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Varicose Veins:
Symptoms, Causes, Diagnosis & Treatment

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1.What are Varicose veins?

Prominently visible, large, purplish veins appearing through the skin are usually known as varicose veins. A milder version of this is known as spider veins. This condition more commonly affects women and is usually benign. The condition may, however, become painful at times. Veins that are affected with varicose are usually a cosmetic concern only, however, and appear to affect the legs due to the weight borne by them, more often. This condition is most often self-diagnosed and does not require laboratory imaging. In some cases, it may signify an underlying circulatory problem.

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2.Symptoms of Varicose veins

Varicose vein symptoms are visible to the naked eye and include bulging, cord-like, twisted veins that are dark blue, red or purple. These may appear on feet and legs, and spider veins may appear on the face as well. In the case of inflammation, these veins can cause the surrounding skin to become highly sensitive and tender, itchy and may cause aches in limbs. Other symptoms of varicose veins include:

  • Muscle cramps in legs
  • Swelling of feet or limbs
  • Skin discolouration
  • Pain after sitting or standing for intervals
  • Skin tender to the touch due to being stretched taut over varicose veins
  • Ulcers, if varicose veins have advanced and remained untreated

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3.Types of Varicose veins

Varicose vein treatment

There are different types of varicose affecting superficial veins, and more rarely, more internal veins which can become swollen. Some of these types include:

  • Trunk varicose veins: These are usually long, bulging veins, deemed unsightly due to their prominence. They are thicker than the other types of varicose veins and often result from dilation of the venal walls.
  • Reticular varicose veins: These are usually red and form a network under the skin. They are less bulging than trunk varicose veins and may indicate circulatory concerns.
  • Telangiectasia varicose veins: Commonly known as spider veins, these small clusters of thin, visible venal networks appear on the face or the legs. They are not as prominent as other types in terms of stretching the skin and are harmless.

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4.Causes of Varicose veins

In order to circulate blood to the heart, veins depend on muscles and valves to ensure correct circulation. These valves are one-way systems and in case any are damaged, the blood may flow backward and collect and pool in the veins, causing them to swell and become discoloured. The walls of the affected veins swell up to accommodate the increased pressure and thus varicose veins become visible. In affected veins, instead of flowing through the circulatory system from valve to valve, the blood leaks and continues to pool in the vein, increasing pressure and creates some congestion while causing the vein to bulge and twist. The veins that are most close to the surface (superficial veins) have less muscle support than deep veins, they are more likely to become varicose.

It is not always known why the valves are weakened or damaged, but there are some risk factors that may cause a higher probability of incorrect circulation. Causes of varicose veins include:

Gender: Women are at much greater risk of developing varicose veins as compared to men. Weight gain during pregnancy, or otherwise, hormonal changes, and menopause may be some factors which influence the appearance of varicose veins. Birth control pills and pre menstruation are also known to influence this and maybe one of the causes of varicose veins.

Aging: Older people are more likely to have varicose veins, and the probability of this development increases as one continues to age, possibly due to the weakening strength of the muscles holding up the veins and the epidermis. The valves that help push the blood to the heart also face increased wear and tear with aging and their slow degeneration may cause varicose veins by letting the blood pool in the veins, instead of being able to correctly circulate it.

Pregnancy: Pregnancy requires that a larger than usual volume of blood being circulated through the mother's body, thus creating more pressure on the valves to circulate more efficiently. It also causes weight gain and hormonal changes which are responsible for increased chances of varicose veins.

Family history: The chances of varicose veins, as with many other medical conditions, is increased if family members are afflicted with the same condition. While varicose veins are generally not considered very serious, some patients find it unsightly as well as painful, and in case a close family member is known to suffer from the condition, it is helpful to take preventative measures where possible. Most often, family history is one of the determining causes of varicose veins in later life.

Standing / Sitting for long: Since varicose veins are caused by circulatory issues, sitting or standing for lengthy periods of time puts undue pressure on more susceptible people, being one of the more common causes of varicose veins and increasing the probability of their development.

