Those bulging, bluish cords that show up on your legs are called varicose veins, and they are very common. Varicose veins are swollen, twisted veins that lie just under the skin and usually occur in the legs. For many people they are purely a cosmetic concern. But they can also ache, itch, swell, and sometimes lead to more-serious health problems, so it helps to understand what is going on and when to get care.
What are varicose veins?
Varicose veins are bulging, enlarged veins close to the surface of the skin. Veins are the blood vessels that carry blood back to the heart. In the legs they work against gravity, and they contain tiny one-way valves that open as blood flows toward the heart, then close to stop blood from flowing backward. If those valves are weak or damaged, blood can flow backward and pool in the veins, causing them to stretch, twist, and bulge. That backward flow has a name: reflux. The small web-like red or blue lines on the skin, called spider veins, are a milder form of the same problem.
Why do veins become varicose?
Weak or damaged vein walls and valves are the main cause. Varicose veins may form whenever blood pressure inside the veins rises, which can happen with age, pregnancy, overweight and obesity, or repeated sitting or standing for long periods. Because the veins in the legs must work against gravity, varicose veins are far more common there than anywhere else in the body.
Who gets varicose veins?
The two main risk factors are a family history of varicose veins and obesity, because carrying extra weight puts added pressure on the veins. Other risk factors include age, being female, pregnancy, and long stretches of standing or sitting. Hormones tend to relax vein walls, which helps explain why women are more likely to get the condition.
Symptoms of varicose veins
Varicose veins do not always hurt, and some people have large veins with no pain at all. When symptoms do appear, they can include:
- Aching pain in the legs
- A feeling of heaviness in the legs and feet
- Nighttime leg cramps
- Swelling in the legs
- Itching or burning discomfort around the veins
- Achy or heavy feelings that get worse after sitting or standing for a long time
Many people notice that their symptoms improve when they lie down or put their feet up.
When varicose veins are more than cosmetic
For most people, varicose veins never cause serious problems, and complications are rare, according to the Mayo Clinic. But they can include:
- Ulcers: painful open sores on the skin, most often near the ankles
- Blood clots: sometimes deeper leg veins enlarge, and ongoing leg pain or swelling can be a warning sign of a clot
- Bleeding: rarely, a vein close to the skin bursts; the bleeding is usually minor, but it still needs medical help
- Leg swelling: long-standing varicose veins can make the legs swell
Varicose veins are also one of the symptoms of chronic venous insufficiency, a long-term vein condition that becomes more common with age. And the CDC lists varicose veins among the factors that can raise the risk of a blood clot during long-distance travel. Neither of those facts means every varicose vein is dangerous, but both are reasons to have vein problems looked at instead of brushing them off.
Warning signs that need attention
Most varicose veins do not need urgent care, but a few situations are different.
- Bleeding from a varicose vein. Call 9-1-1 if you see any bleeding from a varicose vein; this is a medical emergency.
- A vein that suddenly gets much worse, or a sore that appears. Call your provider right away.
- A painful leg ulcer, especially near the ankle, or a discolored spot on the skin that forms before an ulcer. See your healthcare professional right away.
- Ongoing leg pain and swelling, which can mean a blood clot. Seek medical help.
How varicose veins are diagnosed
A healthcare professional usually diagnoses varicose veins with an exam, looking at your legs while you stand to check for swelling. Many providers also order a duplex ultrasound, a painless test that uses sound waves to see how blood flows through the veins and their valves. The same test can help find a blood clot if one is suspected.
Treatment options
Treatment has a few goals: relieve symptoms, keep the veins from getting worse, prevent serious complications, and improve the way the legs look. Keep in mind that new varicose veins may form even after treatment, and some veins need more than one session.
Self-care and compression
- Exercise, especially walking, makes the calf muscles contract and helps push blood back toward the heart.
- Lie down with your feet above the level of your heart for a few minutes several times a day.
- Avoid standing or sitting for long stretches, and change position often.
- Compression stockings, which put gentle pressure on the legs to prevent swelling, are often the first approach to try.
Procedures
Most procedures for varicose veins are minimally invasive and do not require a long recovery. They work by closing off or removing the vein that is letting blood pool, so the other veins take over.
- Sclerotherapy: a provider injects a solution or foam that scars and closes the vein; treated veins fade over a few weeks and usually do not require anesthesia.
- Laser treatment: bursts of light make the vein fade; no cuts or needles are used.
- Endovenous ablation: a provider heats the inside of the vein with laser or radiofrequency energy to close it off, usually in the doctor’s office with ultrasound guidance.
- Ambulatory phlebectomy: tiny pricks in the skin remove smaller varicose veins.
- Vein ligation and stripping: surgery for larger, more severe veins. It can often be done as an outpatient procedure, and removing a varicose vein does not stop blood flow, because deeper veins carry the larger amounts of blood.
Living with varicose veins
Simple habits help. Walk regularly, keep a healthy weight, follow a low-salt diet to limit swelling, and avoid high heels. Skip tight clothes around the waist, legs, or groin, and take a few short breaks daily to raise the legs above the level of the heart. Quitting smoking matters too, because damage to the veins from smoking makes varicose veins more likely.
When to see a vascular surgeon
If the way your veins look or feel bothers you and self-care has not helped, an evaluation is worth it. A doctor who specializes in vein conditions, such as a phlebologist or a vascular surgeon, can examine your legs, order the right tests, and talk through the treatment options with you. If you also notice leg pain or cramping that comes with walking and eases with rest, you can read our article on peripheral artery disease and leg pain.
This article is for general information and is not a substitute for evaluation by your health care team. Dr. Emilio B. Hisse provides cardiovascular consultations and care for leg circulation problems, including varicose veins and venous insufficiency, in Houston. If you have painful or swollen varicose veins, skin changes, or leg ulcers, call 713-667-3885.