Varicose veins

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.