Varicose veins

Varicose veins are a very common chronic (long-term) condition that usually occurs in the legs or feet. However, varicose veins can happen anywhere, including around your anus (bottom), when they’re called haemorrhoids.

Types of varicose veins

• Reticular varicose veins — these are red and can group together into a network
• Telangiectasia varicose veins (thread veins or spider veins) — these are small, harmless clusters of blue or red veins, which do not bulge under your skin; they sometimes occur on your face or legs
• Trunk varicose veins — these are knobbly, thick and often long; they occur near to the surface of your skin and may look unpleasant

A varicose vein occurs when the one-way valves in a vein become weak or damaged, or the walls of a vein weaken — sometimes the walls of a vein are stretched and become less elastic, which can weaken the valves. This allows blood to flow backwards and pool in your vein, which becomes swollen and enlarged (varicose). 

You may also suffer from varicose eczema, which is a chronic skin condition that causes dry, flaky and sometimes itchy skin on your lower legs. It’s also known as venous, gravitational or stasis eczema.

About three in 10 adults are affected by varicose veins. They're more likely to develop as you get older.

You’re also at a higher risk of developing varicose veins if you:

• Are a woman — female hormones relax the walls of the veins, which increases the risk of leaky valves
• Are obese — this puts more strain on your veins and forces them to work harder
• Are older — veins become less elastic with age 
• Are pregnant — this is due to several changes during pregnancy: 
• An increase in hormones can relax the walls of your veins
• An increase in the amount of blood in your body to support your baby puts more strain on your veins
• Your growing womb puts pressure on the veins in your pelvic area
• Have a family history of varicose veins
• Have an occupation involving a lot of standing

Other medical conditions can also increase your risk of varicose veins, such as: 

• A previous blood clot
• A swelling or tumour in your pelvic area
• Abnormal blood vessels

Lifestyle changes such as losing weight or doing more exercise can sometimes prevent varicose veins symptoms worsening.

If your varicose veins are causing problems, they can be removed through surgical and non-surgical techniques.

The main symptom of a varicose vein is a swollen, twisted, blue or purple vein that may have bulges or lumps. Other varicose vein symptoms include:

• Aching, heavy, painful legs, which are often worse after long periods of standing or in warm weather
• Dry, flaky, itchy and discoloured skin around your varicose veins (varicose eczema)
• Leg ulcers — chronic sores that can cause pain, itching and swelling
• Legs that bleed or bruise easily
• Muscle cramps, burning or throbbing in your legs
• Swollen feet and ankles

Varicose veins do not always cause pain. 

Your symptoms will usually be worse after standing for a long time or in warm weather. However, you may not experience any pain or discomfort from your varicose veins and therefore may not need to see your GP. However, you should see your GP if:

• Aching in your legs caused by varicose veins is keeping you up at night
• The skin over your varicose veins is irritated and sore
• Your varicose veins are causing you discomfort 
• You’re unhappy about the appearance of your varicose veins

They'll advise how to get rid of your varicose veins or suggest ways of relieving your symptoms.

Your GP will ask about your general health and how your symptoms are affecting you. They may discuss what causes varicose veins and provide lifestyle advice about ways to relieve your symptoms, including:

• Avoiding standing for long periods
• Exercising more
• Losing weight
• Raising your feet when relaxing
• Using a varicose vein cream to relieve discomfort and swelling
• Wearing compression stockings to improve your circulation

If your symptoms are troublesome, your GP may recommend varicose vein removal and refer you to a vascular surgeon, a surgeon who specialises in surgery on blood and lymph vessels. 

Your surgeon will examine your affected veins and may send you for an ultrasound scan to locate the damaged valves in your varicose veins.

Varicose vein treatment is usually only needed if: 

• The appearance of your varicose veins is bothering you
• You have complications eg leg ulcers, skin discolouration or swelling 
• Your symptoms are causing you discomfort or pain

Treatment involves closing off and destroying the affected veins. There are several surgical techniques and innovations that can be used to remove varicose veins, including:

• Endovenous laser ablation (EVLA) — a tiny laser inside a catheter is inserted into the affected vein, which emits bursts of energy to heat and seal the vein
• Ligation and stripping — open surgery that involves tying off and stripping out your varicose veins
• Radiofrequency ablation (Venefit/VNUS closure) — a probe inside a catheter is inserted into the affected vein and uses radiofrequency energy to heat and seal the vein

Other treatments include:

• Hook phlebectomy or microphlebectomy — small cuts are made close to the vein and a hook-shaped instrument is used to remove the affected veins through the cuts
• Mechanochemical ablation — a catheter is inserted into your vein and the end rotates and releases a chemical that seals the vein
• Transilluminated powered phlebectomy — a special light is used under your skin to see the affected veins, which are then cut and removed by suction
• Ultrasound-guided foam sclerotherapy (USGFS) — special foam is injected into the affected vein, which blocks it
• Vein closure system — a catheter is inserted into the affected vein and special glue is released at regular intervals down the vein to seal it closed

Your doctor will discuss which surgical treatment is best for you. This will depend on your general health and the size, shape and severity of your varicose veins.

Varicose veins prevent proper blood flow, which can cause complications. Although most people with varicose veins do not develop complications. If complications do occur, this is usually several years after the first varicose veins appear. 

Complications include: 

• Bleeding 
• Deep vein thrombosis (DVT) — blood clots in deep veins, usually in your legs, causing pain and swelling; DVT can lead to the potentially life-threatening complication of a pulmonary embolism
• Painful ulcers on the skin near your varicose veins — this is common near the ankles and starts as a discoloured spot; see your GP immediately if you think you have developed an ulcer
• Thrombophlebitis — swelling of the veins in your legs caused by blood clots in veins just under the surface of your skin 

Evidence suggests that there isn't much you can do to stop new varicose veins developing or stop existing ones getting worse. However, you can ease your symptoms by: 

• Avoiding standing or sitting still for a long time 
• Exercising regularly to improve your circulation and maintain a healthy weight
• Moving around every 30 minutes
• Taking regular breaks where you can raise your legs on pillows