Varicose Veins: Symptoms, Causes and Treatment

Introduction

Varicose veins are enlarged, twisted veins found just below the skin ^[1,4]. They most often affect the legs, feet, and ankles ^[1,4].

Some people view these veins as a cosmetic concern ^[4,6]. Others have pain, swelling, skin changes, or limits on daily activity ^[1,4].

This guide covers varicose veins symptoms, causes, treatment, and when to seek care. It explains warning signs, risk factors, tests, self-care, and medical procedures.

Overview: What Are Varicose Veins?

Varicose veins are swollen and twisted superficial veins ^[1,3]. A superficial vein lies close to the skin’s surface ^[3,6].

These veins usually form in the legs ^[1,2]. Standing and walking raise pressure in the veins of the lower body ^[6]. Varicose veins can also form in other parts of the body ^[2].

How healthy leg veins move blood

Veins move blood toward the heart ^[2]. Small, one-way valves help blood travel in the correct direction ^[2,4].

Healthy valves help stop blood from flowing backward ^[2]. Leg veins and valves work against gravity during standing ^[7].

Regular movement is often part of conservative treatment ^[6,10]. Avoiding long periods of standing may also help reduce symptoms ^[10].

How weak valves lead to pooled blood

Varicose veins develop when weak or damaged valves allow backward blood flow ^[2,4]. The blood then pools inside superficial veins ^[2,4].

Weak vein walls may also play a part ^[4,10]. Pooled blood raises pressure inside the affected veins ^[2,10].

The veins may stretch, swell, and twist under this pressure ^[2,4]. They can then form blue or purple bulges beneath the skin ^[4].

This pattern is linked to poor vein function. The affected veins have trouble keeping blood moving toward the heart ^[2,4].

Varicose veins versus spider veins

Varicose veins are often raised, enlarged, and twisted ^[1,4]. They may look like blue or purple cords beneath the skin ^[1,4].

Spider veins are smaller red or purple lines ^[4]. They may appear close to larger varicose veins ^[4].

Spider veins are often considered a mild form of varicose veins ^[6]. A clinician can examine either type when symptoms or changes cause concern.

Symptoms and Possible Complications

Varicose vein symptoms differ among people. Some people have visible veins without much discomfort ^[4,6]. Others develop pain, swelling, itching, or skin changes ^[1,4].

Visible and physical symptoms

The first sign may be a vein that looks enlarged or twisted ^[8]. It may appear blue, red, or purple ^[1,4,8]. Some affected veins also bulge above the skin ^[1,4].

Common varicose vein symptoms include:

• Aching or pain in the legs ^[1,10]
• A heavy feeling in the legs or feet ^[1,10]
• Itching near an affected vein ^[1,4]
• Burning discomfort around a vein ^[1,10]
• Swelling in the legs ^[1]
• Skin color changes near the vein ^[1]
• Nighttime leg cramps ^[1]
• Enlarged, twisted, or bulging veins ^[1,4]

A person may have several symptoms at the same time. Symptoms can limit walking, exercise, work, or other daily tasks ^[1].

Pain is not always present ^[4,6]. Some people seek an exam because they dislike how the veins look ^[4].

Patterns that can make symptoms worse

Symptoms often worsen after prolonged sitting or standing ^[1]. They may improve after lying down or raising the legs ^[1].

Jobs that require long periods of standing can raise pressure in leg veins ^[7,10]. Symptoms may become more noticeable after several hours spent upright ^[1,7].

Leg elevation can help relieve symptoms for some people ^[1,6]. Exercise may also be included in a conservative care plan ^[6,10].

Notice when your symptoms occur. Tell your clinician what makes them better or worse. Also explain whether they affect sleep, work, walking, or exercise.

Skin changes and other complications

Varicose veins do not always cause major health problems ^[4,6]. However, complications can develop in some people ^[4,6].

