Varicose Veins: Symptoms, Causes, Treatment & Care
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Introduction
Learning about varicose veins symptoms causes treatment and when to seek care can make health choices clearer. This guide calls that broad topic “vein care” for short.
Varicose veins may cause pain, swelling, skin changes, ulcers, clots, or bleeding 1,2. However, some people have no symptoms and mainly dislike their appearance 1,7.
This guide explains common warning signs, risk factors, diagnosis, self-care, and medical procedures. It also shows when symptoms need medical assessment.
Overview: Varicose Veins at a Glance
What are varicose veins?
Varicose veins are permanently enlarged veins located under the skin 1. They often appear swollen, twisted, bulging, or rope-like 5,7.
These veins most often form in the legs, ankles, and feet 5,7. Their color may look blue, purple, or similar to the surrounding skin 7. Skin tone can affect how easy they are to see 7.
Varicose veins are a common sign of chronic venous disease 4. This broad term describes problems involving blood flow through the veins.
Some varicose veins cause aching or other symptoms 1,6. Others cause no physical discomfort and remain a cosmetic concern 1,7.
How healthy leg veins move blood
Veins return blood from the body to the heart 7. Leg veins must move that blood upward against gravity 7.
Lower-leg muscles tighten and act as pumps during movement 7. Small valves inside the veins also guide blood toward the heart 7.
Healthy valves open as blood moves upward 7. They then close to stop blood from flowing backward 7.
Weak or damaged valves may fail to close correctly 5,7. Blood can then move backward and collect inside the vein 5,7. This pooling raises pressure and makes the vein stretch, swell, and twist 5,6.
Varicose veins versus spider veins
Spider veins are smaller than varicose veins 7. They lie close to the skin and may resemble a web 7.
Spider veins often look red or purple 5. They can appear near varicose veins on the legs 5. Spider veins may also develop on the face 7.
Large bulging veins are more consistent with varicose veins 5,7. A health professional can examine unclear or troublesome vein changes.
Symptoms and Complications
Common appearance and sensations
Varicose vein symptoms differ between people 6. Symptoms may involve one leg or both legs 6.
Common varicose vein symptoms and visible signs may include:
Twisted, swollen, or rope-like veins beneath the skin 5,7.
An aching, sore, or heavy feeling in the legs 5,7.
Tired or fatigued legs, especially during long periods of standing 1,4.
Burning, itching, tingling, or throbbing near affected veins 5,6.
Muscle cramps or restless feelings in the legs 1,6.
Swelling around the lower legs, ankles, or feet 1,5.
Changes in skin color near an affected vein 6,7.
Tender or uncomfortable areas around visible veins 5,6.
Visible veins do not always cause pain 1,7. The size of a vein also does not describe every symptom a person may feel 6.
How symptoms may change during the day
Aching, heaviness, itching, and burning often worsen after prolonged standing 1,6. Symptoms may also become worse near the end of the day 6.
Sitting and raising the legs may ease symptoms for some people 6. Walking and other light activity are also included in recommended lifestyle advice 2,7.
If certain activities make symptoms worse, note when the change happens. A clear symptom pattern may help during a medical visit.
Signs of chronic venous disease
Long-term vein problems can affect the skin and nearby tissue 1,6. Possible changes include pigmentation, eczema, swelling, and open sores 1,2.
Venous eczema is inflamed skin linked with poor vein function 2,6. It may occur near areas with discoloration or swelling 2,6.
Lipodermatosclerosis involves lower-leg narrowing from chronic inflammation, fibrosis, and tissue contraction 6. Fibrosis means the development of thick, scar-like tissue.
Venous ulcers are open sores associated with chronic vein disease 1,6. They often occur near the ankle and may not heal without proper care 6,7.
Other recognized complications include superficial vein thrombosis and bleeding 1. Superficial vein thrombosis means a clot has formed inside a surface vein.
Ongoing leg pain or swelling can sometimes signal a blood clot 7. If either problem continues, seek medical help rather than assuming varicose veins caused it 7.
Causes and Risk Factors
Weak vein walls and damaged valves
Varicose vein causes involve weak vein walls, faulty valves, and raised pressure inside veins 5,6. Experts continue to debate the exact process behind these changes 6.
Valve failure allows blood to flow in the wrong direction 6. This backward flow is called venous reflux. Reflux increases pressure within the affected vein system 4,6.
Higher pressure can make larger veins lengthen and become twisted 6. Weak vein walls may also stretch as blood collects inside them 5.
Not every person has one clear varicose vein cause 5,6. Genetic and environmental factors may both play a role 6.
Factors linked with higher risk
Recognized varicose vein risk factors include:
Older age, which is linked with wear affecting vein valves 1,7.
A family history of varicose veins or other vein disease 1,6.
Female sex, which is an established risk factor 1,6.
Pregnancy or having given birth several times 1,4.
Overweight or obesity, which places added pressure on blood vessels 5,7.
Previous deep vein thrombosis, which may damage vein valves 1,6.
Prolonged standing, including standing for long periods at work 1,6.
Long periods of sitting, which are linked with increased risk 5,7.
Raised pressure within the abdomen from obesity, pregnancy, or chronic constipation 6.
These factors do not explain every case 5,6. They help clinicians understand a person’s background and possible risk.
Risk reduction and daily habits
Some risk factors, including age and family history, remain part of a person’s health background 1,7. Other factors may respond to changes in daily habits.
Exercise, healthy weight management, and frequent position changes may improve circulation 7. These habits may also help control discomfort linked with existing varicose veins 2,7.
NICE includes weight loss and light-to-moderate activity in its lifestyle advice 2. NICE also advises avoiding known symptom triggers when possible 2.
