Varicose veins are a typical manifestation of chronic venous insufficiency. Varicose veins are abnormally enlarged, dilated, tortuous superficial veins in the lower extremity due to weakening in the vessel wall. We mostly find these veins in the lower extremity. It may appear as prominent or bulging blue protrusion under the skin surface. Varicose veins usually harmless but it can be painful & disfiguring. It can occur in men or women of any age but most frequently affect women in childbearing age & older people. They are very common & do not cause medical problems in most people.
The weakening of the vessel walls can lead to loss of elasticity. As a result, the vessel wall becomes wider & longer which causes the valve flaps to separate. It subsequently causes blood to flow backward & pool in the vessel wall. The veins become swollen, twisted & wider due to these abnormal blood flows.
A wide range of home approaches may aid to diminish the presence and pain of varicose veins. There are numerous medical treatments for this condition, even though a person may also try natural home remedies to alleviate their symptoms. Generally, larger varicose veins are treated with ligation and stripping, laser treatment, or radiofrequency treatment. Sometimes, a combination of approaches may work best. Usually, smaller varicose veins and spider veins treated with sclerotherapy or laser therapy on your skin. In this article, we focus on natural treatment for varicose veins with surgical treatment and briefly describe on preventive measures.
Varicose Veins Symptoms:
In varicose veins, some individuals may not experience any symptoms at all whereas some may experience symptoms. In varicose veins, symptoms vary considerably among patients. However, the most common symptoms that may appear are-
- Bulging or twisting of the affected vein
- Swollen, twisted, bluish or purple appearing under the surface of the skin.
- Painful legs (aching / heaviness feel)
- Swelling present in the legs, ankle & feet
- Itching (especially nocturnal)
- Legs cramps especially at night
- Burning or throbbing sensation in legs
- Skin ulceration
- Pain relief when legs are elevated
Varicose Veins Complication:
Most of the people who suffer from varicose veins do not experience any difficulties and do not require any treatment. They can manage their symptoms without the need for medical treatment. But complications can arise and if they do will require treatment as soon as possible. The complications associated with varicose veins are related to blood flow. Some possible complications of varicose veins are explained below-
- Chronic venous insufficiency
- Varicose eczema
- Venous ulcer
- Restless leg Syndrome
- Deep Vein Thrombosis (DVT)
- May – Thurner syndrome
It may happen due to skin trauma overlying varicosity or secondary to spontaneous varicosity rupture. Near the skin surface of varicose veins can sometimes bleed due to cut or bump leg. The bleeding may be difficult to stop. In that case, the patient should lie down, raise the leg, and apply direct pressure to the wound. Seek immediate medical advice if this does not stop the bleeding.
Blood clots form in the vein, causing swelling (inflammation) of the vein called thrombophlebitis. It can occur within varicose veins also. When the blood flow pool in the lower legs, the superficial veins become susceptible to injury & irritation. It can be painful, local warmth, tenderness & reddish color. When it occurs in one of the superficial veins in lower extremity it is known as superficial thrombophlebitis. It can be treated with compression stockings.
Chronic venous insufficiency:
If the blood in veins does not flow properly, it can interfere with the way that skin exchanges oxygen, nutrients, and waste products with blood. If the normal exchange of waste products, oxygen & nutrition between the skin & blood is disrupted over a long period of time it is known as chronic venous insufficiency. It usually occurs by a faulty valve in the vein system.
Poor skin circulation related to varicose veins leads to developing skin itching. In these conditions, skin becomes red, scaly & flaky. It may also develop blisters in the skin around the varicose veins.
It causes the skin around the varicose veins to become hardened, tight. & thicken it turns a red or brown color. It usually affects the calf muscle area.
Increasing pressure in the veins of the lower extremity leads to develop venous ulceration. It causes fluid to seep from the vein and collect under the skin. The fluid can cause the skin to thicken, become fragile, and eventually break down to form an ulcer. It usually forms in the ankle area.
Restless leg syndrome:
It is one of the annoying complications of varicose veins disorder. Varicose veins can cause an ache in the legs because of a build of fluid and toxins. It worsens at night or during rest. It can disrupt sleep.
