Varicose veins

Page last reviewed: 13/07/2011

Varicose veins are swollen and enlarged veins that are usually blue or dark purple. They may also be lumpy, bulging or twisted in appearance.

Varicose veins develop when the small valves inside the veins stop working properly. In a healthy vein, blood flows smoothly to the heart. The blood is prevented from flowing backwards by a series of tiny valves that open and close to let blood through. If the valves weaken or are damaged, the blood can flow backwards and can collect in the vein, eventually causing it to be varicose (swollen and enlarged).

How common are varicose veins?

Varicose veins are a very common condition, affecting up to three in 10 adults. Usually, women tend to be more affected than men.

Any vein in the body can become varicose, but they most commonly develop in the legs and feet, particularly in the calves. This is because standing and walking puts extra pressure on the veins in the lower body.

Outlook

For most people, varicose veins do not present a serious health problem. They may have an unpleasant appearance, but they should not affect the circulation or cause any long-term health problems. Most varicose veins do not require any treatment.

For some people, varicose veins can cause aching, swollen and painful legs. In rare cases, they can also cause complications, such as skin discolouration and leg ulcers (see Varicose veins - Complications). Varicose veins are more likely to require treatment if they are causing significant discomfort or if complications develop.

There are now a number of different surgical procedures to remove varicose veins, although the first treatment is usually compression stockings. These are stockings that have been specially designed to squeeze the legs and improve circulation. See Varicose veins - Treatment for more information about the different treatment options.

 

Types of varicose veins

Some types of varicose veins are explained below.

  • Trunk varicose veins are near to the surface of the skin and are thick and knobbly. They are usually visible, often quite long and can look unpleasant.
  • Reticular varicose veins are red and are sometimes grouped close together in a network.
  • Telangiectasia varicose veins, also known as thread veins or spider veins, are small clusters of blue or red veins that sometimes appear on your face or legs. They are harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the skin.

Page last reviewed: 13/07/2011

Varicose veins are dark purple or blue in colour and they are usually twisted and bulging in appearance. Some people with varicose veins do not experience any pain or discomfort, while others are more severely affected.

As well as their distinctive appearance, symptoms of varicose veins can include:

  • aching, heavy and uncomfortable legs
  • swollen feet and ankles
  • burning or throbbing in your legs
  • muscle cramp in your legs, particularly at night
  • dry, itchy and thin skin over the affected vein

These symptoms will usually be worse during warm weather or when you have been standing up for long periods of time. Your symptoms may improve when you walk around or if you rest and raise your legs up, on some pillows (for example).

Varicose veins usually develop on the legs, either on the back of your calf or on the inside of your leg. However, they can also sometimes occur in other parts of your body, such as your:

  • gullet (oesophagus)
  • womb (uterus)
  • vagina
  • pelvis
  • rectum (back passage)
Vagina
The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).
Veins
Veins are a type of blood vessel that carry blood back to the heart.

Page last reviewed: 13/07/2011

To understand what causes varicose veins it is first useful to understand how blood is circulated around your body.

Circulation system

The system that controls your circulation is made up of arteries and veins. Your arteries carry blood from your heart to the organs and tissues in your body. Veins return the used blood back to your heart.

In order to return the blood, your veins must work against gravity. The muscles in your leg contract, helping to pump the blood back towards your heart.

Weakened valves

Inside your veins are tiny one-way valves that open to let the blood through and then close to prevent it flowing backwards.

Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the valves to become weakened. If the valves do not function properly, this can cause the blood to leak and flow backwards. If this happens, the blood will collect in your veins, which will become swollen and enlarged.

The reasons why the walls of the veins stretch and the valves in your veins weaken are not fully understood. Some people develop the condition for no obvious or apparent reason.

Risk factors

There are a number of risk factors that can increase your likelihood of developing varicose veins, including:

  • gender
  • genetics
  • age
  • being overweight
  • occupation
  • being pregnant

These risk factors are discussed in more detail below.

Gender

Women are more likely to be affected by varicose veins than men. Research suggests that this may be because female hormones tend to relax the walls of veins, making the valves more prone to leaking. Hormones are chemicals that are produced by the body.

Genetics

Your risk of developing varicose veins is increased if a close family member has the condition. This suggests that varicose veins may be partly caused by your genes (the units of genetic material that you inherit from your parents).

Age

As you get older, your veins start to lose their elasticity and the valves inside them stop working as well.

Being overweight

Being severely overweight puts extra pressure on your veins, which means they have to work harder to send the blood back to your heart. This can put increased pressure on the valves, making them more prone to leaking.

Occupation

Some research suggests that jobs that require long periods of standing may increase your risk of getting varicose veins. This is because your blood does not flow as easily when you are standing for long periods of time.

