What are varicose veins?

Varicose veins are enlarged blood vessels that bulge out, generally on the leg but sometimes on arms and elsewhere on the body. They can cause medical issues, as well as being unsightly, but are treatable. If they get especially bad they can even be life threatening (if the leg gets cut).

There is a distinction between varicose and reticular or spider veins, which is that varicose veins bulge out while spider veins are just a visible web of blood vessels, and reticular veins are particularly blue.

The enlarged blood vessels can be painful and cause minor circulation issues but are generally not a life-threatening condition. The main exception is if they occur near major blood vessels, particularly on the thigh, as in this case even a minor cut to the leg can result in severe blood loss.

What causes them?

The veins become varicose when the valves that prevent backflow separate and stop working properly, which leads up to a build-up of blood in sections of the vein. This then damages more valves further down, which makes the bulges bigger. They generally happen in superficial veins, which means they can be removed without restricting general blood flow.

Varicose veins are partially hereditary and affect women more commonly than men. They can be brought on by factors like pregnancy, obesity, menopause and general ageing. Prolonged sitting or standing can also contribute to the issue by starting off the process of valve damage in the legs. Heavy alcohol consumption can also bring on the issue and damage valves.

Signs and symptoms

Apart from the obvious bulges coming out of your legs, people with varicose veins can experience leg pain (could be aching, burning or throbbing), heaviness, cramping, rashes, skin darkening over the veins and possibly swollen ankles. In especially serious cases people can experience ulcers, clotting and even internal bleeding (which will look like a bruise).

Generally these symptoms are worse at the end of a day, especially after sitting at a desk all day at work (or standing all day at a standing desk). People who are active throughout the day will generally not experience this, but they are also much less likely to have varicose veins in the first place.

The veins generally happen on the backs of your legs, but that is also where most of the veins are. They can occur on the front, particularly on the thigh but on the shins as well. In rare cases they can also happen on your arms or even torso.

The issues will generally progress, rather than all popping up at once. The first sign of a problem is often reticular veins, which then start to varicose and bulge. Then you might start to see your skin pigment changing over the bulges or get rashes. You may also get ulcers if your problem is particularly bad.

Treatments

Before we get into the treatments for varicose veins it should be pointed out that if you only have bulging with no discomfort then the problem is usually more cosmetic than medicinal. There are also steps you can take to stop the problem from getting any worse, and possibly help it get better, such as wearing support stockings. You might need surgery to help fix the problem if it is particularly bad, but there are other options.

The veins that bulge are usually superficial, surface blood vessels so they can be blocked or removed without impairing your blood flow or causing any damage to your leg.

Varicose veins clinics, surgery and treatments in Sydney:

Varicose veins clinics, surgery and treatment in Melbourne:

Varicose veins surgery, clinics and treatments in Perth:

Varicose veins treatments, clinics and surgery in Hobart:

Varicose veins treatment, clinics and surgery in Canberra:

Sclerotherapy

Sclerotherapy is a treatment that involves injecting chemicals into the affected vein that will eventually cause the blood vessel to spasm and collapse. The walls of the vein heal together so that blood cannot flow through anymore.

The process takes time, so it is better to get this treatment early on. The veins will clear up over 2 to 6 months, although this can be sped up by wearing compression stockings. The actual injection procedure will take about an hour and a half, although this includes walking around the doctor’s office for half an hour after the injection. You might need to repeat the procedure several times a few weeks apart.

After the treatment you will need to wear a compression stocking and walk around a lot. Regular exercise and weight control are important after the treatment (or between treatments if you need multiple injections).

There are some potential side effects to sclerotherapy, generally the same ones you will get with any injection. You might experience bruising or slight skin discolouration, and potential swelling. If you get the treatment on large veins you might end up with lumps of trapped blood as well – these should go away on their own, and if not they can be removed a few weeks after the injection.

More seriously you could get inflammation or clotting if you ignore compression after the injections or are taking hormonal medication during or soon after the injections. You may also experience ulcers within a few days after the injections, and if you are allergic to the irritant you may have serious problems.

Ablation therapy

This therapy is based around using heat to seal the vein. Ablation therapy can use lasers or radio-frequency to collapse the blood vessel and make it close and is suitable for bigger veins or if you want them to heal quickly.

The operation will be quite quick, and you don’t have to do anything special for recovery except wear support stockings. You will also need to speak to your doctor before you exercise heavily. Apart from that you will be back to your normal activity immediately.

The treatment involves inserting a catheter into the varicose vein and using either laser fibres or radio-frequency energy to collapse the vein and seal the walls of the blood vessel – eventually it will turn to scar tissue. In a similar way to sclerotherapy this will make the bulge go away and won’t damage your circulation.

The operation will take about 45 minutes, although if you have a lot of varicose veins or they are especially large it will take longer. You will be under anaesthetic for the procedure, so you will need to recover from this, especially if you go under for a general anaesthetic. Even if you only get local it will be a few hours before your legs can move normally again.

Within a week you should start to see the varicose veins going down, although it can take weeks or even months for them to disappear completely. If the veins do not go down completely you might need another course of treatment or a sclerotherapy treatment to get rid of them.

Apart from the complications that can occur from any operation or anaesthetic, you could suffer minor burns from ablation therapy. You might also develop a lump or lumps, or damage to other blood vessels around the varicose veins.

