severe varicose veins

What are varicose veins?

Varicose veins or varicosities occur when your veins become enlarged, dilated, and overfilled with blood.  The appearance of the veins may be blue, dark purple and often bulging or raised. Any normal vein can become varicosed, but those most commonly affected are found in the lower legs.

Over 25% of adults suffer from this condition, however, it is more common in women than men.

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What causes varicose veins?

Varicose veins are a consequence of weak or damaged valves in your veins. Muscles contracting in your lower legs act as pumps, using the elastic veins to push blood back to the heart.

A series of tiny one-way valves open up to help pump the blood towards your heart, and then close to stop it from flowing backwards.

If the valves are not functioning correctly, blood will flow backward, where it collects in pools, resulting in stretched and twisted swollen veins commonly known as varicose veins.

varicose veins illustration

Common causes and risk factors include:

  • Age: the risk of developing varicose veins increases as you get older (especially for those over the age of 50) The valves that regulate blood flow in your veins age too, meaning that over time, they become weaker and less efficient. 
  • Gender: women are more predisposed to developing varicose veins. Hormonal fluctuations resulting from pregnancy, menopause or pre-menstruation cause changes in hormone levels which may affect the valves’ performance. 
  • Pregnancy: during pregnancy, the blood flow increases to help support the baby, along with the womb, adding extra strain to the veins. This, alongside other hormonal changes may lead to varicose veins. 
  • Weight: obesity or being overweight adds pressure to your veins and compresses the valves and walls. Losing weight may help, although in many cases treatment is needed. 
  • Lifestyle & occupation: office jobs or jobs that involve standing all day may result in the development of varicose veins. Exercising regularly to compensate for long periods of sitting or standing may help prevent varicose veins.
  • Genetics: if your family members have or had varicose veins, there is a higher chance you may develop them too. 
  • Other conditions: in rare cases, varicose veins may appear as a result of another underlying problem. These include a previous blood clot, a swelling or tumour in the pelvis and abnormal blood vessels. Previous leg injuries can also be a risk factor. 
varicose veins surgery

How to get rid of varicose veins

Although varicose veins are usually completely harmless, they can affect your confidence and cause discomfort if left untreated. Therefore, many people decide to take action and have them removed.

If treatment is necessary, your doctor may first recommend at-home self care. This could involve using compression stockings, exercising regularly and making certain lifestyle changes (e.g. avoiding standing for long periods of time or elevating your feet when resting to enable blood flow).

If your varicose veins are causing you pain and/or emotional distress, then minimally invasive procedures could be the best approach to resolve the issue. A vascular surgeon will suggest the most appropriate treatment path for you, such as Sclerotherapy or Endovenous Laser Ablation.

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Sclerotherapy

Sclerotherapy is a minimally invasive procedure which uses a fine needle to inject sclerosant into the veins that need treatment, under the guidance of ultrasound imaging. Sclerotherapy treatments are usually suitable for removing small varicose veins (reticular veins) and thread veins (spider veins).

This procedure is known to help relieve the symptoms of varicose veins, including pain and itching. Sclerotherapy is a very safe procedure and, unlike surgical methods, carries minimal risks and doesn't usually require anaesthesia.

Depending on the size and severity of your varicose veins, sclerotherapy can take up to 1 hour. You may be advised to wear compression socks or stockings for 24 hours following sclerotherapy. These can then only be worn during the day and removed at night.

Your surgeon will provide you with clear instructions as to what you need to do and avoid to make sure the results of the procedure are maximised.

People with varicose veins or spider veins should consider sclerotherapy when:

  • the veins are painful, itchy and/or causing discomfort
  • the legs feel sore
  • the skin on the legs is dry or patchy
  • rashes develop around the vein area

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Endovenous Laser Ablation (EVLA)

Recommended by the National Institute of Care and Excellence (NICE), Endovenous Laser Ablation has transformed the treatment of varicose veins, demonstrating safe, long-term results. This procedure is guided by an ultrasound scanner to insert a laser fibre into the leg veins that need treatment.

The veins are then destroyed using heat and naturally absorbed by the body over time. EVLA is also carried out under local anaesthetic, so the level of discomfort is minimal and most patients do not feel any pain at all.

Depending on the number of veins to be removed, EVLA takes 1-2 hours, meaning you can return home the same day. After the procedure, you will be given a compression stocking to wear for 1 week along with clear instructions on what to do and what to avoid.

To ensure the best results, you will also be asked to return for a follow-up appointment with your surgeon

vascular surgeon

When to see a doctor

Although varicose veins are typically harmless, you should see your doctor if you experience the following symptoms:

  • Severe and continuous pain and swelling in the legs
  • Heavy, aching legs at the end of the day, or following physical activity
  • Muscle cramps in the legs (especially at night)
  • Varicose veins are red, warm and tender to the touch and/ or are prone to bleeding on their own or due to injury
  • The skin surrounding the varicose veins is dry and/or itchy

Ignoring some of these symptoms can lead to serious health issues including blood clots,  deep vein thrombosis (DVT), skin ulcers and other conditions.

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How to prevent varicose veins

Although in some cases varicose veins are caused by genetic inheritance, certain lifestyle changes can help prevent varicose veins from forming or becoming worse:

  • Avoid standing for extended periods of time.
  • Maintain a healthy weight.
  • Exercise regularly to improve your circulation.
  • Rest or sleep with your legs elevated
  • Use compression socks or stockings as advised by your doctor.

Summary

Varicose veins normally get worse over time and it's impossible to get rid of their unsightly appearance without medical intervention, even if you make the necessary lifestyle changes to control them and manage your pain.

Sometimes, varicose veins can lead to complications such as ulcers or sores on your legs, blood clots, or chronic inflammation. In severe cases, your veins could rupture.

You should see your doctor immediately if you develop any of these symptoms. They may recommend taking an alternative approach, such as surgery or other interventions.

FAQs

Varicose veins are generally just a cosmetic issue. While there is no proven connection between the appearance of varicose veins and the pain caused, sometimes they can become extremely painful, especially during the warmer season and at night time.

Varicose veins are rarely dangerous and do not usually require treatment. However, if you’re experiencing discomfort which you can’t find relief for, get in touch with a doctor.

Yes, heredity and genetics is one of the risk factors of varicose veins. If one of your family members has varicose veins, it doesn’t necessarily mean you will get them too, but you are more likely to develop them at some stage in your life.

Although varicose veins indicate a blood flow issue, they are not an indicator of heart disease. Nevertheless, they can point to other serious conditions, such as DVT or Pulmonary Embolism.

As a low-impact form of exercise, walking can help strengthen the calf muscles and pump blood through your veins without putting strain on the valves.

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