Varicose veins

These are swollen, lumpy, blueish coloured veins which protrude from the surface of the skin. They affect women more than men which are due to the effect of female hormones on the veins but can develop in both sexes.

Varicose veins develop in the legs and feet which are due to the amount of pressure put on these veins by standing, walking and other movements.

Different types of varicose veins

There are 3 types of varicose veins which are:

  • Reticular: red veins which cluster together to form a network.
  • Telangiectasia: also known as thread veins. They are small blue or red veins which appear on the surface of your skin.
  • Trunk: thick, lumpy, veins which develop near the surface of the skin. Extremely visible and unattractive.

Causes of varicose veins

A healthy vein enables blood to flow through it by means of two tiny valves which open and close as a form of control. They stop blood from flowing back into the legs, causing problems such as varicose veins. They form part of your body’s circulation system.

But damage to these valves prevents them from working properly, enabling blood to flow backwards and pool in the lower limbs. This weakens the veins in the legs, resulting in a swollen, lump appearance.

There are factors which increase your risk of varicose veins. These include:

  • Gender: women are more prone than men
  • Age: more common in older people
  • Genetics: varicose veins are inherited
  • Job/career: if you have a job which involves standing on your feet all day then this increases your risk.
  • Overweight/obese: extra weight puts additional stress on your veins, resulting in damage and varicose veins.
  • Pregnancy: female hormones relax the walls of the veins which weaken them, increasing the risk of developing varicose veins. This often clears up after childbirth.

Symptoms of varicose veins

Varicose veins are unsightly looking. They become knobbly, lumpy and twisted in appearance, often bulging out of the skin. They have a distinctive blue or purple colour and are often painful. They develop on the legs, often on the backs of the calves. But they can appear around your back passage, vagina or inside the womb.

They are accompanied by other symptoms such as a throbbing pain (especially if they develop in your legs), swollen ankles, aches and pains, itching and cramp.

These symptoms worsen if you have been stood up for long periods of time or during hot weather.

Diagnosing varicose veins

If your varicose veins are mild and not causing any problems then you do not need to take any action. But if you spend a great deal of time on your feet then it may be good idea to factor in periods where you take a break and sit down. This will take the weight (literally!) off your feet and give them a rest.

If this applies to your occupation then discuss this with your employer to see if it is possible.

But if you have severe varicose veins or your veins are itching, painful or causing you a great deal of discomfort then see your GP.

Your GP will examine your varicose veins before asking you a series of questions about your health, family history and whether you have suffered from these before. He or she will also ask you about your weight and if you have ever suffered from a blood clot in your leg or a lower leg injury.

The aim is to see if there are any risk factors which have led to the development of this condition.

If your condition warrants it you will be referred for further investigations. This is the case if you have had varicose veins before, have a leg ulcer or your veins are causing you problems to the extent that they are impacting on your life.

This means a series of tests with a vascular specialist: he or she will use ultrasound to check blood flow through your veins as well as carry out a scan to check the condition and structure of your veins.

Treatment for varicose veins

This is offered if your veins are large, painful or causing serious problems. Your GP or vascular specialist will recommend a form of treatment based on the severity of your varicose veins and your overall health.

The options are:

  • Compression stockings
  • Surgery
  • Sclerotherapy
  • Laser treatment
  • Ablation
  • Phlebectomy

Compression stockings

These are similar to those worn on long haul flights. They squeeze your legs which help to improve your circulation and aid with blood flow towards your heart. Plus they also relieve any swelling caused by varicose veins. These stockings are designed so that they fit tightly around the ankle but looser the further they go up your leg.

Surgery

Large or particularly chunky varicose veins will be removed by surgery. The most common technique for this is ‘ligation and stripping’ where the affected veins are tied off and then removed. This may cause pain, bruising and possibly bleeding.

Sclerotherapy

This is a procedure in which a chemical is injected into the varicose veins which closes the veins, enabling them to fade into the background. These are then replaced by new, strong veins which allow blood to flow through as normal.

Laser treatment

This is known as ‘endovenous laser treatment’ and involves the insertion of a small laser into the damaged vein using a catheter as a guide. The laser emits short bursts of energy at the vein which seals it shut. This is done for the entire vein.

Ablation

The full name for this is radiofrequency ablation: a small probe is inserted into the varicose vein through guidance from an ultrasound scan. It transmits energy into the vein which causes the walls to collapse, sealing off the entire vein.

Phlebectomy

Known as ‘transilluminated powered phlebectomy’: this procedure involves two incisions in your leg through which a special light (endoscopic transilluminator) is passed through. This light clearly displays the varicose vein which is then incised and removed via suction.

Complications of varicose veins

This can develop several years following the appearance of varicose veins. These are:

  • Bleeding
  • Inflammation of the veins (thrombophlebitis)
  • Venous ulcers
  • Chronic venous insufficiency
  • Varicose eczema
  • Lipodermatosclerosis

Bleeding from varicose veins occurs due to an accident or injury to the leg. Apply pressure to the injury and seek medical advice if it does not stop bleeding. Bleeding is difficult to control in people with varicose veins.

Inflammation of the veins is caused by the formation of a blood clot within the varicose vein. This becomes red, warm and painful.

Venous ulcers occur when excessive pressure in the vein causes fluid to leak and collect under the skin. The skin thickens and enlarges forming an ulcer, usually in the ankle area.

Chronic venous insufficiency is caused by insufficient blood flow through the veins. This disrupts other vital processes such as the exchange of nutrients within the body which has a knock on effect.

Varicose eczema presents as red, itchy, flaky skin with a scaly appearance. This can lead to blisters which ooze fluid before turning to hard crusty lesions.

Lipodermatosclerosis is a condition which causes the skin around the varicose veins to become hard, red and shiny. This usually occurs around the calf muscle.

Preventing varicose veins

Can these be prevented? Once varicose veins have developed it is very difficult to prevent them from worsening or new ones from forming. But there are a few things you can do which will ease the pain and discomfort.

These include:

  • Avoid standing or sitting in the one position for long periods of time. Get up and move around or have a break from standing and sit down. Do not cross your legs as this worsens the symptoms.
  • Raise your legs at intervals throughout the day. Place 2 or 3 pillows (or cushions) underneath your legs and keep them elevated for a short period of time.
  • Take regular exercise, e.g. walking

Varicose veins are not life threatening but they are unpleasant and unattractive. However, many cases of varicose veins do not need to be treated.