Pregnancy

When a woman is pregnant, the amount of blood in her body increases to help support the developing baby. This puts extra strain on your circulatory system. Increased hormone levels during pregnancy also cause the muscular walls of the blood vessels to relax. Both of these factors may increase your risk of developing varicose veins.

Varicose veins may also develop during pregnancy as the womb (uterus) begins to grow. As the womb expands it puts pressure on the veins in your pelvic area, which can sometimes cause them to become varicose.

Although being pregnant can increase your risk of developing varicose veins, most women find that the condition significantly improves after their pregnancy.

Page last reviewed: 13/07/2011

If you have varicose veins and they do not cause you any discomfort, you may not need to visit your GP. Varicose veins are rarely a serious condition and they do not usually require any treatment.

However, you should seek advice from your GP if:

  • Your varicose veins are causing you pain or discomfort.
  • The skin over your veins is sore and irritated.
  • The aching in your legs is causing irritation at night and disturbing your sleep.

Varicose veins are diagnosed by their appearance. Your GP will examine your legs while you are standing to check for any signs of swelling. They may also ask you to describe any pain that you have and whether there are any situations that make your varicose veins worse. For example, some women find that their menstrual cycle (periods) affect their varicose veins.

Your GP will also ask about any risk factors that could make varicose veins more likely, such as:

  • having a family history of varicose veins
  • being pregnant
  • having a healthy (BMI)
  • having deep vein thrombosis (a blood clot in one of the deep veins of the body)
  • a history of leg injury (for example, having previously broken a bone in your leg)

Further investigation

If your GP feels it is necessary to investigate your varicose veins further, they may refer you to a vascular specialist (a doctor who specialises in veins). After examining your veins, the specialist will decide whether any further investigations are necessary.

There are a few tests that can be used to investigate varicose veins. These are:

  • Doppler test
  • colour duplex ultrasound scan

These are briefly outlined below.

Doppler test

A Doppler test uses an ultrasound scan to provide information about the direction of blood flow in your veins. It provides an indication of how well the valves in your veins work.

An ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your body. A Doppler test can also be used to check for any blood clots or obstructions in your veins.

Colour duplex ultrasound scan

A colour duplex ultrasound scan provides colour images of your vein structure. This allows the specialist to look for any abnormalities in your veins. A colour duplex ultrasound scan can also measure the speed of your blood flow.

See the Health A-Z topic about Ultrasound scans for more information about this type of procedure.

Veins
Veins are a type of blood vessel that carry blood back to the heart.

Page last reviewed: 13/07/2011

Not everyone who has varicose veins needs treatment for the condition. If you do not have any symptoms and your varicose veins are not causing you discomfort, you may not need to have treatment.

However, there are some instances when it may be necessary. For example:

  • to ease symptoms, if your varicose veins are causing you pain or discomfort
  • to treat complications, such as leg ulcers, swelling or skin discolouration
  • cosmetic reasons, however this kind of treatment is rarely available from the HSE so you will usually have to pay for it to be done privately

If you require treatment for varicose veins, the type of treatment you will receive will depend on your general health and the size, position and severity of your veins.

Some of the treatments that are available for varicose veins are outlined below. Your GP or vascular specialist (a doctor who specialises in veins) will be able to advise you about the most suitable form of treatment for you.

Compression stockings

Compression stockings are specially designed to steadily squeeze your legs to improve your circulation. They are often tightest at the ankle and get gradually looser as they go further up your leg. This encourages your blood to flow upwards towards your heart.

Compression stockings may help to relieve the pain, discomfort and swelling in your legs that is caused by your varicose veins. However, it is not known whether the stockings help prevent your varicose veins getting worse, or prevent new varicose veins appearing.

One review of a number of different studies looking into compression stockings found mixed results for their effectiveness. One reason for this may be that people are reluctant to wear the stockings. You should make sure that you are happy with the style and fit of the stockings and wear them as directed by your GP or pharmacist. 

Compression stockings are available in a variety of different sizes and pressures. Most people with varicose veins will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking. They are also available in:

  • different colours
  • different lengths: some come up to your knee and some also cover your thigh
  • different foot styles: some cover your whole foot and some stop before your toes

Compression tights are also available. They can be bought from pharmacies or directly from the manufacturers.

Wearing compression stockings

You will usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed. Wearing compression stockings can be uncomfortable, particularly during hot weather, but it is important to wear your stockings correctly for you to get the most benefit from them.

Pull them all the way up so that the correct level of compression is applied to each part of your leg. Don't let the stocking roll down or it may dig into your skin in a tight band around your leg. Speak to your GP if the stockings are uncomfortable or if they do not seem to fit. It may be possible to get custom-made stockings that will fit you exactly.

