Varicose Veins

Overview

Veins are blood vessels that caries blood from your organs and limbs back to your heart. Varicose veins, or varicosities, are swollen, twisted veins that lie just under the skin and usually occur in the legs. Sometimes varicose veins form in other parts of the body. For example, hemorrhoids are a type of varicose vein that develops in the rectum, and varicoceles are swollen veins in the scrotum.

Varicose veins are a common condition caused by weak or damaged vein walls and valves. Veins have one-way valves inside them that open and close to keep blood flowing toward the heart. When these valves or walls are weak or damaged, blood can pool and even flow backward in a process called reflux, which causes the veins to grow larger and become distorted.

Related Terms

• Varicosities
• Hemorrhoids
• Telangiectasias
• Varicoceles

Signs and Symptoms

Talk to a healthcare provider if you think you may have varicose veins. Getting treatment early can stop them from getting worse and help you avoid complications such as bleeding and ulcers, which are open sores that don't heal well and can get infected or cause other problems.

Common symptoms of varicose veins include:

• Bulging, bluish veins
• Itching or burning discomfort around the veins
• Skin color changes around the veins
• Swelling in the legs
• Aching pain in the legs
• A feeling of heaviness in the legs and feet
• Nighttime leg cramps

Symptoms may get worse when you sit or are on your feet for long periods, and they may get better when you lie down or put your feet up. Sometimes varicose veins can limit your daily activities.

Related Health Effects

Varicose veins can lead to serious complications if left untreated, including bleeding and ulcers. Some lifestyle changes that help with varicose veins may also lower your chance of developing deep vein thrombosis and other medical problems.

Causes and Risk Factors

Varicose veins may form whenever blood pressure increases inside your veins. Several factors can raise your risk:

• Age: Aging can weaken vein walls and valves
• Pregnancy: Increases pressure inside the veins
• Overweight and obesity: Adds pressure to the veins
• Repeated sitting or standing for long periods: Reduces blood flow back to the heart
• An inactive lifestyle: Limits the muscle contractions that help blood move through veins
• Family history of varicose veins: May increase your risk
• Smoking: Can damage your veins and make you more likely to develop varicose veins

Prevention Guidance

Your healthcare provider may recommend healthy lifestyle changes to help prevent varicose veins or keep them from getting worse:

• Aim for a healthy weight to improve blood flow and ease pressure on your veins.
• Staying physically active and exercising makes the muscles in your lower legs contract, which can help blood return toward your heart and not pool in the veins in your legs. However, strenuous exercise, especially if it involves heavy lifting, might make varicose veins worse. Before starting any exercise program, ask your provider about the level of physical activity that is right for you.
• Avoid standing or sitting for long periods. If you must, try changing your position often to help your blood flow.
• Elevate your feet when sitting and try lying down with your feet above the level of your heart for a few minutes several times per day to lower the pressure in your veins.
• Avoid high heels or shoes that limit your ankle movement, as some shoes may affect blood flow in the veins of your legs.
• Quit smoking.

Diagnosis

To diagnose varicose veins, your healthcare provider will do a physical exam and ask about your symptoms, family history, activity levels, and lifestyle.

Your provider may also order an imaging test, such as a duplex ultrasound. This noninvasive method uses sound waves to assess blood flow through the vessels in your legs. It is common for providers to recommend duplex ultrasonography to diagnose varicose veins.

Treatment and Management

Depending on how serious your symptoms are, your healthcare provider may recommend a combination of treatments and preventive measures. Keep in mind that new varicose veins may form even after treatment, or you may need to receive treatments more than once.

The goal of treatment is to relieve symptoms, keep varicose veins from worsening, improve appearance, and prevent serious complications such as ulcers and bleeding.

Lifestyle Changes

Your healthcare provider may recommend adopting healthy lifestyle changes to relieve symptoms or prevent varicose veins from getting worse. These include maintaining a healthy weight, staying physically active, avoiding prolonged sitting or standing, elevating your feet, avoiding restrictive footwear, and quitting smoking.

Compression Therapy

Your healthcare provider may recommend compression therapy alone or, more likely, after a procedure to remove or close off varicose veins. Compression therapy involves special elastic stockings or compression bandages that put gentle pressure on the legs to help prevent swelling.

For some people, especially those who must sit or stand for long periods, compression may help relieve symptoms such as pain, swelling, and heaviness in the legs. If you are pregnant, your provider may recommend compression hose.

It is important to know that compression therapy only relieves symptoms. Most providers now recommend procedures to correct the reflux problem that is causing your varicose veins.

After a procedure to remove or close off varicose veins, your provider will probably recommend wearing compression stockings for at least a week. Compression stockings may also help heal leg ulcers or sores that are a complication of varicose veins. Because vein problems are long-term issues, your provider may suggest that you continue to wear compression stockings.

For some people, compression stockings can cause discomfort, itching, skin irritation, or swelling.

Procedures

Your healthcare provider may do a duplex ultrasonography or other exams to see how well your veins are working and may use ultrasound as guidance during a procedure. The goal of these treatments is to block or destroy the varicose vein that is causing blood to pool, allowing other veins to take over. Most procedures for varicose veins are minimally invasive and do not require a long recovery.

Your provider may recommend that you avoid being in the sun or that you wear sunscreen with an SPF of 30 or higher after some procedures to help prevent scars and skin changes.

Endovenous ablation uses laser or radiofrequency energy to heat the inside of the vein and close it off. This procedure usually happens in a doctor’s office, with ultrasound to guide the treatment, and the area around the vein is numbed so that you do not feel pain during the procedure. Bruising, pain, and changes in skin color are common after receiving the treatment. More serious complications — including numbness, venous thromboembolism, and skin burns — are rare. Venous thromboembolism is a condition that occurs when a blood clot forms in a vein.

Sclerotherapy involves your provider injecting liquid or foam chemicals into the vein to create a plug that seals it shut. The procedure can take place in a doctor’s office with ultrasound guidance. Liquid sclerotherapy is more often used for spider veins. Complications of foam sclerotherapy may include skin color changes and, rarely, venous thromboembolism, nerve damage, serious allergic reaction, or stroke. Some people may have temporary vision problems, headaches, or confused mental states after this procedure.

Phlebectomy involves your provider making small cuts to remove smaller veins near the skin. This procedure can be added on during endovenous ablation or open surgery to enhance treatment effects.

Surgery may be recommended for larger, deeper veins, where your provider may tie off and remove varicose veins in a procedure called vein ligation or stripping. Surgery can often be done on an outpatient basis, meaning you do not need to spend the night at the hospital, but you may need medicine to sedate you so that you are not awake during the procedure. Surgery may be more painful and require more recovery time, so it is usually recommended only for people who cannot get a less invasive procedure. Surgery complications may include infection, nerve damage, bruising, pain, and changes in skin color, though more serious complications are rare.

Finding Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on varicose veins.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH is committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart and vascular diseases, including varicose veins.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.