Lifestyle advice and medical procedures serve different purposes 2,7. Procedures may close or remove veins, while daily care mainly addresses symptoms 7.
How Varicose Veins Are Diagnosed
Medical history and physical examination
A health professional may diagnose visible varicose veins during a physical examination 5. The examination may take place while you sit and stand 5.
The clinician may ask about pain, itching, swelling, heaviness, and daily symptom patterns 5,6. Questions may also cover family history, past clots, pregnancy, and other risk factors 1,6.
During the examination, the clinician checks vein size and location 6. The clinician may also look for swelling, discoloration, irritated skin, or ulcers 6.
The legs may be checked from the thigh to the ankle 4. Veins in the groin or pelvic region may suggest another source of vein problems 6.
When duplex ultrasound is used
Duplex ultrasound is a painless, noninvasive test for examining leg veins 6. It uses imaging to assess vein structure and blood flow 4,6.
The test can assess valve function and identify venous reflux 4,6. It can also check for deep vein thrombosis or an obstruction 4.
NICE recommends duplex ultrasound for suspected primary or recurrent varicose veins 2. The test confirms reflux and helps plan treatment 2.
Ultrasound becomes especially important when vein disease is severe 6. It is also the preferred test when an intervention is being considered 6.
Problems that may need separate evaluation
Pain and swelling should not automatically be linked to visible surface veins. A clinician may use ultrasound to check whether deep clots or blocked veins are contributing 4.
Ongoing leg pain or swelling may indicate a blood clot 7. If these symptoms continue, seek medical help 7.
A full assessment helps define the vein problem before treatment planning 2. It also shows the location and extent of confirmed reflux 2.
Treatment Options for Varicose Veins
Self-care and symptom relief
Self-care may reduce discomfort linked with varicose veins 2,7. It does not replace assessment for bleeding, ulcers, clots, or severe skin changes.
Helpful self-care measures may include:
Walk or choose another light-to-moderate activity regularly 2,7.
Raise the affected leg while sitting or lying down 6,7.
Change sitting or standing positions often throughout the day 7.
Take movement breaks during long periods of sitting or standing 2,7.
Work toward a healthy weight if weight management applies to you 2,7.
Avoid activities that clearly make symptoms worse when possible 2.
Exercise and leg elevation may help relieve discomfort 7. Daily activity also lets the lower-leg muscles support upward blood flow 7.
If self-care does not improve how the veins look or feel, see a health professional 7. A medical review can explore other treatment options.
Compression stockings
Compression stockings squeeze the lower legs and support circulation 5. They may help control swelling or discomfort for some people 1,4.
Evidence remains insufficient for compression stockings without active or healed venous ulcers 6. NICE does not advise them as routine treatment when an intervention remains suitable 2.
NICE reserves compression hosiery for people who cannot have an intervention 2. BMJ also describes its use in chronic venous disease or after healed ulcers 1.
Ask a health professional about using compression stockings. This conversation can place their role within your wider treatment plan.
Endothermal ablation
Endovenous thermal ablation is an intervention for symptomatic varicose veins 1,6. “Endovenous” means the procedure is performed within a vein.
For confirmed truncal reflux, NICE says clinicians should offer endothermal ablation 2. Truncal reflux involves faulty flow within a main superficial vein 2,6.
Thermal ablation has largely replaced surgery as the standard approach described by AAFP 6. It can be performed with local anesthesia 6.
Foam sclerotherapy and other closure methods
If thermal ablation is unsuitable, NICE recommends ultrasound-guided foam sclerotherapy 2. Sclerotherapy uses a chemical substance to close unwanted surface veins 4.
Some clinics also use other methods that close affected veins. Cyanoacrylate glue is one such minimally invasive option 4.
Ultrasound confirms the reflux and supports treatment planning 2. A vascular service should explain available options, expected benefits, and possible risks 2.
Surgery
If foam sclerotherapy is unsuitable, NICE recommends surgery 2. Surgical treatment is also listed among the options for symptomatic varicose veins 1.
Guidance and access may differ between health systems. NICE guidance follows the sequence of thermal ablation, foam treatment, and then surgery 2.
New varicose veins may develop after treatment 2. Some people may need more than one treatment session 2. Recurrent veins have a higher recurrence risk after further treatment 2.
When to See a Doctor for Varicose Veins
When immediate care is needed
When leg pain or swelling needs assessment
Ongoing leg pain or swelling may signal a blood clot 7. If either symptom continues, seek medical help 7.
A clinician may use duplex ultrasound to check for deep vein thrombosis or obstruction 4. Do not assume persistent symptoms come only from visible varicose veins.
When to request vascular care
NICE recommends vascular assessment in several situations 2. Arrange care if any of these conditions apply:
If pain, aching, swelling, heaviness, or itching becomes troublesome 2.
If previously treated varicose veins return and cause symptoms 2.
If pigmentation or eczema develops from chronic venous disease 2.
If a clinician identifies superficial vein thrombosis with suspected faulty vein flow 2.
If a sore below the knee remains open after two weeks 2.
If a venous leg ulcer has healed but vein disease remains 2.
If self-care has not improved how the veins look or feel 7.
Skin discoloration can appear before a painful ulcer forms 7. If an open leg sore develops, seek medical assessment without delay 7.
Swelling, eczema, and ulcers may reflect more advanced vein disease 1,6. Early assessment can identify whether further testing or treatment is appropriate 2.
Conclusion
Varicose veins form when weak walls or faulty valves allow blood to collect 5,6. Symptoms may include aching, heaviness, itching, cramps, fatigue, and swelling 1,5,6.
Walking, leg elevation, weight management, and position changes may ease discomfort 2,7. Compression or a vein procedure may also have a role 1,2.
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