If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure that your stockings will be the correct size. If your legs are often swollen, they should be measured in the morning, when any swelling is likely to be minimal.

You may find that wearing compression stockings can cause the skin on your legs to become dry and flake off. When you take your stockings off before bed, try applying a moisturising cream to keep your skin supple and moist. Speak to your GP if the skin on your legs feels dry after wearing compression stockings.

Caring for compression stockings

Compression stockings usually have to be replaced every three to six months. If your stockings become damaged, speak to your GP because they may no longer be effective. 
 
You should also be prescribed two stockings, (or two sets of stockings if you are wearing one on each leg) so that one stocking can be worn while the other is being washed and dried. Compression stockings should be hand-washed in warm water and dried away from direct heat.

Surgery

Large varicose veins may sometimes need to be surgically removed. Varicose vein surgery is usually carried out under general anaesthetic, which means that you will be unconscious during the procedure. You will usually be able to go home the same day. However, in some cases an overnight stay in hospital may be necessary, particularly if you are having surgery on both legs.

Ligation and stripping

Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.

Two small cuts (incisions) will be made, approximately 5cm (2in) in diameter. The first cut is made near your groin, at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle. The top of the vein (near your groin) is tied up and sealed.

A thin flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in your leg. 

The blood flow in your legs will not be affected by the surgery. This is because the veins that are situated deep within your legs will take over the role of the damaged veins.

Ligation and stripping can cause:

  • pain
  • bruising
  • bleeding

More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body.

Following the procedure, you may need between one and three weeks to recover before returning to work, although this will depend on your general health and the type of work that you do. You may need to wear compression stockings for up to two weeks after surgery.

You may need to wear compression stockings for the rest of your life if you have deep venous incompetence. Deep venous incompetence is where you have problems with the valves, or blockages, in the deep veins in your legs. In these circumstances, you will need to wear compression stockings even if you have had surgery to treat some varicose veins.

Sclerotherapy

Sclerotherapy is usually suitable for people who have small to medium-sized varicose veins. The treatment involves injecting a chemical into your veins. The chemical scars the veins, which seals them closed.

Larger veins may require foam sclerotherapy. Instead of the liquid chemical, a special type of foam is injected into the affected vein. This type of treatment may not be suitable if you have previously had deep vein thrombosis.

The injection is guided to the vein using an ultrasound scan, which uses sound waves to create an image of the inside of your body. It is possible to treat more than one vein in the same session.  Both standard sclerotherapy and foam sclerotherapy are usually carried out under local anaesthetic, where a painkilling medication will be used to numb the area being treated.

Following sclerotherapy, your varicose veins should begin to fade after a few weeks as stronger veins take over the role of the damaged vein, which is no longer filled with blood. You may require treatment more than once before the vein fades and there is a chance that the vein may reappear.

Although sclerotherapy has proven to be effective, it is not yet known how effective foam sclerotherapy is in the long term. Studies into foam sclerotherapy that were evaluated by the National Institute for Health and Clinical Excellence (NICE) found that, on average, the treatment was effective in 84 out of 100 cases. However, in one study, the varicose veins returned in over half of those treated.

Sclerotherapy can also cause side effects, including:

  • blood clots in other leg veins
  • headaches
  • lower back pain
  • changes to skin colour, for example, brown patches may develop over where the treated veins were
  • fainting
  • temporary vision problems

After having foam sclerotherapy, avoid driving for at least 30 minutes in case you develop any vision problems. However, you should be able to walk and return to work immediately afterwards. You will need to wear compression stockings or bandages for up to two weeks.  

Other treatments

There are a number of new treatments that have been developed to treat varicose veins. They are:

  • radiofrequency ablation
  • endovenous laser treatment
  • transilluminated powered phlebectomy

These new treatments are less invasive than traditional surgery because they require fewer or smaller incisions. However, less is known about their long-term effectiveness and some, particularly transilluminated powered phlebectomy, are not used very often. 

Radiofrequency ablation

Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut that is made just above or below the knee.

A narrow tube, called a catheter, is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy. This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins.

Radiofrequency ablation is carried out under local anaesthetic. The procedure may cause some short-term side effects, such as:

  • minor burns to the skin      
  • pins and needles (paraesthesia)

You may need to wear compression stockings for up to two weeks after having radiofrequency ablation.       

Endovenous laser treatment

As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. A tiny laser is passed through the catheter and positioned at the top of your varicose vein.

The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it and allowing the entire length of the vein to be closed.

Endovenous laser treatment is carried out under local anaesthetic. After the procedure you may feel some tightness in your legs and the affected areas may be bruised and painful. Nerve injury is also possible, but is usually only temporary.