There are several possible complications that arise out of varicose veins, and although rare, they may sometimes trigger severe health consequences such as:

Blood clots: Blood clots can arise out of the faulty circulation in the legs, especially with the blood continually pooling in veins, and may cause swelling and much pain to the patient. In some rare cases, a blood clot may also travel along and cause more severe blockages. Home treatment of varicose veins can prevent such complications, or, in more advanced cases, surgery may be advised.

Ulcers: Ulcers may occur on the discoloured skin near the varicose veins and can be very painful. In case a varicose vein has swollen to stretch a patch of skin for a lengthy period of time,

Bleeding: Varicose veins may burst at times, if close to the surface of the skin, and while these are rarely serious, it is a resulting complication of the condition.

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5.Steps to prevent Varicose veins

If family history ensures that varicose veins are to be inherited, there is little that may be done, but preventative measures may lessen their prominence, and keep the risks of developing varicose veins lower. Ensuring better circulation and building better muscle tone in the legs may help with the varicose veins, and also aids in mitigating the discomfort caused by existing ones. Some of the varicose veins prevention techniques include:

  • Avoiding weight gain: Weight gain is often linked to poor circulation, and one of the most common suggestions for varicose vein prevention is to avoid weight gain.
  • Exercising: Exercising helps with improving circulation as well as keeping weight under control and is a regularly suggested means to relieve discomfort arising from varicose veins, as well as preventing them.
  • Preventing water retention: A diet rich in fiber and low in salt can help with water retention issues and better circulation to help with the prevention of varicose veins.
  • Avoiding tight hosiery and uncomfortable pants: Tight clothing can wreak havoc on the body’s circulation, and in case of valves already susceptible to damage, such clothing may increase the chances of developing weaker walls of veins and ineffective valves.
  • Compression pants: Wearing compression pants has been shown to aid circulation, and it has been suggested to be worn even during long flights. These may help with the prevention of varicose veins.
  • Keeping legs elevated: While this is not the most comfortable means of varicose veins prevention, keeping the lower portion of the body elevated prevents the pooling of blood in the veins, preventing discolouration and ensuring that pressure on possibly weakened venous walls is prevented from building in the legs.

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6.Diagnosis

Varicose veins are usually self-diagnosed, and there is little in the way of diagnosis that may be attempted by experts since the condition is immediately apparent. Spider veins on feet may appear initially, with clusters of veins showing through and causing discolouration of the patches of skin they show through. A doctor will typically check for further inflammation and possible complications in the case of varicose veins to avoid ruptures and bleeding. They may also suggest an ultrasound test which is non-invasive or a venogram which requires the injection of a dye after which an X-ray is performed to understand if circulation is affected in the body, and in case the legs have blood clots.

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7.Treatment

Varicose vein treatment

Varicose vein treatment is usually suggested through lifestyle changes rather than through surgery. Lifestyle changes such as diet modification or exercise, as mentioned above, may help with curtailing the pain or prevention of further complications arising from varicose veins.

Compression may be suggested in combination with other lifestyle changes, and specialized compression socks or tights will help the blood be pushed to the heart correctly despite damaged valves and help relieve some of the pressure on the veins in patients with varicose veins, thus reducing swelling.

If the varicose veins are extremely painful and causing recurring discomfort to the patient, and none of the other methods provide relief, the doctor might suggest an invasive operation through which the varicose veins are removed. Vein ligation and stripping is a surgical treatment during which the surgeon surgically removes the varicose vein through incisions on the skin while the patient is anaesthetized.

In some cases, slightly less invasive techniques may be utilized as well, which have become more commonly recommended in recent years.

Other treatment options

Currently, a wide variety of minimally invasive treatment options for varicose veins are available. These include:

Sclerotherapy: This procedure requires a special foaming chemical to be injected into the vein that in turn scars and closes the vein. This is repeated until the desired objective of mitigating the varicose is achieved. In a few weeks, and sometimes requiring a few sessions, the varicose veins fade and are thus removed. This does not require anesthesia or a hospital stay.

Laser surgery: A relatively new technique, laser surgery is used to expose the veins to strong, focused bursts of light to help the varicose fade into the skin. This procedure is typically used for minor varicose veins or spider veins in feet.

