Varicose Veins: The Definitive Guide to Treatments & More

Varicose veins are a common condition where your veins bulge and appear rope-like, and it can sometimes cause aching pain and discomfort. Learn about the factors that lead to varicose veins and the treatment options available to you.

What are varicose veins?

Varicose veins are bulging, blue or purple veins that are caused by an improper, backwards flow of blood. Varicose veins most commonly occur in your legs and lower extremities.

Your veins have tiny one-way valves in them that keep your blood flowing in one direction back into your heart. In varicose veins, the valves are weakened or damaged allowing blood to flow backwards, causing swelling and vein damage.

This condition may lead to serious problems such as thrombosis (blood clots) or venous stasis ulcers (slow or non-healing sores). Varicose veins may also mean that you’re at higher risk of other circulatory system disorders.

Varicose vein treatment options

There are many non-invasive and effective treatments for varicose veins, including lifestyle changes and medical procedures.

Lifestyle changes

Losing weight, eating a balanced diet and engaging in regular exercise can alleviate varicose veins and associated discomfort and pain. If you sit for prolonged periods of time, taking activity breaks will help improve your blood circulation.

Compression garments are a common first step for treating varicose veins and work by supporting your weakened veins and boosting circulation. Support socks or hose give mild compression. Compression stockings give stronger support, and are available in different lengths and styles. Your doctor may recommend a prescription level compression garment, which can usually be purchased from a medical supply store or pharmacy.

Non-Invasive Treatments

There are a number of medical procedures available if lifestyle changes and compression garments aren’t enough to manage your varicose veins.

  • Sclerotherapy is a common procedure to remove small varicose veins and spider veins. In this non-surgical procedure your doctor injects a liquid chemical into your varicose vein to make it shrink, collapse, and eventually dissolve. Sclerotherapy is a quick procedure performed in your doctor’s office and usually does not require anesthesia. You can return to your normal routine the same day.
  • Endovenous thermal ablation (EVTA) uses a thin wire-like catheter to deliver laser or radiofrequency energy to heat and close your varicose veins from the inside. This procedure is minimally invasive and most effective on small to medium sized veins. Veins that have been closed off are eventually reabsorbed into the body. There is little down-time required.
  • Ambulatory phlebectomy uses tiny punctures or incisions to remove your varicose vein, one section at a time. No stitches are necessary and there is a short recovery time.
  • Vein Ligation & Stripping are older methods of treating varicose veins. Ligation involves making small incisions over the problem vein and tying it off to stop blood flow, which causes the vein to shrink and become less visible. Vein stripping involves pulling out long sections of your varicose veins through incisions in your groin and ankle. It is an invasive procedure that is now mostly replaced by EVTA.

Diagnosing varicose veins

Prior to making a diagnosis, your doctor will take a complete patient history, taking special note of family history, and any previous injury or illness which may affect your veins and circulation. Be sure to bring a list of your current and past medications to your appointment, as well as a list of questions or concerns you might have.

Your doctor will perform a thorough physical exam, which will include examining your legs while standing to check for swelling. Your doctor may perform a duplex ultrasound to examine the blood flow in your legs and identify any venous conditions.

Symptoms of varicose veins

Varicose veins can be a cosmetic issue, but some people experience discomfort or pain too. Here are the most common symptoms associated with varicose veins:

  • Dark blue or purple veins
  • Twisted, rope-like veins
  • Achiness or heaviness in the legs
  • Burning, throbbing or itchiness around the veins
  • Swelling in the lower legs
  • Pain after sitting or standing for long periods of time
  • Skin ulcers on the leg and ankle. (Skin ulcers can indicate severe vascular disease, and may require immediate attention.)

Risk factors for varicose veins

It’s important to understand the risk factors that can lead to varicose veins.

  • Standing for long periods of time: Blood doesn't flow as well if you're in the same position for long periods of time because your muscles are not contracting to push the blood back to the heart.
  • Obesity: Extra weight puts more pressure on your veins.
  • Age: As you age, normal wear and tear weakens your vein walls and the valves inside your veins that regulate blood flow.
  • Sex: Women are more likely than men to develop varicose veins and spider veins. This is attributed to hormonal changes during pregnancy, PMS and menopause. The female hormone estrogen may relax vein walls, and hormone replacement therapy and birth control pills may also increase your risk of varicose veins.
  • Genetics: You are more likely to have varicose veins if close family members have them.
  • Injury or Trauma to the leg: Physical damage to your veins and surrounding tissue can lead to long-term vein issues.

Pregnancy and Varicose Veins

Varicose veins may appear for the first time during pregnancy. While pregnancy increases the volume of blood in a woman’s body, it decreases the flow of blood from the legs to the pelvis. This change in circulation is designed to support a growing baby, but it can also lead to enlarged veins in the legs. Hormonal changes during pregnancy, including an increase in estrogen, can also contribute to the development of varicose veins. Varicose veins may worsen in late pregnancy because the uterus exerts greater pressure on the veins in your legs. Many women experience relief from varicose veins within 3 months of delivery.

Prevention of varicose veins

There's no way to completely prevent varicose veins, but improving your circulation and muscle tone can reduce your risk and slow down the development of existing varicose veins.

  • Exercise regularly. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend a safe and appropriate exercise routine for you.
  • Watch your weight and your diet. Shedding excess pounds takes unnecessary pressure off your veins. What you eat makes a difference, too. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention and constipation.
  • Watch what you wear. Avoid high heels. Low-heeled shoes exercise calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin that restrict circulation.
  • Elevate your legs. To improve venous circulation, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows.
  • Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow. Try to move around at least every 30 minutes.

Alternative medicine and varicose veins

Horse chestnut seed extract may be an effective treatment for poor venous circulation, especially for symptoms such as varicose veins characteristic of chronic venous insufficiency (a chronic condition in which leg veins have problems returning blood to the heart.) The herb may help improve swelling and discomfort caused by varicose veins. Make sure you talk with your doctor before trying horse chestnut seed extract or any other herb or dietary supplement.

Related medical conditions

Hemorrhoids

Hemorrhoids, also known as piles, are actually varicose veins located in and around the anus. This condition can cause itching, bleeding and pain in the affected area. Causes include straining during a bowel movement or the increased bowel pressure during pregnancy.

Effective medications and procedures are readily available to treat hemorrhoids. Fortunately, most people can get relief from hemorrhoids by changing their lifestyle.

Leg ulcers

In advanced stages of venous disease, painful ulcers may form on the skin near varicose veins, particularly near the ankles. When venous circulation is compromised, blood can pool in the veins (venous stasis) which increases pressure within affected veins, causing skin breakage and venous ulcers to form. It is important to see a physician immediately if you suspect you've developed an ulcer.

Sudden swelling of the leg

If you have considerable swelling in your leg (caused by the enlarging of veins deep within the legs) you must see a doctor immediately. Sudden leg swelling requires urgent medical attention because it could indicate thrombophlebitis, a condition where a blood clot blocks a vein, leading to inflammation and other potentially serious problems.

Be a careful consumer

Before undergoing any procedure, ask your doctor about any health risks and possible side effects.

Some insurance companies will cover varicose vein treatment if you display signs or symptoms such as swelling and bleeding. Insurance companies may not cover procedures that are done for cosmetic reasons. Check with your health insurance provider and doctor to see what coverage options you have.

You may also consider the merits of getting a second opinion when having vein issues diagnosed.

Reviewed March 17, 2017

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