changes such as:

  • Weight loss through exercise and dietary modifications;
  • Wearing looser fitting clothing;
  • Elevating the legs whenever sitting or lying down. Extra pillows under the feet on a bed or footrest can be used to raise the legs above the level of the hips.
  • Avoiding sitting or standing for extended periods. Try to change position every few minutes instead.

A moisturising cream or ointment to protect the skin can be used if the skin in the affected area is dry, flaky or itchy.

Pregnancy Related Varicose Veins

It should also be noted that most cases of varicose veins that appear during pregnancy disappear within 3 to 12 months after childbirth. So, in these cases, no treatment is actually required.

Compression Socks Or Stockings

Compression stockings are not recommended for routine long-term treatment of varicose veins, but, rather, only when all other treatment options are unsuitable. They should be put on first thing in the morning before getting out of bed and taken off at the end of the day before going to bed.

Many compression stockings use graduated compression technology. This means that they employ higher levels of compression around the ankles than around the knees.

As a result, they help to force blood up through the veins of the lower legs. The blood will be returned more quickly to the heart, thus reducing the symptoms of varicose veins.

You can buy graduated compression stockings with several different compression levels. This is helpful for finding a balance between compression levels and wearing comfort that works for each person.

Other Treatments

For individuals with more severe cases of varicose veins, doctors can suggest a range of treatments, including:

  • Endothermal ablation is often one of the first treatments to be offered. It involves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins
  • Sclerotherapy, in which the varicose veins are injected with a solution that scars and eventually closes them. It is reserved mainly for small disfiguring veins below the knee which have not been treated properly or have recurred after surgery. This procedure can be performed in a doctor’s office and there will be no need for an overnight hospital stay. In order to enable fibrosis to occur, compression stockings or bandaging need to be worn for one to six weeks afterwards;
  • Simple laser treatments on the exterior of the skin can be used to close smaller varicose veins as well as spider veins. One key advantage of this approach is that it is non invasive;
  • Varicose veins can also be treated by means of laser energy introduced into a vein by means of a catheter (a thin tube). As the catheter is withdrawn, the varicose vein will collapse and be sealed shut. Many larger, deep varicose veins are treatable using this technique – endovenous (invasive) laser treatment ;
  • Vein stripping after litigation, which involves tying off the varicose vein before it joins a larger one.The varicose vein can then be removed  via small incisions (vein stripping). Compression stockings sometimes need to be worn for up to a week after surgery.

If the varicose veins have advanced to the point at which there are complications like ulcers, endoscopic vein surgery can be tried. Tiny cameras are inserted into the leg to help the surgeon to see and then remove (strip) the varicose veins.

Additional information on varicose veins treatments can be found here.

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