Endovenous ablation therapy or catheter-assisted procedures: In cases of larger varicose veins, the doctors use a catheter, the tip of which is heated to insert into the vein. Either heat or radiofrequency may be used, and the catheter is pulled through the swollen vein, causing it to collapse and fade.

Ambulatory phlebectomy: A number of skin punctures, with local anesthesia applications are performed by the doctor to scar and close smaller varicose veins. This is a minimally invasive procedure, not requiring a hospital stay.

Endoscopic vein surgery: An endoscope insertion into the afflicted varicose vein aids the operation and this process is recommended only in cases involving leg ulcers or other suspected complications arising from varicose veins, and if other techniques have failed. This is also an outpatient process.

Very often, varicose veins arising out of sudden weight gain, a flux in hormones or pregnancy fade within a few months without medical treatment if the underlying causes are cured, or the gestation is complete, in case of pregnancy.

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8.Outlook and Prognosis

Varicose veins are often considered ugly but rarely develop extreme complications. They tend to worsen with age, once developed, however, even if precautions are maintained. In case of surgery is not recommended by doctors, check-ups at frequencies suggested by doctors can help keep the possibilities of developing sores, ulcers or blood clots at bay. Being on the lookout for complications such as the development of a sore on or near a varicose vein, swelling of feet or ankles would help prevent worse developments.

If such complications do not develop, varicose veins do not cause any medical problems.

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9.Road to Recovery and Aftercare

Recovery after varicose vein surgery usually takes 1-5 weeks depending on the procedure, overall health of the patient, the size of the vein operated upon and care procedures followed. Some pain may be expected after the anaesthesia wears off, even in outpatient procedures. It is important to exercise and stretch after the procedure to ensure correct circulation. Also, watching out for any deteriorating symptoms after surgery is necessary, especially for the first few days, since areas operated upon are most prone to infection immediately after the procedure. Blood clots may also be seen in case of varicose vein surgery, and need to be considered seriously to avoid any circulatory issues.

In case lifestyle changes such as quitting tobacco or restriction of alcohol are suggested by the doctor, it is necessary to ensure that these aftercare measures are adhered to since some substances such as tobacco can delay healing. These may also affect the performance of pain medication, which, following varicose vein surgery, must be used in accordance with prescribed methods.

Other lifestyle measures such as wearing compression socks or tights will help keep varicose veins under control and help quicker recovery from the surgery. Any measures to improve circulation to the legs, such as exercise regimens involving specialised yoga or stretching can help with aftercare following varicose vein surgery.

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10.Physiotherapy and Exercise plan for Varicose veins

Physiotherapy after surgery to deal with varicose veins is often recommended. The practices of exercise and / or physiotherapy include rhythmic movements that build muscle tone and improve circulation to help support the veins and valves better.

Bed exercises that require raising the legs and rotation of ankles gently and slowly, followed by knee and hip exercises to remove possible soreness and stiffness from the muscles after varicose vein surgery are usually suggested. Gentle exercises such as walking and yoga aid recovery without putting undue stress on the operated upon varicose vein. After a week, more aggressive physiotherapy and exercises may be suggested to focus on muscle building or rebuilding to aid recovery and prevent further development of varicose veins, and these exercises will continue for several weeks afterward till visible results are achieved, and till the appearance of varicose veins has been reduced.

Exercise regimens created particularly for varicose veins often include stretches and massages for each area of the affected leg by targeting:

Hamstrings: Resistance band stretching by looping one end of the band (or a substitute cord) around the knee while slowly stretching it high with the other leg while lying on the back helps stretch the hamstring muscles. Holding the position of the band, and repeating the movements a few times for each leg is one of the oft-suggested pats of exercises following varicose vein surgery.

Calf muscles: Gentle flexing and stretching of the ankle while the leg is raised helps reduce swelling in the calf muscle. This can be begun the day after the varicose vein surgery and continued, and it can also be performed on the bed itself.

Inner thigh muscles: Side stretches that are performed slowly help strengthen the inner thigh muscles and aid with easier recovery from the operation. Further symptoms of varicose veins may be prevented from appearing if such stretches are incorporated into a regular regimen following varicose vein surgery.

