Varicose Veins

Swollen and enlarged, dark purple varicose veins on the inside of the leg or the backs of the calves are more than just a cosmetic problem. Left untreated, varicose veins can progress to cause discoloration of the skin, inflammatory dermatitis, the bacterial infection known as cellulitis, ulceration, and worse.

Who Gets Varicose Veins

Varicose veins are found more often in older people than in younger people, and in more women than men. In the Tecumseh Health Study, varicose veins were diagnosed in 72% of all women aged 60 to 69, and even in 1% of all men in their 20's. In the adult population as a whole, about 50 to 55% of women and 40 to 50% of men have vascular changes that can lead to varicose veins, and about 20 to 25% of women and 10 to 15% of men have already-visible varicose veins. The vascular damage that causes varicose veins, however, often originates in childhood and can begin causing all the symptoms of varicose veins except their characteristic purplish blue bulges as early as the age of 10.

Not Just a Cosmetic Problem

Varicose veins are unsightly, but they are not just a cosmetic problem. A varicose vein may cause troubling symptoms even it is entirely invisible to the naked eye. The legs may ache and feel itchy even though the skin is still smooth. There may be leg cramps at night, worse after long days spent standing. The skin of the leg may feel ropey before the varicose veins begin to bulge under the skin.

Varicose veins may cause:

  • Pain or tenderness along the course of a vein.
  • Heaviness, itching, burning sensations, numbness, swelling, restless legs, and leg cramps. These symptoms are worse when the condition is producing spider veins (telangiectasia) and are less severe as the veins become varicose, then severe again when the varicose veins become numerous and large.
  • Dull pain that is worse after standing, especially after varicose veins become noticeable.
  • Pain that is improved by walking or elevating the legs. Pain that is worse after walking or elevating the legs is associate with arteries inside the leg, not veins on the surface of the leg.
  • In women, symptoms that change with the menstrual cycle, during pregnancy, or after hormone replacement therapy. Treatment of existing varicose veins prior to pregnancy has been shown to prevent the progression of the condition to other veins during pregnancy.

 

Because varicose veins develop over so many years, many people become so accustomed to these symptoms they do not even notice them by the time varicose veins are evident on the skin.

What Causes Varicose Veins

Some experts describe varicose veins as the result of a high-pressure flow into a low-pressure system. To understand how this can happen, first it is necessary to understand the difference between arteries and veins.

Arteries can oxygenated blood away from the heart, and veins carry oxygen-depleted blood back to the heart. When we are standing, the veins in the legs have to transport blood back to the heart against the force of gravity. The blood in these veins in the outer layers of leg tissue has to be compressed to about five times atmospheric pressure to make sure it does not flow backwards.

Years of localized high blood pressure can wear out the "leaflets" on the valves in these veins that keep blood flowing back towards the heart, so that blood vessels eventually become chronically overfilled and begin to bulge. The strain on one vein causes strain on its neighbors, and more and more veins in the leg from the thighs down to the ankles become varicose. The muscles and skin around varicose veins suffer because they are only fed by oxygen-poor, acid-laden blood that squeezes them against the fascia and tendons that hold them in place.

Surgical Treatment

Doctors have used surgery to treat varicose veins at least since the time of Hippocrates around 400 BC. Surgical technique has improved over the centuries so that less and less invasive procedures are used to "strip" the veins. Doctors also use endovenous (EV) laser and radiofrequency (RF) ablation to collapse varicose veins. Sclerotherapy involves injecting the vein with various soap-like chemicals that dissolve its proteins and leave a cord of fiber in its place; accidental injection of these chemicals into an unidentified artery can cause profound injury to the leg.

Surgical treatment usually results in major changes to the appearance of the leg in just a few weeks. Sometimes, however, surgery can actually make varicose veins worse, by removing a bypass pathway that was protecting veins that had not yet developed the twisting, bulging, bluish appearance on the surface of the legs.

Treatment with Compression Stockings 

Compression stockings are a kindler, gentler approach to treating varicose veins. They compensate for the damage to the valves in the veins that keep blood flowing upward to the heart by applying gentle pressure to the leg. Unlike a tourniquet or a long bandage, compression stockings are designed to provide more pressure lower on the leg and less pressure higher on the leg, allowing the veins to do as much of their own work as possible.

There have been extensive studies of the usefulness of compression stockings in treating varicose veins with and without surgery in the UK. Studies find that the outward manifestations of varicose veins heal as well after the use of compression stockings as after surgery, which is always followed by the use compression stockings during recovery. Of course, the earlier in the course of the condition compression stockings are used—preferably as soon as symptoms are noticed—the better the results.

What You Can Do to Help Heal Varicose Veins

Surgery, sclerotherapy, and compression stockings are not the only ways to control varicose veins. You can help heal yourself by simple changes in daily habits:

  • Wear support stockings.
  • Don't cross your legs.
  • Avoid socks and stockings that restrict circulation, especially if they have a tight band at the top.
  • Take walks on a regular basis to improve circulation. If you do not have time to leave your home of work to take a walk, try rotating your feet at the ankles while you are seated in a chair. Alternate clockwise and counterclockwise motion. Raise your legs parallel to the floor, and then point your toes up and down. Ideally, some kind of exercise should be performed about once an hour when you cannot get up to walk.
  • If you have to stand for a long time, shift your weight to one leg and then the other.
  • When you fly, ask for an aisle seat so you can stretch your legs as often as possible.
  • Pain in the calf that won't go away can be caused by a blood clot, and requires immediate medical attention. A hot feeling in the chest or arms combined with a cold feeling in the legs is also a symptom of a clot. Chest pain after vein stripping is a medical emergency.