Transilluminated powered phlebectomy

During transilluminated powered phlebectomy, one or two small incisions are made in your leg. Your surgeon will place a special light, called an endoscopic transilluminator, underneath your skin so that they are able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.

Transilluminated powered phlebectomy can either be carried out under general anaesthetic or local anaesthetic. As with endovenous laser treatment, you may experience some bruising or bleeding afterwards.

 

Veins
Veins are a type of blood vessel that carry blood back to the heart.

Referral

If you have varicose veins, your GP may refer you for further treatment, such as surgery, if:

  • You are bleeding from a varicose vein that has broken down.
  • You have previously bled from a varicose vein and are at risk of it happening again.
  • You have a leg ulcer (open sore) that despite treatment is getting worse or is painful.
  • You have a leg ulcer or changes to your skin and your GP thinks that you could benefit from having surgery.
  • You have had several episodes of thrombophlebitis (inflammation of a vein).
  • Your veins are causing troublesome symptoms.
  • The size, extent and location of your varicose veins is severely affecting your quality of life.

 

Questions about your treatment

If you are referred for surgery, you may want to ask your GP or surgeon some questions. For example, you may want to ask:

  • Who will do my operation?
  • How long will I have to wait for treatment?
  • Will I have to stay in hospital overnight?
  • How many treatment sessions will I need?

Treatment options

Not every treatment option will be suitable for everyone. What is available to you may depend on:

  • the size and extent of your varicose veins
  • how easy it is to access your varicose veins
  • your body mass index (BMI)
  • what your vascular specialist can offer

Page last reviewed: 13/07/2011

Varicose veins can cause complications because they stop your blood from flowing properly. Most people who have varicose veins will not develop any complications, but if you do, it will usually be several years after your varicose veins first appear.

Some of the possible complications of varicose veins are explained below.

Bleeding

Varicose veins that form near the surface of your skin can sometimes bleed if you cut or bump your leg. The bleeding may be difficult to stop. You should lie down, raise your leg and apply direct pressure to the wound. Seek immediate medical advice if this does not stop the bleeding.

Thrombophlebitis

Thrombophlebitis is inflammation (swelling) of the veins in your leg which is caused by blood clots forming in the vein. This can occur within your varicose veins and it can:

  • be painful
  • look red
  • feel warm

When thrombophlebitis occurs in one of the superficial veins in your leg it is known as superficial thrombophlebitis. A superficial vein is a vein that is located just under the surface of your skin.

Thrombophlebitis can be treated with compression stockings (see Varicose veins - Treatment). In some cases, painkillers, such as paracetamol, may be prescribed.

Chronic venous insufficiency

If the blood in your veins does not flow properly, it can interfere with the way that your skin exchanges oxygen, nutrients and waste products with your blood. If the exchange is disrupted over a long period of time it is known as chronic venous insufficiency.

Chronic venous insufficiency can sometimes cause other conditions to develop, including those described below.

Varicose eczema

Varicose eczema is a condition that causes your skin to become red, scaly and flaky. You may also develop blisters and crusting of your skin.

Lipodermatosclerosis

Lipodermatosclerosis causes your skin to become hardened and tight, and you may find that it turns a red or brown colour. The condition usually affects the calf area.

Venous ulcers

A venous ulcer develops when there is increased pressure in the veins of your lower leg. This causes fluid to seep from your vein and collect under the skin. The fluid can cause the skin to thicken, swell and to eventually break down to form an ulcer. Venous ulcers most commonly form in the ankle area.

You should see your GP immediately if you notice any unusual changes in your skin, such as those mentioned above. These conditions can usually be easily treated, but it is important that you receive treatment as soon as possible.

See the Health A-Z topic about Venous leg ulcers for more information about this condition.

Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Veins
Veins are a type of blood vessel that carry blood back to the heart.

Page last reviewed: 13/07/2011

There is little evidence to suggest that you can stop varicose veins from getting worse, or prevent new ones developing. However, if you already have varicose veins, there are a number of things that you can do that may help to relieve any pain or discomfort.

Sitting or standing still

If you can, avoid sitting or standing still for long periods of time. If you are unable to avoid sitting or standing, make sure that you change position frequently and try to move around at least once every 30 minutes.

Do not cross your legs because this can make your symptoms worse.

Take regular breaks

If possible, take regular breaks throughout the day. Try also to keep your legs raised while you are resting, because this will help to improve blood flow.

Ideally, raise your legs above the level of your heart. When resting, you may find that lying down and placing your legs on three or four stacked pillows will help to relieve any pain and discomfort.

Exercise regularly

Regular exercise is a great way of keeping your legs active and it will help to improve your circulation.

Exercise will also enable you to maintain a healthy weight, help prevent serious health conditions, such as coronary heart disease, as well as improving your overall general health and fitness.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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