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Varicose veins

NHS Direct Online Health Encyclopaedia

 

Introduction

Varicose veins are swollen, irregularly shaped veins that most commonly appear in the legs. They happen because the valves in the veins are not working properly to keep the circulation of blood flowing in the veins.

Varicose veins in the legs affect about 1 in 5 adults, and are more common in older women. They usually develop slowly and may run in the family. Although varicose veins can be embarrassing and uncomfortable they’re not usually a risk to your health.

Varicose veins can also develop in the internal organs such as the lower end of the gullet (oesophageal varices) and in the veins from the testicles (varicocoele). Hemorrhoids are varicose veins around the anus.

Symptoms

Because of the slow blood flow in the veins, there is a poor supply of oxygen to the surrounding tissues.

Varicose veins are veins that look swollen and stretched all the time. They are more noticeable when you stand up. They are most commonly found on the legs, usually around the back of the calf, but they can go up the leg to the groin.

Other symptoms include:

  • Twisted looking blue veins- some people call them spider veins;
  • Aching, heavy legs – this is usually worse at night;
  • Ankle swelling;
  • Permanent brownish-blue shiny skin discoloration around the veins;
  • Skin over the vein may become dry, itchy and thin, leading to eczema (venous eczema) 
  • The skin may darken (stasis dermatitis), because of the waste products building up in the legs;
  • Minor injuries to the area may bleed more than normal and/or take a long time to heal;
  • Rarely, there is a large amount of bleeding from a ruptured vein; and
  • In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.

Varicose veins stop the blood flowing properly. This can cause other conditions to develop such as build up  of fluid in the legs, deep vein thrombosis and ulcers.

Thrombophlebitis is a common problem related to varicose veins. It is like a blood clot and you may feel swelling and pain around the affected vein. Thrombophlebitis is usually treated with rest, painkillers and NSAIDS (non-steroid anti-inflammatory drugs) but if it gets infected you may be prescribed antibiotics.

Causes

Blood returning to the heart flows upwards from the legs. It is moving against gravity so the veins in the legs have to work hard to pump a heavy amount of blood. The flow is helped by a series of one-way valves in the veins that only allow the blood to move upwards (against gravity). This reduces the pressure of blood below by supporting it at different stages on its way up.

If the vein valves are leaky, the weight of the blood going from the heart to the lower legs presses on the walls of the veins. The blood cannot drain properly and so flows back down again causing the veins to bulge and stretch. Veins near the surface of the leg aren’t supported by muscles, so there is nothing to stop them getting bigger with the increased pressure of blood. This pressures causes the surface veins to stretch, bulge and become winding in shape (tortuous). It is only usually the surface veins that are affected because the deep veins are well supported by surrounding tissue.

Varicose veins tend to run in families, and there is probably a genetic tendency to leaky valves. Being overweight increases the risk of varicose veins, as does tight clothing and standing up for long periods of time, for example as part of your job. 

Pregnant women can get varicose veins because of the pressure on the veins in the pelvis as the uterus expands. Women who have had children are more likely to have varicose veins. For women, the veins can also get worse before and during your period because of the increased pressure in your abdomen.

People with conditions that affect the blood flow, such as diabetes, are more prone to varicose veins, as are people with a previous vein disease such as thrombophlebitis.

 

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Diagnosis

Your GP will ask you a few questions about how your varicose veins are affecting your life and they will examine your legs. You should tell your GP if you have any family history of blood clots including deep vein thrombosis.

Most people with varicose veins are not referred to a specialist. This is because most varicose veins are not a threat to your overall health.

If your GP agrees that you have varicose veins and they are causing you problems, they may refer you to a specialist who will do tests such as checking your blood flow, your skin and your joints. They also need to find out if the problem is affecting just your surface veins or your deep veins too. You may have a scan called a Doopler ultrasound, which lets the doctor ‘hear’ how the blood is flowing.

Treatment

If your varicose veins are not causing you any trouble you probably don’t need any treatment. If they are painful, sore or bleeding, if you have ulcers or if they affect your daily activities or your sleep, your GP may suggest treatment. Treatment options depend on your general health and how severe your varicose veins are.

Support stockings - compression stockings help to support the surface veins. They come in different strengths and are tighter at the bottom than the top. You should put them on when you get up in the morning. To avoid getting any skin conditions related to varicose veins, keep your legs well moisturized, but avoid perfumed moisturisers.

Leg elevation (raising your leg up higher than your chest) at frequent intervals will improve blood flow, get more oxygen into the blood and help prevent waste products building up and causing pain. It helps to re-direct blood from the surface veins into the deep veins, and stops blood from flowing back out to the surface veins.

Injection sclerotherapy is a surgical treatment in which the veins are injected with a chemical that closes them completely. This technique is most effective on smaller varicose veins that have not yet formed properly. Injections of chemicals into the veins can improve their appearance but the legs may still ache. It may not be successful long term; the varicose veins may come back after a while. You will need to wear pressure bandages for 3-6 weeks after you have the injections.

Ligation and stripping (which means tying and pulling out) is a technique used to remove the surface veins either partly or altogether. This can only be done if the deep veins are working properly because the deep leg veins will take over from the vein that was removed. It is done under a general anaesthetic and you will have an incision in your groin and many small incisions lower down your leg. This operation usually has very good results and surgery can be more effective than other methods in the long term. You will probably need to stay in hospital for a few days. You may want need to take painkillers after the operation and you will need to support the legs with support bandages and leg elevation.

Thinner veins can be removed with laser or heat  treatment (thermal ablation).

Some people use complementary therapies such as horse chestnut for their varicose veins.

Prevention

Here are some ways you can try to prevent varicose veins:

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Heart
The heart is a muscular organ that pumps blood around the body.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Joint
Joints are the connection point between two bones that allow movement.
Uterus
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Vein
Veins are blood vessels that carry blood from the rest of the body back to the heart.
Testicle
Testicles are the two oval-shaped reproductive organs that make up part of the male genitals. They produce sperm and sex hormones.
Anus
The anus is the opening at the end of the digestive system where solid waste leaves the body.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Genetic
Genetic is a term that refers to genes- the characteristics inherited from a family member.
Incision
An incision is a cut made in the body with a surgical instrument during an operation.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Ulcer
An ulcer is a sore break in the skin, or on the inside lining of the body.
Ache
An ache is a constant dull pain in a part of the body.
Constipation
Constipation is when you pass stools less often than usual, or when you are having difficulty going to the toilet because your stools are hard and small.
Rupture
A rupture is a break or tear in an organ or tissue.
Analgesic
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Antibiotic
Antibiotic s are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.

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Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland

 

 

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