Possible complications include:

• Bleeding from an affected vein ^[1]
• Skin discoloration or other skin changes ^[1,10]
• Inflammation near the vein ^[10]
• Venous leg ulcers ^[10]
• Infection ^[10]
• Thrombosis, which means a blood clot has formed ^[3,10]

Long-term vein problems can cause skin changes near affected veins ^[1,10]. The area may become discolored or irritated ^[1,10].

A venous ulcer is a leg sore linked to poor vein function ^[10]. Leg ulcers need medical assessment because they may lead to further problems ^[10].

Infection may occur in damaged skin or near an ulcer ^[10]. New skin breakdown, pain, or redness should receive medical attention.

Thrombosis is another possible complication ^[3,10]. Sudden changes in one leg may need prompt assessment for a possible clot.

A vein near the skin can also bleed ^[1]. Active bleeding from a varicose vein is a medical emergency ^[1].

Causes and Risk Factors

The causes of varicose veins include weak walls, faulty valves, and raised vein pressure ^[4,10]. Several other factors can increase a person’s risk.

A risk factor does not mean the condition will occur. It only means the condition may be more likely.

Valve failure and increased vein pressure

One-way valves normally help blood move toward the heart ^[2,4]. Damaged valves may allow blood to flow in the wrong direction ^[2,4].

The blood then collects inside the vein ^[2,4]. This pooling raises pressure in superficial veins ^[2,10].

The affected vein may stretch, swell, and become twisted ^[2,4]. Weak vein walls can make the problem worse ^[4,10].

Genes may also play a part in varicose vein development ^[7,10]. Valve problems and weak vessel walls often occur together ^[10].

Age, family history and pregnancy

Older age raises the chance of developing varicose veins ^[2,3,10]. Family history is also an important risk factor ^[3,7,10].

Varicose veins can run in families ^[7]. This pattern may involve inherited weakness in vein walls or valves ^[7].

Women develop varicose veins more often than men ^[7]. However, people of any sex can have them ^[2,7].

Pregnancy is another common risk factor ^[7,10]. Blood volume rises during pregnancy and can make veins expand ^[7].

Pregnancy can also raise pressure inside the abdomen ^[10]. Ongoing high abdominal pressure is linked to varicose vein risk ^[10].

Weight, activity and prolonged standing

Obesity is linked to a higher risk of varicose veins ^[7,10]. It can also increase pressure inside the abdomen ^[10].

Long periods of standing make leg veins work against gravity ^[7]. Prolonged standing is a known risk factor for varicose veins ^[10].

Long periods of sitting may make existing symptoms worse ^[1]. Regular movement may form part of a symptom management plan ^[6,10].

Other conditions can increase pressure inside the abdomen ^[10]. These include chronic constipation and tumors ^[10]. A clinician should assess the cause of new or lasting symptoms.

Diagnosis and Treatment Options

Varicose vein treatment depends on each person’s symptoms and examination. Ultrasound findings may also guide the treatment plan ^[5].

Not everyone needs a procedure ^[5,6]. A clinician may suggest self-care or compression stockings first ^[5,6].

Treatment decisions may also reflect complications and personal goals. Ask your clinician to explain the benefits and limits of each option.

Physical examination and ultrasound

A healthcare professional usually starts by examining the legs ^[5]. The clinician may examine you while you stand ^[5]. This position helps reveal swelling and visible veins ^[5].

The clinician may ask about pain, aching, swelling, and activity limits ^[1,5]. Explain when the symptoms began. Mention whether they have changed or become worse.

A venous Doppler ultrasound can assess blood flow and valve function ^[5]. It may also help identify a blood clot ^[5].

This test is painless and uses sound waves ^[5]. It shows blood moving through the valves in the leg veins ^[5].

Ultrasound results can show how blood moves through the veins ^[5]. The findings can help the clinician choose suitable care.

Self-care and compression stockings

Conservative treatment may include exercise, leg elevation, weight management, and compression stockings ^[5,6,10]. These steps may help manage swelling and discomfort ^[6,10].

Exercise is often included in self-care plans ^[6,10]. Ask your clinician about safe activities if pain makes movement difficult.

