Varicose veins are swollen and enlarged veins which are usually a blue or dark purple. They may also be lumpy, bulging or twisted in appearance. Varicose veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows smoothly to the heart, and is prevented from flowing backwards by a series of tiny valves, which open and close to let blood through. If these valves weaken or are damaged, the blood can flow backwards and can collect in the vein, eventually causing it to be varicose.

Varicose veins are a very common condition. Women tend to be more affected than men, with approximately 30% of women developing varicose veins in their lifetime, compared to 15% of men. Any vein in your body can become varicose (swollen and enlarged), but they most commonly develop in the legs and feet. The calves are most commonly affected. This is because standing and walking puts extra pressure on the veins in the lower body.

For most people varicose veins do not present serious health problems. They may appear unsightly, but they should not affect your circulation or cause any long-term health problems. Varicose veins rarely cause complications. Most will not require any treatment. For some people varicose veins can cause aching, swollen and painful legs. In rare cases, they can also cause complications, such as skin discolouration and leg ulcers. If your varicose veins are causing you significant discomfort, or you have developed complications, you are more likely to require treatment.

Symptoms of varicose veins 

Varicose veins are dark purple or blue in colour, and are usually twisted and bulging in appearance. Some people with varicose veins will not experience any pain or discomfort, while others are more severely affected. Other symptoms of varicose veins can include aching, heavy and uncomfortable legs, swollen feet and ankles, burning or throbbing in your legs, muscle cramp in your legs (particularly at night), and dry, itchy and thin skin over the affected vein.

If you have these symptoms, they will usually be worse in warm weather, or when you have been standing up for long periods of time. Varicose veins often develop on the legs, usually on the back of your calf, or on the inside of your leg. However, they can sometimes form in other parts of your body, such as your gullet (oesophagus), womb (uterus), vagina, pelvis, or rectum (back passage).

Causes of varicose veins 

The system that controls your circulation is made up of arteries and veins. Your arteries carry blood from your heart to the organs and tissues in your body. Veins return the used blood back to your heart. In order to return the blood, your veins must work against gravity. Muscles in your leg contract, helping to pump the blood back towards your heart.

Weakened valves

Inside your veins, there are tiny one-way valves, which open to let the blood through, and then close to stop it from going backwards. Sometimes, the walls of the veins start to stretch and lose their elasticity, causing the valves to become weakened. When the valves fail to function properly, it can cause your blood to leak and flow backwards. It then collects in your veins, causing them to become swollen and enlarged. It is not fully understood why the valves in your veins weaken. Some people develop the condition for no obvious or apparent reason. There are a number of risk factors which can increase the likelihood of getting varicose veins.

Gender

Women are more likely to be affected by varicose veins than men. Research suggests that this may be because female hormones tend to relax the walls of veins, making the valves more prone to leaking.

Genetics

You are more at risk of developing varicose veins if a close family member has it.

Age

As you get older, your veins start to lose their elasticity, and the valves within them stop working as well.

Being overweight

Being severely overweight puts extra pressure on your veins, which means that they have to work harder in order to send the blood back to your heart. This can put increased pressure on the valves, making them more prone to leaking.

Occupation

Some research suggests that jobs which require long periods of standing may increase your risk of getting varicose veins. This is because your blood does not flow as easily when you are standing for long periods of time.

Pregnancy

When you are pregnant, the amount of blood in your body increases to help support your growing baby. This puts an extra strain on your circulatory system. Increased hormone levels during pregnancy also cause the muscular walls of your blood vessels to relax. Both of these factors may increase your risk of developing varicose veins. Varicose veins may also develop during pregnancy as your uterus (womb) starts to grow. Your expanding uterus puts pressure on the veins in your pelvic area, which can sometimes cause them to become varicose.

Although being pregnant may increase your risk of developing varicose veins, most women will find that their condition improves considerably after their pregnancy.

Diagnosing varicose veins 

If you have varicose veins and they do not cause you any discomfort, you may not need to visit your doctor. Varicose veins are rarely a serious condition and they do not usually require any treatment. Seek advice from your doctor if your varicose veins are causing you pain or discomfort, if the skin over your veins is sore and irritated or if the aching in your legs is causing irritation at night and disturbing your sleep.

Varicose veins are diagnosed by their appearance. Your doctor will examine your legs while you are standing to check for any signs of swelling. They may also ask you to describe any pain. If your doctor feels it is necessary to investigate your varicose veins further, they may refer you to a vascular specialist (a doctor who specialises in veins). After examination, the specialist will decide whether any further investigation is necessary.

There are a few tests which can be used to investigate varicose veins:

Doppler test

The Doppler test uses an ultrasound scan to provide information about the direction of the blood flow in your veins. It can give an indication of how well the valves in your veins work. An ultrasound scan is a painless procedure that uses high frequency sound waves to produce an image of the inside of your body. A Doppler test can also be used to check for any blood clots or obstructions in your veins.

Colour duplex ultrasound scan

A colour duplex ultrasound scan provides colour images of your vein structure. This allows the specialist to look for any abnormalities in your veins. A colour duplex ultrasound scan can also measure the speed of your blood flow.

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