You may also develop more varicose veins in the future after this treatment, as not every superficial vein is being closed. Your lifestyle and genetics will play a major role in this.

Surgery

Surgically removing the veins is the final treatment option for varicose veins. It involves a surgeon physically cutting the swollen blood vessels and stripping them out of your leg.

Surgery is the most extreme treatment for varicose veins. It is usually only performed in the worst cases or when there is a high likelihood of recurrence for the veins. This operation will probably be the most effective – and certainly the fastest – treatment for varicose veins, but it also has the most impact on your regular routine and is likely to cause scarring.

For the operation you will be put under a general anaesthetic as the surgeon disconnects the superficial veins in your leg from the deeper, more essential, blood vessels. They will need to make many small cuts to do this, and you will probably have a lot of scars on your leg when it heals. They will then strip out the varicose veins using a special device.

The operation can take anywhere from 20 minutes to 3 hours, depending on how bad your varicose veins are and how many you have. You will need longer afterwards to recover from the anaesthetic, but should be able to go home either the day of or the day after the operation.

There will be a lot of pain after you wake up, and you need to be careful to avoid infections afterwards. It will take a few days before you can resume your normal daily activities, including work (if you do a lot of standing or manual labour at work it will take longer). Regular exercise will help you recover, but speak to your doctor before you start.

The surgical option carries the highest risk of unsightly scarring out of all the treatment types, and there is also a risk of suffering nerve damage while under the knife. After the surgery you might experience a tingling sensation or numbness because of this. There is also a very slight risk of damage to the major blood vessels in your leg that the varicose veins are being disconnected from.

Prevention

If you believe you are at risk for varicose veins, or you currently have small ones that you want to keep from getting worse, there are some things you can do. Even if you do everything right, however, you may still develop varicose veins or see them get worse.

The main things you can do involve improving circulation to your legs and other extremities, because this can help keep the valves that collapse to form the unsightly bulges from working too hard. Staying generally healthy and keeping good blood pressure and cholesterol levels will also help.

Clothes

While compression socks and stockings can help to support your veins and help prevent already varicosed ones from getting worse, tight clothing generally should be avoided. Tightness around your waist or tight leggings and jeans on your legs can restrict circulation, which will force the valves in your legs to work harder and potentially fail.

If you want to wear tight clothes or shapewear, it is best to save it for special occasions and find some looser options to wear on a day to day basis.

Standing and sitting

Standing or sitting in one position for too long makes it harder for your veins to pump blood back up your leg and causes higher blood pressure – and can lead to blood pooling in your ankles and swelling. This, naturally, forces your valves to work harder and can contribute to varicose veins.

Because standing and sitting both contribute to the issue, standing desks are unfortunately as bad as seated ones. If you are stuck at a desk all day, try to get up and walk around the office every hour or so. If your desk has adjustable height, change throughout the day between sitting and standing to help keep your muscles engaged and aid blood flow.

If you are stuck sitting all day, moving your feet will help a little. Wiggling your toes and stretching your ankles will also keep your blood moving more fluently – and walk around when you get up for a coffee or to go to the bathroom!

Elevate legs

If you elevate your legs a few times a day you will be able to reduce the blood pressure in your lower extremities. The best (and easiest) way to do this is to lie down with your feet resting on something so they are raised above your heart. You can do this on a couch with some pillows under your feet, or just rest your feet on the armrest!

If you can comfortably sleep with your feet elevated, this is a very easy way to reduce pressure in your legs and feet – although if you do it for too long you might end up with not enough blood getting through your legs.

Avoid high heels

High heels can increase the blood pressure in your legs and don’t engage your calf muscles, which help to pump blood through your veins. Wearing them for the odd function or night out won’t hurt you, but it’s best to wear flats to work if possible. As a side benefit, flats are much better for your ankles and the tendons in your legs – if you wear heels too much your calf ligaments and tendons can shorten.

Control your weight

Keeping your weight under control is a major factor in avoiding varicose veins. Being overweight puts extra pressure on your feet and legs, which contributes to the problem, while a poor diet will probably also raise your blood pressure by being high in salts and cholesterol.

A healthy diet helps to keep your blood vessels clear and under less pressure, while being physically lighter will also help keep your blood pressure down and help prevent the valves in the superficial veins in your legs from being overloaded and becoming varicose.

Exercise is also a hugely important factor in varicose vein prevention. Apart from helping to keep your weight down, exercise (even just walking) helps the blood pressure in your legs and strengthens the calf muscles that your leg veins use to pump blood back towards your heart.

If you are at risk for varicose veins walking is the best form of exercise for preventing them, while yoga is also a good option. Yoga can help to strengthen your deep leg muscles, which aids blood flow and takes some of the pressure off your superficial veins. Cycling and swimming are also very good, but really any form of exercise is better than nothing.

Obesity is a major aggravating factor for varicose veins, so eating healthily and exercising are ways to reduce the risk of either becoming obese or, if you are already overweight, bringing yourself back to a healthy body composition.

Compression stockings

Yes – compression stockings are technically tight clothing. However, rather than the tightness constricting your blood flow, they are tight in the right places to support the veins in your legs and try to prevent them from becoming varicose or getting worse if you already have the condition.

The compression stocking can also alleviate the problems caused by varicose veins by offering support, which can help you to suffer less pain from the condition. If you wear them during the day you are also less likely to get leg cramps at night.