Overview
Varicose veins are swollen, twisted veins that you can see just under the skin, usually on the legs. They can look lumpy or bulging, and are often blue or purple. They are common and usually not serious. They are different from spider veins, which are smaller, thread-like and usually harmless.
Without treatment they may get worse, but usually slowly over several years.
Symptoms
- Aching, pain or a heavy feeling in the legs
- Swollen ankles or legs
- Itching or burning around the veins
- Skin changes, such as darker skin or dry, flaky patches
- Night-time cramps
Symptoms are often worse after standing for a long time and ease when you lie down with your legs raised.
When to see a doctor
See a doctor if the veins cause pain, itching or swelling, if the skin around them changes, if a sore on the leg has not healed after two weeks, or if the veins are getting worse. A vein that becomes hard and painful should also be checked.
Causes
Veins have one-way valves that keep blood flowing up towards the heart. When the valves or the vein walls are weak or damaged, blood flows backwards and pools in the vein. The pressure makes the vein swell and twist.
Risk factors
- Being female
- Older age
- Pregnancy
- Being overweight
- Standing or sitting for long periods, or not being active
- A family history of varicose veins
- A past deep vein thrombosis (DVT)
Complications
Varicose veins usually do not cause serious problems, but they can lead to:
- Bleeding
- Varicose eczema: itchy, flaky skin over the veins
- Venous leg ulcers: sores that heal slowly
- A clot just under the skin (superficial vein thrombosis), which makes the vein hard and painful
- A clot in a deeper vein of the leg (deep vein thrombosis, DVT)
Prevention
There is no proven way to prevent varicose veins, and some risk factors, such as age and family history, cannot be changed. These habits can help with symptoms and may stop them getting worse:
- Keeping to a healthy weight
- Exercising regularly, for example by walking
- Raising your legs when you can
- Avoiding long periods of standing or sitting
- Not smoking
- Avoiding leg injuries, which can cause bleeding
Diagnosis
A doctor examines the legs and asks about symptoms and family history. A duplex scan, which shows how blood flows in the veins and how well the valves work, is usually done by a specialist to confirm the diagnosis and plan treatment.
Treatment
Varicose veins do not always need treatment. Self-care helps: stay active, raise your legs, keep to a healthy weight, and use a moisturiser on dry or itchy skin. Compression stockings improve blood flow and reduce swelling and pain. They are not suitable if the leg arteries are poorly supplied with blood, so ask a doctor first.
If symptoms or problems such as ulcers need treatment, the options include:
- Endovenous ablation: heat from a laser or radio waves closes the vein from inside, through a thin tube guided by ; this is usually the first choice
- Foam sclerotherapy: a foam injected into the vein closes it
- Surgery: the vein is tied off and removed through small cuts
Ablation and sclerotherapy are usually done under local anaesthetic as day procedures. Surgery is usually under general anaesthetic, and most people go home the same day. A bandage or stocking is worn for about a week afterwards. Varicose veins can come back, and treatment may need repeating. Procedures are usually avoided in pregnancy, and veins often improve after the birth.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Varicose veins are only a cosmetic problem.”What is true?
Fact
Many are just unsightly or cause aching and heaviness. But they can lead to itchy, flaky skin, slow-healing leg ulcers, bleeding and blood clots, so symptoms, skin changes or sores should be checked by a doctor.
Myth“Walking and exercise make varicose veins worse, so rest as much as possible.”What is true?
Fact
Regular exercise improves blood flow in the legs and helps. It is standing or sitting still for long periods that tends to make them worse. Raising the legs when you rest eases the aching.
Myth“The treatment is a big operation with a long stay in hospital.”What is true?
Fact
The usual first choice is to close the vein with heat from a laser or radio waves, or with an injected foam. Both are usually done under local anaesthetic as day procedures. Even vein removal surgery usually lets people go home the same day.
Myth“Rubbing oil or massaging the leg will cure varicose veins.”What is true?
Fact
The problem is faulty valves inside the vein, and oil or massage does not repair them. A moisturiser can soothe dry, itchy skin, and exercise, a healthy weight and raising the legs can ease symptoms. Closing or removing the affected vein is done by a doctor.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Will varicose veins go away on their own?
They do not usually go away by themselves, and they may slowly get worse. Those caused by pregnancy often improve or disappear after the birth. Exercise, a healthy weight and raising the legs help the symptoms, and a doctor can advise if treatment is needed.
Can varicose veins come back after treatment?
They can, and treatment may need to be repeated. A doctor can explain what to expect for the type of treatment you are offered.
Can I exercise and work normally with varicose veins?
Yes, and exercise such as walking helps blood flow in the legs. If your job means standing or sitting for long periods, take breaks, move around and raise your legs when you can.
