Varicose veins
How do normal veins work?
What are varicose veins?
What symptoms do varicose veins cause?
What causes varicose veins?
What can I do to stop the veins getting worse?
Can my veins be treated on the NHS?
Investigating your veins
How do normal veins work?
Veins normally carry blood back from the peripheries towards the heart. In the legs the blood has to be carried upwards against gravity. The muscles in your legs squeeze the blood back up the veins every time they contract. One way valves in the veins then prevent the blood falling back downwards when the muscles relax. In this way the muscles act like your heart pushing the blood through your veins.
What are varicose veins?
Varicose veins occur when the one way valves in the veins stop working properly. The veins become enlarged, weakened and dilated.
The veins have permanently lost their ability to carry blood from the legs back up to the heart against the force of gravity. As the blood falls back down the leg and pools due to gravity, the veins overfill giving them their typical unsightly bulging appearance. There is no way of repairing the one way valves in the veins and without treatment the veins usually continue to get worse as time passes.
Above, the images on the right show the leaking one way valves and blood leaking back down the vein as the muscles relax.
Some patients have very small veins right under the surface of the skin. These veins often group together in clusters and are called “spider veins” or “reticular veins”. These are not true varicose veins. Around a quarter of people with spider or reticular veins do have underlying problems with deeper veins and these should be checked by a specialist before any surface treatments are undertaken. These types of veins rarely cause significant medical problems but can be very unsightly. If you wish to know more about the treatment of spider or reticular veins please click here.
What symptoms do varicose veins cause?
There is a large variation in the problems that varicose veins cause. Some patients with very large unsightly veins get few symptoms and at the other end of the spectrum some small varicose veins cause lots of problems. Quite naturally many people simply don’t like the appearance of their veins and wish to have them treated. For others, varicose veins can cause
- Tired or heavy legs
- Aching or throbbing along the veins is common
- Leg swelling can be caused by varicose veins
- All of these tend to be worse at the end of the day
- Cramps in the legs at night
- Restless leg syndrome
- Brown staining of the skin
- Bleeding
- Blood clots and inflammation in the veins (phlebitis)
- Leg ulcers
Below is an example of the skin changes that occur before an ulcer develops, and the typical position of a small, painful venous ulcer.
Treatment of the diseased veins will usually eliminate these symptoms. If left untreated, varicose veins worsen over time. The damage they do to the skin and underlying tissues is often permanent and early treatment should prevent this deterioration. If you have been unlucky enough to develop a painful ulcer on your legs because of your veins, treatment of your veins can halve the risk of it coming back in the future.
Varicose veins are a very common affliction. At some point in their lives around 1 in 4 people suffer with varicose veins.
The genes you inherit from your parents are the number one contributing factor causing varicose veins. A genetic tendency causes veins to weaken and wear out over time. The greater this genetic tendency the sooner it will happen. So regardless of treatment, if you have a strong hereditary predisposition, you will probably form new problems as time goes on.
Not all patients though have affected family members and other contributing factors include age, pregnancy, excess weight, hormone-containing medications, standing for long periods, and traumatic injury to the leg.
In most cases, nothing can be done to prevent veins from wearing out, but if effective treatment is given early in the course of the disease complications like phlebitis, thrombosis and ulcerations can be prevented and symptoms relieved.
What can I do to stop the veins getting worse?
There are a few simple things that you can try to reduce the symptoms caused by your varicose veins but unfortunately none of these will rid you of the veins.
- Raise your feet when possible. This reduces the pressure in the leaking veins and aides the circulation to get the blood back towards your heart.
- If standing or sitting for prolonged periods, try tensing and relaxing your calf muscles to aide your circulation.
- Regular exercise is felt by some to help their symptoms.
- Losing weight can result in improvements in the way your circulation functions.
- Look after your skin. If it becomes dry and itchy try some simple moisturiser. If you notice brown, flaky patches contact your GP as this could be signs that your varicose veins are damaging the skin.
Can my veins be treated on the NHS?
Varicose veins can present in many ways and cause multiple different problems. The severity of your veins will affect your chances of being eligible for treatment under the NHS.
The decision about whether you are eligible for treatment of your varicose veins is not one that is made by your GP or your specialist. The Primary Care Trust (PCT) that employ your GP usually have their own local rules about who is eligible and your GP will be aware of these.
The following points should act as a guide as to whether you may get NHS treatment:
- If you are simply worried about the appearance of your veins then it is very unlikely treatment would be offered.
- Aching or painful varicose veins don’t often qualify unless there are other problems with the veins
- A single episode of thrombophlebitis, inflammation in the vein due to clotting, may not qualify but repeated attacks often do.
- If you have developed brown scaly patches on your lower legs, especially around the ankles and have varicose veins you should think about seeing your GP as you will probably qualify for treatment and may reduce your risk of ulceration in the long term.
- Varicose veins that have bled will be very likely to be offered NHS treatment.
- If you have, or have had, an ulcer on your lower legs and have varicose veins, then you should ask to see a specialist because treatment of your veins is likely to halve the risk of your ulcer coming back in the future. Patients such as this will nearly always be offered some treatment if they are well enough to undergo a procedure to treat their veins.
In the past getting pictures of your veins involved needles and the use of x-rays. Now all of our investigations into your veins are undertaken through an ultrasound scan.
Venous duplex ultrasound is the gold standard for diagnosis of vein disease. Duplex ultrasound imaging provides moving images of the blood vessels within the affected leg. Using the ultrasound, the veins in your legs are evaluated for blockage (clots) and leakage (reverse flow). The size, location and the various branches and connections are "mapped-out." This enables a record to be made showing the precise location of the leaking valves.
The scan is vital in establishing an accurate diagnosis which is the only was to assure the most effective treatment of your varicose veins.
Below is a Duplex scan underway and above the ultrasound pictures showing a leaking valve.
