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Varicose veins
Varicose veins

 


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Condition
Varicose veins
Class
Cardiovascular system
Description
Varicose veins are simply swollen veins. They usually appear on the legs, on the back of the calf or thigh muscle, as raised blue and lumpy blood vessels. Although they may look unsightly, they do not normally pose any risk to health.

Varicose veins are extremely common. They can affect anyone at any age but they do not usually become noticeable until after the late 20s because they develop slowly. It is estimated that about 10 to 15 out of every 100 men and 20 to 25 out of every 100 women will develop varicose veins.
Causes
Varicose veins occur because the walls of the veins are too weak to withstand the pressure of the weight of the blood in the veins.

When the blood is pumped around the body, it is returned to the heart through the veins. As the heart is normally at a higher position in the body than the legs, blood in the legs has to be pumped against gravity in order to reach the heart. It is the contraction of the muscles in the legs when walking around that acts as the pump, squeezing the veins and pushing the blood upwards. As the blood moves further and further upwards with each contraction of the leg muscles, it is prevented from falling back down again when the muscles relax by small one-way valves in the veins.

During long periods of inactivity, for example when standing or sitting in the same position for a long time, the leg muscles do not contract sufficiently hard enough or long enough to force the blood upwards. As a result, blood gathers in the leg veins. If this condition continues, eventually the small valves in the veins of the legs stop working properly. More and more blood gathers in the veins causing the veins to swell. As the large veins of the leg are situated near the surface of the leg, the walls of the veins have very little support from the surrounding tissue and so swell easily. Also, being close to the surface, the swelling is very noticeable. As the veins swell, they also twist and turn, creating the appearance of 'knots' in the leg veins.

Factors, other than sitting or standing still for long periods, that can lead to varicose veins include:
  • Being overweight, wearing tight clothing or crossing the legs, which restricts the blood flow in the legs
  • Being pregnant can have a double effect; the weight of the baby pressing down on the top of the legs may restrict the return of blood, while hormones released during pregnancy may cause the walls of the veins to relax
  • Excessive heat, humidity or alcohol consumption, causing the veins to enlarge and blood to pool in the legs
  • Wearing high heels or shoes with rigid soles, which stop the leg muscle pump working properly
  • Smoking cigarettes and other forms of tobacco, having a high cholesterol level or high blood pressure, all of which damages the veins
  • Having parents or close relatives who have also had varicose veins, which indicates that there may be a genetic link
  • People who have a thrombosis (blood clot) in the leg may also develop varicose veins because of damage to the one-way valves
Symptoms
The most obvious symptom is the appearance of the swollen veins in the legs, particularly at the back of the calf and thigh. Some people find that their legs ache and feel tired or heavy, especially towards the end of the day. The skin around the veins may itch, change colour or become shiny. The ankles may swell (oedema). Minor cuts to the legs may take a long time to heal and ulcers may eventually develop.
Treatment
Support hosiery is useful both to prevent varicose veins developing and to prevent them from getting worse. Support hosiery squeezes or compresses the legs from the ankles upwards, so providing support to the veins and improving the flow of blood in the leg veins.

Support hosiery is available in three compression strengths. Class 1 hosiery provides light support and is used in the early stages of varicose veins or for support during pregnancy. Class 2 hosiery provides medium support and is used for varicose veins of moderate severity, for mild leg oedema and to help in the treatment of leg ulcers. Class 3 hosiery provides the strongest support and is used for very large varicose veins or severe oedema. The support hosiery is available in a variety of sizes, styles and colours and is suitable for women and men. Support stockings are available on NHS prescription, but support tights are not. Support tights may be purchased from pharmacies.

If leg pain is particularly severe, analgesics such as paracetamol or ibuprofen may bring relief.

If the varicose veins are very troublesome or unsightly, there are a number of medical or surgical procedures that can be used to remove or block the veins, provided other veins in the legs are working properly and capable of carrying the blood that would have been carried in the removed or blocked vein.

The medical or surgical procedures used will depend upon the size and location of the veins affected. Small, spider veins (telangiectasias) and small veins that are not part of the main veins can be treated by phlebectomy or sclerotherapy. Phlebectomy involves making small puncture-like incisions in the leg through which the vein can be removed. Sclerotherapy involves injecting a drug called sodium tetradecyl sulphate that causes the vein to harden and close off.

For large veins, ablative (removal) procedures such as vein stripping, vein ligation or use of laser or radiofrequency may be used.
When to see your pharmacist
Whether you decide to buy support hosiery or whether it has been prescribed for you by your doctor, you should speak to your pharmacist. Your legs will need to be measured to make sure that the support hosiery fits correctly otherwise it will not work properly. Your pharmacist will also show you how and when to use the hosiery.
When to see your doctor
If you are unhappy about the appearance of varicose veins on your legs, if they are causing you pain, or if you or your family has a history of thrombosis you should see your doctor. If your doctor thinks it is necessary you may be referred to a vascular surgeon for tests to determine if a medical procedure is appropriate.
Living with varicose veins
Some simple life-style changes can help to keep your legs, and therefore your leg vein circulation, in good condition. Life-style changes can reduce the chances of getting varicose veins, delay varicose veins from forming and, if you have varicose veins, help reduce pain.

Try to exercise regularly as it will help strengthen your leg muscles, thereby increasing the efficiency of the leg muscle pump in returning blood to the heart. If sitting or standing for long periods tense and relax your leg muscles, rotate your feet and wiggle your toes. Keep your legs, ankles and feet moving during the day. Try not to cross your legs for long periods as this restricts blood flow in the veins.

In the workplace, if your job means that you have to stand for long periods, wear comfortable shoes and support hosiery. Try to switch your body weight from one leg to another at regular intervals, rather than letting one leg take most of the strain.

If overweight, try to lose weight. Eat a balanced diet, increase the amount of fruit and vegetables and cut down on junk foods and saturated fats. Drink plenty of water to maintain hydration, keep the blood volume within normal range and maintain a healthy circulation. Avoid wearing tight clothes, especially those that are tight around your waist, upper thighs and legs. Tight clothes obstruct the flow of blood back to the heart and can make varicose veins worse

If you smoke, try to give up. Besides benefiting varicose veins, stopping smoking is the single most effective way of improving health and reducing premature death.

If your varicose veins are causing pain, try rinsing your legs with a burst of cool water in the shower or bath. Stimulate circulation by 'dry brushing' with a natural bristle brush daily or gently massaging your legs. If you do get tired, aching legs, lying down with your legs resting on a cushion or pillow, raised above the level of your heart will help ease the discomfort.

Following a medical procedure to remove or block varicose veins, it will help to wear support hosiery. You can return to normal activities but should avoid strenuous leg activity, such as running or cycling for about a week.

Remember too that even though you've had a medical procedure to treat varicose veins, there remains a risk of new varicose veins developing and therefore it is also important to follow the life style advice given here.
Useful Tips
  • Stop smoking - see Give up Smoking section
  • Avoid crossing your legs
  • Avoid tight elastic around the legs
  • Put your feet up whenever possible
  • Gentle exercise can help
  • Ice and heat packs may ease the pain
  • Avoid standing still for long periods


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