Deep Vein Thrombosis:
In 20% of varicose veins, some individuals may develop deep vein thrombosis due to clotting blood in superficial veins (varicose veins).
In the most severe cases, the clot may be break loose from the vein and spread to other parts of the body., which leads to creating a potentially life-threatening condition. It can be very painful and is often initially noticed as a pulling sensation in the calf of the lower leg. Other symptoms are warmth and redness of the skin and swelling that may extend above the knee.
May – Thurner syndrome:
It’s a very rare condition of the leg where veins of legs are affected. In this medical condition where one leg will swell as a result while the other one will.
What Varicose Veins Causes:
The main cause of varicose veins is leaking or damaged valves in the venous system. Leaking or damaged valves may cause poor venous circulation which leads to the varicose vein.
When the valves of veins fail to work properly, it starts leaking. Then blood will follow the wrong direction. As a result, the affected area will bulge out & looking bluish & lymphy on the leg. The legs & feet are most prone to varicose vein because in these areas where veins have to work hardest against gravitational force.
Superficial veins also have less muscle compare to deep veins in our bodies. As a result, superficial veins are most likely to become varicose.
The common causes of varicose veins are –
- Pregnancy – During the first trimester, pregnant women prone to develop varicose veins. The amount of blood and hormonal levels increases in this period which puts extra pressure on the venous system. In turn, it causes veins to enlarge. During pregnancy, the uterus expands usually which also puts extra pressure on veins in the pelvic area. Increased hormonal level during pregnancy also aggravates the muscular bulging of the blood vessels to relax which also increases the risk of varicose vein.
- Occupation – These veins are most commonly found in people who sit or stand in one position for prolonged periods of time (waitress & waiter, nurse, mothers with a young child). Uninterrupted standing may force leg veins & valves to work against gravitational force. For prolonged periods which increase the risk of pressure-related venous damage.
- Obesity – overweight part always gives extra stress/pressure on the vascular system. As a result, veins need to work harder to pump blood to pool in the extremities which lead to the development of varicose veins. Overweight can put increased pressure on the valves of the venous system making them more prone to leaking. For that reason, vascular surgeons always give advice to lose weight after surgery to decrease the risk of further attack.
- Inactivity – Calf muscle is known as a heart of leg. It works like a pump that always pushing blood vessels. So if a patient has to stay standing or sitting position for prolonged periods, calf muscle can’t work properly to push blood upwards. It causes a lack of blood flow in veins which developed varicose veins in the future.
- Constipation – During constipation, the presence of straining to have a bowel movement which gives extra pressure in the vascular system. Constipation only aggravates the varicose veins.
- Inherited vein wall weakness
- Faulty valves
Less commonly varicose veins are caused by such diseases –
- Phlebitis (inflammation of the veins)
- Congenital abnormality present in the vein
- Blood clots
Varicose Vein Risk Factors:
There are several risk factors which can increase the likelihood of developing varicose veins including –
- Aging- The walls of veins tend to weaken on the aging process. During older age veins lose their elasticity which causes them to stretch. As a result, the valves of veins weaken. Getting older may put on higher risk for varicose veins.
- Gender – Women are more likely to develop a higher incidence of varicose veins & venous insufficiency than men. Hormonal fluctuations that occur during puberty, pregnancy & menopause or with the use of birth control pills tend to relax the walls of veins, making the valves more prone to leaking.
- Family history – About 50% of people with varicose veins have a family history of them. A close family member history of varicose veins may raise the risk of developing varicose veins.
- Obesity – Being overweight can give extra stress or pressure on the venous system in the lower extremity. As result veins need to work harder to pump blood to pool in the extremities. It can put increased pressure on the valves which lead to the development of varicose veins. If body mass index (BMI) is high, consequently the risk of varicose veins also high.
- Pregnancy – The amount of blood increase to help support the developing baby during pregnancy. This puts extra stress or pressure on the venous system. The growing fetus in the uterus puts pressure on the veins in the lower abdomen which causes increases the blood pooling in the lower extremity. It usually gets better within 3 months of delivery. Increasing hormonal levels during pregnancy also increase the risk of varicose veins due to causing muscular bulging of blood vessels to relax.
