What Are Varicose Veins?

Varicose veins are enlarged, dark-colored veins that have a twisting, cord-like appearance. They form when the valves inside the affected veins weaken, a process that often occurs with normal aging. Between 30% and 50% of adults develop varicose veins, typically in the lower legs.

While they can produce an unwanted appearance, they rarely cause health issues. There are a number of options for treating varicose veins for cosmetic and therapeutic purposes, and they have a range of success levels. 

This article outlines how to recognize varicose veins, how they are diagnosed and treated, and what to do if you experience complications, such as infection.

Varicose Veins Symptoms

You can have one or several varicose veins. They might not all be the same exact size or have the same appearance. They may remain stable or become larger and/or increase in number with time.

Common symptoms of varicose veins include:

• Bluish, purplish, or pinkish appearance of one or more veins 
• A twisted or bulging vein (or veins) beneath the skin
• Itching or a rash near the affected vein
• Aching legs
• Small areas of superficial bruising near the veins (these should heal within a few days)
• Tenderness or discomfort near the veins

Generally, varicose veins appear in the legs. They can also develop on other parts of the body, but this is less common.

The veins should feel soft if you press on them, and they normally don’t hurt or change in size or appearance when you press on them. Touching them is not dangerous or harmful.

Pain is not necessarily correlated with the size of a varicose vein. If you have any pain associated with your varicose veins, it’s likely that you would only experience pain in one of them rather than all of them.

Varicose veins are similar to spider veins in that they are visible, but there are notable differences in appearance.

Complications

It is uncommon for varicose veins to cause other health issues. However, when complications develop, they require medical or surgical intervention. If left untreated, they can lead to serious issues.

It is important to get medical attention if you develop signs of medical issues associated with your varicose veins.

Complications you should look out for include:

• Hematoma: A large area of bruising or bleeding underneath the skin 
• Ulceration: A open wound that won't heal
• Phlebitis: Infection of the vein 
• Thrombophlebitis: Infection and blood clots in the vein, either superficial thrombophlebitis or in a deeper vein

Symptoms of these complications can include fever, redness, swelling, pain, severe tenderness, or warmth near a varicose vein. Because varicose veins can impact your circulation, you could also develop numbness, tingling, or burning sensations. 

Causes

Varicose veins develop when valves inside veins weaken or damaged.

There are two types of major blood vessels in the body: arteries and veins. Each plays a role in the movement of oxygen and carbon dioxide as part of the respiration process.

Arteries carry oxygen-rich blood from the heart to the rest of the body, while veins carry carbon dioxide-rich blood back to the heart. The pumping action of the heart pushes blood through the arteries; valves in veins are what help move blood along.

When these valves are not functioning well, blood can move slowly or even pool down in the veins due to gravity. This is what causes the bulging appearance of varicose veins.

Varicose veins are more common in women than men. Other risk factors for varicose vein formation and/or worsening include:

• Older age
• Pregnancy 
• Obesity 
• Family history of varicose veins 
• Regularly standing for hours at a time 
• Chronic constipation 
• A history of a deep vein thrombosis (DVT)

Many of these common risk factors can be managed with lifestyle changes.

Contrary to what you may have heard, crossing your legs does not cause varicose veins.

Risk Factors for Complications

If you have varicose veins, you may have a higher risk of complications if you have a chronic illnesses like diabetes, a blood clotting disorder, peripheral vascular disease, immune deficiency, or an inflammatory condition.

These issues can raise the risk of infection, bleeding, or blood clots in your varicose veins.

Diagnosis

Generally, varicose veins are diagnosed based on their appearance.

Varicose veins usually don't cause symptoms by themselves. If you have pain or other symptoms, your healthcare provider might also examine you to rule out other medical issues.

Physical Examination

The diagnosis process will include a physical examination. Your healthcare provider will inspect your veins and the area around them to confirm that they are varicose veins and look for signs of complications (e.g., swelling, warmth, or redness).

If you have a skin wound, it could be an ulceration related to your varicose vein or another health issue. A large area of swelling, or a blue or red patch under the skin, can be a sign of a hematoma.

Your healthcare provider will also check your pulse near the varicose veins to identify whether you have a blood flow problem. They may press on your varicose veins to identify any irregularities, and will ask you if that physical pressure is causing pain or discomfort.