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11.Varicose veins FAQs: All your concerns addressed

Q.  How do I prevent varicose veins if my parents have them?

  1. If genetic, it may be that preventative lifestyle measures are not effective at keeping varicose veins at bay. However, regular yoga, exercise and wearing of compression stockings may reduce their prominence and the appearance of spider veins on legs may be aided by regular exercise and maintenance of a low-sodium diet.

Q.  Should I get surgery for varicose veins if I don't have pain?

  1. The decision of having surgery on varicose veins will depend on examination by a doctor, and it is possible that a minimally invasive procedure will be performed in order to help with their appearance. However, most doctors are conservative about varicose veins without complications, and it is necessary to be aware that any invasive surgery carries some amount of risk that is best avoided if the cosmetic concern is not too high.

Q.  Are varicose veins dangerous?

  1. Varicose veins look unsightly, and they can be more than just that. They can result in many symptoms that can have a negative impact on the daily activities and qualities of life, such as aching legs, pain, swelling, restless leg syndrome, etc. Varicose veins can be dangerous if untreated because the blood that is pooling in the veins can clot and create further problems.

    The clotting of blood in the varicose veins can lead to a painful condition called superficial phlebitis, which is not necessarily dangerous. However, if the condition advances into a deep vein clot known as deep vein thrombosis, it can be dangerous and need immediate medical care.

    Chronic venous disease is another serious condition that may result due to varicose veins. It is characterised by brawny skin discolouration at the calf and ankle and is the first stage of developing the disease. When blood starts to pool in the varicose veins, they may leak into the tissue of the lower leg and ankle leading to hardening and darkening of the skin, potentially leading to ulcers of the skin.

Q.  Are Varicose Veins A Sign of Heart Risk?

  1. No, varicose veins are not a sign of heart risk. Veins carry blood to the heart and arteries bring oxygen-rich blood from the heart to other parts of the body. Heart disease and peripheral artery disease are caused due to problems in the arterial system and varicose veins are the problems of the venous system.

    As they are really separate systems, varicose veins aren’t a precursor to heart risks or diseases. Nonetheless, individuals with varicose veins tend to suffer from night cramps or restless legs syndrome, and in severe cases, the skin may become discoloured and thick.

Q.  Is massage good for varicose veins?

  1. Although massage can work to reduce the swelling and discomfort caused due to varicose veins, they won’t make it go away. If they are causing symptoms like swollen legs or feet, cramps, soreness, heavy legs, they can be managed with proven treatment methods, such as sclerotherapy and laser therapy.

Q.  Is walking good for varicose veins?

  1. As walking is a low-impact form of physical exercise, it works very well for people suffering from varicose veins. It can also help to strengthen the calf muscles without putting much strain on the body and also improves blood circulation. Hence, it is beneficial in the management of varicose veins.

    You can walk for at least thirty minutes, five days a week. Try speeding up your pace gradually. Brisk walking is a great way to raise the heart rate and burn more calories.

Q.  Can varicose veins cause a blood clot?

  1. Usually, varicose veins develop in the legs and affect the veins that lie closer to the surface of the skin. But they can also occur in other parts of the body. When an individual is affected by varicose veins, the veins bulge out and become twisted slowing down the flow of blood through them. Sluggish blood flow can lead to superficial blood clots, which is also known as superficial thrombophlebitis or superficial venous thrombosis. These superficial clots can produce symptoms like redness, pain, swelling and tenderness in the affected limb around the vein.

    Superficial clots, unlike DVT or deep vein thrombosis, do not advance to the lungs and cause a pulmonary embolism. DVT and pulmonary embolisms are serious conditions that are not caused due to varicose veins. However, if the case is severe, there is a risk that DVT might result.

Q.  Can varicose veins burst?

  1. If the varicose veins problems make further progress, the blood pooling can increase. This won’t immediately affect the individual’s overall health, but over time, may result in sudden bleeding from a surface varicose or spider vein. As varicose veins grow larger, the vein wall stretch and weaken. Due to the backflow or reflux of blood, high pressure can form leading to a spontaneous burst and bleeding.

    People with varicose vein bleeding can be treated with thermal vein ablation with or without micro phlebectomy.

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