- Lack of movement – Prolonged periods standing or sitting with the legs crossed or bend can develop the risk of varicose veins due to lack of blood flow in vessel walls.
- History of blood clots – If a patient has a blood clot history in the past, or deep vein thrombosis, he or she has a high risk for developing varicose veins. The clot may cause damage to the valves and/or the walls of veins.
Damaged veins – traumatic damaged vein history also increases the incidence of varicose veins in the future.
- Use of oral birth control pills
- Wearing a girdle or clothing that’s too tight
- Sun exposure
Pregnancy & Varicose Veins:
During, pregnancy newborn baby & placenta needs extra blood. The amount of blood in a pregnant mother’s body increase to help support the developing baby. It puts extra pressure on the venous wall which leading to develop varicose veins.
During pregnancy, increased hormonal levels also aggravate the muscular bulging of blood vessels wall to relax which also increases the risk of incidence of varicose veins. During pregnancy, the progesterone hormone causes blood to pool down.
As the baby grows, the uterus compresses some blood flow returning to the heart contributing to an enhanced risk of varicose veins. Each pregnancy puts at higher risk & older moms are more prone to develop varicose veins. Varicose veins during pregnancy can be discomfort but they are not dangerous for the baby. Usually, varicose veins due to pregnancy get better within 3 to 12 months after delivery.
Diagnosis of Varicose Veins:
In most cases, doctors diagnose varicose veins based on a physical examination which is sufficient to diagnose. This will including asking about any family history of varicose veins, the duration & presence of any symptom. After observing the affected area a doctor may ask the patient about his or her sign & symptom. In addition, general inspection & palpation & evaluation for the presence of any bleeding & ulceration.
- Sometimes a doctor also recommended a Doppler ultrasound test to measure blood flow of the vessel wall in the lower extremity or the presence of blood clots. Sound waves are used in Doppler ultrasound to create realistic pictures of the vessel wall circulatory process in extremity.
Duplex ultrasound visualization is very helpful to evaluate varicose veins. It can help to identify any defective presence in veins & pinpoint that requires intervention.
- If the scan is not clear, an X-ray of the vein may be required which called a venogram. It’s a very rare procedure that recommends getting a more detailed picture of the blood flow through blood vessels. The dye is injected into a vein in the foot in this procedure. The contrast can be seen outlining the veins in the calf & thigh.
Treatments For Varicose Veins:
There are different approaches available for varicose veins. These approaches based upon the size & location of the varicose vein, presence of symptoms & in cases of accompanying skin change.
- Lifestyle change
- Compressions therapy
- Ligation & stripping
- Radiofrequency ablation
- Endovenous laser treatment
- Transilluminated powered phlebectomy
Lifestyle modification can reduce the prevalence of varicose veins. It is one of the first treatment choices for varicose veins.
- Avoid prolonged standing or sitting with legs crossed or bent without taking rest.
- Try to raise legs above the heart level, 30 minutes at least 4 times a day.
- Regularly doing physical activity such as walking and foot flexion exercises in order to encourage blood circulation of legs & improve muscle tone.
- Weight reduces to take unneeded pressure off the veins if you are overweight.
- Avoid wearing clothes that are tight around the waist, groin & legs. Tight clothing can influence varicose veins worse.
- Avoid wearing high heels for a long period to improve the tone of the calf muscle.
- Taking a low sodium diet to prevent swelling.
- Wear compression stockings.
- Smoking cessation should be emphasized in patients with varicose veins.
It is frequently prescribed as the first step in varicose vein treatment. Compression therapy is effective for the treatment of discomfort & oedema. It works simply by gently squeezing the legs, to move blood up toward the heart. Compression therapy improves venous hemodynamics. It also reduces the amount of blood & venous pressure. Usually, doctor may first recommend up to 6 months of using compression stocking. There are various colors, brands & styles of stockings are available. When the leg is not swollen, ideally it has well fitted. It’s maybe difficult to put on stockings for obese & older patients.