Raising your legs while sitting or lying down may ease symptoms ^[1,6]. Symptoms often improve when the feet are raised ^[1].

Weight management may be advised for people with excess weight ^[10]. Obesity is linked to varicose vein risk and raised abdominal pressure ^[7,10].

Compression stockings apply pressure from outside the legs. They are a common conservative treatment for varicose veins ^[5,10].

The stockings should fit well. Ask a healthcare professional whether they are suitable for you.

Other changes may include avoiding long periods of standing ^[10]. Reducing straining may also be part of conservative care ^[10].

Nonrestrictive clothing may form part of a self-care plan ^[10]. Measures that reduce leg swelling may also help manage symptoms ^[10].

Self-care does not remove an existing enlarged vein. Further treatment may be considered if symptoms do not improve ^[8].

Minimally invasive procedures and surgery

Procedural treatments may include sclerotherapy and endovenous ablation ^[5,6]. Endovenous means that treatment takes place inside a vein. Ablation closes the problem vein.

Ablation may use heat or a nonthermal method. Nonthermal ablation closes the vein without heat.

Surgical vein removal is another possible treatment ^[5,6]. Varicose vein procedures aim to close or remove affected veins ^[6].

Many procedures take place in an outpatient setting ^[5]. This means the person does not stay in a hospital overnight.

A clinician may discuss procedures when symptoms remain bothersome. Treatment may also be considered when complications or cosmetic concerns are present ^[3,4].

No single treatment is right for everyone. The choice can depend on symptoms, ultrasound results, and the affected veins.

Health history and personal preferences may also guide treatment. Ask what each procedure involves and what follow-up you may need.

When to See a Doctor

Knowing when to seek care for varicose veins can prevent dangerous delays. Many concerns can wait for a routine visit. Active bleeding cannot wait and requires emergency help ^[1].

Emergency warning signs

Active bleeding from a varicose vein is a medical emergency ^[1]. Call 9-1-1 or your local emergency number right away ^[1].

Do not wait for a routine appointment when active bleeding is present. Tell the dispatcher that blood is coming from a varicose vein.

Symptoms that need prompt evaluation

Seek prompt medical care for sudden changes in one leg. Warning signs include severe pain, swelling, redness, or warmth.

These symptoms may require evaluation for thrombosis or another problem. Blood clots are a possible complication of varicose veins ^[3,10].

A leg sore that does not heal also needs medical care. Venous ulcers, skin damage, and infection are possible complications ^[10].

Arrange an evaluation for worsening skin changes or increased swelling ^[1,10]. Significant pain or inflammation also deserves medical attention ^[1,10].

Seek care when symptoms limit work, walking, sleep, or other daily tasks ^[1]. A clinician can assess the cause and discuss treatment choices.

When to schedule a routine appointment

Make a routine appointment when self-care does not improve your symptoms. These symptoms may include aching, itching, heaviness, burning, or swelling ^[1,10].

A vein specialist can explain treatment options after self-care fails ^[8]. An appointment is also suitable for veins that become larger or more painful.

A healthcare professional can assess whether the veins need treatment ^[4]. The visit may include an examination and a Doppler ultrasound ^[5].

Write down when your symptoms occur. Note which activities make them better or worse. Bring these notes to your appointment.

Conclusion

Understanding varicose veins symptoms, causes, treatment, and when to seek care supports informed choices. Weak valves allow blood to pool and enlarge superficial veins ^[2,4].

Common symptoms include aching, heaviness, itching, burning, swelling, and skin changes ^[1,10]. Nighttime leg cramps may also occur ^[1].

Symptoms often worsen after long periods of sitting or standing ^[1]. Lying down or elevating the legs may provide relief ^[1].

Treatment may include exercise, leg elevation, weight management, and compression stockings ^[5,6,10]. Procedures can close or remove affected veins ^[5,6].

Most varicose vein concerns can be assessed at a routine visit. Active bleeding is a medical emergency that requires immediate help ^[1]. Possible blood-clot symptoms also need prompt medical assessment ^[3,10].