Varicose veins: everything you need to know
Varicose vein aren't pretty but they're a fact of life - one in three of us will suffer from them. Fortunately, most don't cause complications and most people wouldn't know they had them unless they looked - but help is at hand for the worst cases.
Arteries carry blood from the heart around the body, providing oxygen to your muscles and body organs. Veins carry the blood back. There are three kinds of veins in your legs. You can't see the deep veins, but these get blocked when you have a deep vein thrombosis, or DVT. The veins just under the surface cause varicose veins, and the two are connected by a third kind of vein.
The blood in your arteries is under high pressure, but this pressure is much lower in the veins - and the blood is travelling up against gravity from legs to heart. This runs the risk of blood stopping or even flowing backwards, which is why you have small one-way valves in the veins. Clenching the muscles in your calves (walking does this naturally) helps force the blood upwards.
Varicose veins happen because the wall of the vein becomes damaged. If the damage affects a valve, blood can flow backwards, putting more pressure on valves lower down. The result is a domino effect, with several leaking valves and enlarged veins, like little snakes under the skin. These shrink or disappear when you lift your leg up above your heart, letting the blood flow back freely.
Varicose veins often run in families, and are more common in women than in men. Being overweight makes women but not men more prone to varicose veins (life is unfair!). The older you are and the more children you've had, the higher your risk. Occasionally, they happen on the leg where you've had a previous DVT. Doctors used to think that standing (rather than walking) a lot made you prone to varicose veins, but this isn't certain. However, if you have varicose veins, there's no question that standing a lot makes them ache more and makes your legs feel heavier.
Most people don't get complications from varicose veins - if you do get them, it's likely to be many years after you first noticed them. Your lower legs can become swollen; you can develop changes in skin colour or dry thickened skin over your lower legs; the veins can get red and inflamed; and sometimes this area develops an ulcer. Thread veins - like starbursts of tiny red threads - don't cause complications. They often occur in people who don't have troublesome varicose veins at all. Treatment for thread veins is available, but not on the NHS.
Very occasionally, a varicose ulcer can bleed. If this happens, lie down flat with your leg up and apply firm pressure (with a clean cloth) for at least 10 minutes. If bleeding doesn't settle, call an ambulance, and even if it does, make an appointment with your GP.
Many people don't need treatment for varicose veins, and it's not available on the NHS purely because you don't like how they look. You can help yourself by putting your feet up as high as possible when you can and moisturising dry skin regularly. Compression stockings (available to buy or on prescription), worn all day, can relieve aching and discomfort. Compression stockings work best if they're properly fitted - ask for 'below knee class 1 (light) or 2 (medium) stockings.
There's still a bit of a postcode lottery where NHS surgery for varicose veins is concerned. You should be referred if you've had bleeding from a varicose vein or have leg ulcers resulting from them. You may be referred if you get repeated inflammation or severe aching or pain. The 'traditional' treatment involves tying off the veins connecting your varicose veins with your deep veins, then stripping out the varicose veins.
These days, many hospitals offer 'sclerotherapy', where a chemical is injected into the vein to stick one wall to the other. You need to wear bandages or compression stockings to keen the vein pressed down for a few weeks. Other treatments, including laser or foam to close of the vein, are sometimes available on the NHS. Speak to your doctor about the options.
With thanks to 'My Weekly' magazine where this article was originally published.