Gravity and Varicose Veins 

Varicose veins are a common problem, one that affects millions of Americans. Yet despite how widespread this condition is, medical science does not know exactly what causes it. What we do know is that varicose veins happen because we are upright creatures, because we are constantly fighting gravity, and because sometimes small valves within the veins in our legs are no longer working properly. But exactly why those valves malfunction is still a question to be answered.

When working correctly, these valves act as a sort of traffic police, allowing blood to be pumped by our hearts up through the major veins in our legs and back to our upper body, and preventing blood from obeying the pull of gravity and flowing back downward to pool in the veins of our lower legs and feet.

Varicose Veins And Pregnancy

The burdens of pregnancy are many for the mom-to-be. In addition to all the normal demands of daily living, which often include a full-time job on top of the chores of home and family, there is a special need to eat a healthy, balanced diet, to get proper exercise and for plenty of rest.

But even for the expecting mom who is doing an excellent job of keeping all the balls of daily life in the air while also giving herself the tender loving care she deserves, there are still times when her legs are going to feeling tired and achy.

Blood Flow and Tired, Aching Legs

The circulatory system in our bodies has two kinds of blood vessels: arteries and veins. Arteries carry oxygen-rich blood from the heart to the rest of the body. Arteries have thick walls which actually help the heart to pump the blood by gently contracting with each heartbeat.

Veins are the thin-walled blood vessels which return blood back to the heart. The veins have valves that open when the blood flows past them, then close after each heartbeat to stop the blood from flowing backwards in the vein. These valves are especially important in the legs. When weak or damaged valves allow blood to flow backward, it collects at the bottom of the leg. This excess blood increases pressure in the vein and causes that tired aching feeling in your legs.

That increased pressure, over time, can eventually stretch and enlarge your veins. These stretched and twisted veins are what we call varicose veins. The smaller veins close to the skin's surface may be bluish, appearing knotted or like a spider-web.

The Increased Chance of Developing Varicose Veins During Pregnancy

While anyone at any age can develop varicose veins, the changes that a woman's body undergoes during pregnancy increase the chances that varicose veins may occur. Some health experts have estimated that about 40% of women will be affected by varicose veins during pregnancy.

One reason is that pregnancy causes hormonal changes in a woman's body, one of which results in the vein walls relaxing slightly and stretching out. While this can help in increasing blood flow, important for the developing baby, it can also increase the likelihood that varicose veins may form. That likelihood is also increased by the additional weight a woman adds during pregnancy, weight that puts greater pressure on the veins of the expecting mom's legs.

Other factors that can increase the risk of developing varicose veins include activities that require you to spend long periods of time standing or sitting. Such inactivity makes it easier for blood and other fluids to pool in your legs, again increasing the pressure on the veins and causing additional stretching of veins and possible damage to the valves within the veins.

Some women, of course, may already have varicose veins prior to pregnancy. There are numerous things that can lead to the development of varicose veins unrelated to pregnancy. Excessive weight, heavy use of alcohol and lack of exercise can all help contribute to the problem, as can smoking. Becoming pregnant will usually aggravate and worsen the condition when varicose veins already exist.

In some cases, however, there is simply an inherited tendency to have weaker vein walls and valve problems. Often, if a woman's mother developed varicose veins during pregnancy, there is a good chance that her daughter will as well.

Varicose Veins Developed During Pregnancy Are Often Temporary

The good news for many women is that the varicose veins that develop during pregnancy return to normal after the baby is born. As the conditions that led to the varicose veins disappear after giving birth, so too, in most cases, will the varicose veins themselves. There is a greater chance, however, of the problem disappearing if there are steps taken during pregnancy, as outlined below, to minimize both the occurrence and severity of varicose veins.

For a woman who has an inherited tendency for thin-walled veins or weak valves within the veins of the legs, there is, of course, a much higher chance that the varicose veins that have developed will not go away once the pregnancy is over. In any case, it is always worth the effort of taking steps to try and minimize the seriousness and permanence of varicose veins that occur during pregnancy.

Taking Steps to Minimize The Development of Varicose Veins

One of the easiest actions to take to help reduce the risk of developing varicose veins during pregnancy is to wear high-quality compression hosiery. Maternity pantyhose provides gradient compression, providing the highest level of pressure at the ankle and gradually decreasing the pressure up the leg. This design gently compresses the leg muscles, squeezing the veins, and helping to push the blood back toward the heart.

Regular, sensible exercise is another means of minimizing varicose vein risk. Simply walking regularly helps to strengthen the leg muscles, providing more support for the veins in the legs and helping, through the compression of the muscles as your walk, to move the blood out of the leg and back toward the lungs and heart. Your doctor can offer advice on exercise that is appropriate and healthful during pregnancy.

It is also good advice to avoid long periods of standing or sitting. The lack of activity allows blood to pool in the veins of the leg, increasing the pressure on both the veins and the valves within the veins and thus increasing the risk of varicose veins forming. If you will be facing a prolonged period of standing or sitting, break it up with regular periods of exercise, either taking a short walk or, at the very minimum, doing some foot exercises, such as flexing your toes, rotating your feet at the ankles and doing toe lifts with your heels on the floor. All of these will help keep the blood circulating better in your feet and legs.

While varicose veins generally have few if any immediate health implications, they are something most women wish to avoid during pregnancy. Compression hosiery, regular exercise and keeping active can help minimize the risk. Talk to your physician about the problem and see what he or she has to recommend.