If the varicose veins are larger, longer or wider spread on the legs doctor will suggest one of the following methods
In the case of varicose veins, the damaged valve can’t be cured. So surgery is the best method to cure the problems is to remove the affected veins. The aim of surgery is to cut down to normal the pressure in the skin vein. It should help prevent the symptoms & complications that varicose veins cause. It will likewise prevent the existing varicose veins from developing further & will inhibit new varicose vein forming. The surgery is particularly suitable for people with –
- If the veins have caused bleeding through the skin
Surgery for varicose veins usually performed under general anesthesia. It usually takes 20 minutes to 3 hours.
Ligation & stripping:
It is one of the older surgical methods for the treatment of varicose veins. In this procedure, doctor makes an incision in the groin & identifying the varicose vein before tying it off & stripping it away. It can be performed under local anesthesia. In that case, the surgeon must be aware of the surrounding arterial & nervous system.
It is a very effective technique of treating most of the varicose veins. In this procedure, a chemical is injected into a varicose vein that in turn scars & closes the vein. Sclerotherapy is done under ultrasound guidance to ensure the foam does not enter the deep venous system. It usually works best for small veins. In this procedure, do not require anesthesia or a hospital stay. It is a well-accepted method of treating varicose veins for over 50 years.
In this procedure, radiofrequency energy is used inside a vein causing irreversible damage to the vein which close it off. It is performed under ultrasound guidance. It also may be performed under local anesthesia. This procedure can be used to close off a large vein.
Endovenous Laser Treatment:
In this procedure, laser energy is used to destroy the faulty vein from inside the leg without a large incision. It is done under ultrasound guidance. The advantages of EVLT are –
- The patient has fewer cuts in the body
- Less bruising
- Faster recovery
- Lower risk of complications with a better result from surgery
- No cut in the groin
- Less recurrence of varicose veins
- No need to stay at the hospital
Transilluminated Powered Phlebectomy (TIPP) :
It is a minimally invasive method for varicose veins treatment. A device is passed through a tiny incision & removes the vein with suctions. This procedure incorporates three technologies –
- Tumescent anesthesia
- A powered endoscopic tissue dissector
It is one of several treatments that are worth considering for varicose veins. It is considered to be quicker & more effective & with no need for general anesthesia.
Outlook For People With Varicose Vein :
Usually, varicose veins are often tending to be considered ugly but rarely form extreme problems. They tend to get worse with age. Once developed, however even if precautions are maintained.
There are many methods to keep varicose veins from recurring incidents—self-caretaking steps to keep varicose veins from getting worse & prevent more serious problems. Regular exercise, standing only when necessary, elevation lower legs during sitting & sleeping, wearing special compression stockings during daily activities may keep varicose veins from worsening & relieve aching sore legs. If complicated complications do not develop, varicose veins do not cause any medical problems.
If contributing factors of varicose veins are not treated, it may progress in severity & extent. Varicose veins may thromboses or rupture & bleed especially when large, traumatized or located over a bony prominence.
Prevention of Varicose Veins:
We can’t completely prevent varicose veins from forming. But, we can take steps to delay other varicose veins from forming. We can improve blood circulation & muscle tone which can reduce the risk of developing varicose veins. The following measures we can take to treat the discomfort from varicose veins at home can help prevent varicose veins, including:
- Sleep on the left side- it may take the pressure of large the veins & reduce the risk of varicose veins
- Avoid prolonged standing & sitting without taking a break
- Avoid crossed legs during sitting
- Raised legs above the heart level during resting or sleeping
- Regularly done physical activities. It helps blood move through veins
- Try to weight reduction if you are overweight or obese. It eases the pressure on veins
- Use lower-heeled shoes which can help to maintain calf muscle tone
- Use compression stockings
- Foot exercise – gently bend & stretch exercise of foot minimum 30 minutes per day.
- Avoid wearing girdles, control-top pantyhose, garters, and any other tight-fitting clothing around the waist, groin & legs
- Taking high fiber, low salting diet regularly