Diagnostic Tests

A healthcare provider may order tests to help with the diagnosis.

A duplex ultrasound may be ordered. This actually involves the use of two types of ultrasounds: one to evaluate blood flow and one to identify areas of blockage or severely altered blood flow.

If there is a concern that you could have a fracture or another injury, you might need an X-ray or a computerized tomography (CT) scan to help your healthcare providers examine the area of concern. 

You might also have a complete blood count (CBC), which is test done on a sample of blood taken from a vein (but not from a varicose vein itself). This may show elevated white blood cells, which is a sign of an infection.

Differential Diagnosis

The following medical problems can mimic varicose veins. Depending on your risk factors and medical history, you might need an evaluation to determine whether you could have any of these conditions.

Deep Vein Thrombosis (DVT)

A blood clot in a vein can form in the same places varicose veins tend to develop—the lower leg, upper leg, or arm. A DVT may cause painless swelling, but it can be a health danger because the blood clot can travel to the lungs, causing a life-threatening pulmonary embolism (PE).

A DVT can be diagnosed with vascular ultrasound. They usually require treatment, often with blood thinners.

Peripheral Neuropathy

Nerve damage can affect the nerves in the toes, legs, or fingers (i.e., peripheral nerves). This may cause pain, a burning sensation, or a loss of sensation in the affected areas.

Peripheral neuropathy and painful varicose veins can be distinguished based on a physical exam. Varicose veins don't cause the change in sensation that peripheral neuropathy does.

Peripheral neuropathy may also result in infections and wounds that don’t heal. These issues can be initially confused with an infected or painful varicose vein. If you have both conditions, it may be difficult to determine which of them is causing these symptoms.

If needed, tests like a vascular ultrasound or diagnostic nerve examinations like electromyography (EMG) or nerve conduction studies can identify the severity of each condition.

Vascular Insufficiency

Over time, the muscles in your veins can weaken, resulting in slow and diminished blood return to the heart. This is not usually a dangerous condition, but it can cause swelling of the arms and legs. Varicose veins are a symptom of vascular insufficiency.

Vascular insufficiency may seem similar to varicose veins, but there are subtle differences:

• Typically, only a few veins are varicose, while vascular insufficiency usually involves all or most of the veins in your legs.
• Vascular insufficiency does not cause veins to be prominent (visible) like varicose veins.

A physical examination and a vascular ultrasound of the affected area may distinguish the two conditions.

Congestive Heart Failure

Congestive heart failure (CHF) often results in leg or arm swelling that improves with elevation of the extremity. Your veins may become prominent, and the swelling can be confused with swelling of varicose veins.

However, CHF can also cause fatigue and shortness of breath, which are not characteristic of varicose veins.

Heart tests, like an electrocardiogram (EKG) or echocardiogram, can identify heart failure.

Treatment

If you have been diagnosed with varicose veins, there is a good chance that you won’t need any treatment unless you develop complications.

In many cases, varicose veins are treated for cosmetic reasons or if complications develop. If you are unhappy with how your veins look, you can talk with your healthcare provider about different treatments and assess your likelihood of satisfaction after treatment. 

If you don’t like the appearance of your varicose veins but don’t want to have medical or surgical treatment, you can consider lifestyle approaches or strategies for covering them up, like wearing opaque stockings or applying makeup to make them less noticeable. 

Lifestyle Approaches 

Sometimes lifestyle strategies can help make varicose veins appear smaller and less prominent. However, they are more likely to be successful for prevention than treatment.

Exercise: Strengthening the muscles surrounding the varicose veins naturally helps squeeze the veins to push blood back toward the heart. If you are overweight, losing weight can help prevent excess physical pressure from weakening the valves in your veins.

Compression stockings: Sometimes healthcare providers recommend compression socks or stockings, especially if prolonged standing is causing lower leg swelling and/or pain. Compression stockings fit snugly and squeeze the leg. This helps move blood up through the veins toward the heart, preventing pooling.

Medical and Surgical Treatment

There are several different treatment approaches for reducing the visibility of your varicose veins, should you desire that. The right approach for you depends on where your varicose veins are located and how big they are.

Medication is one option. Vasculera (diosmiplex) is a prescription drug used for the treatment of chronic venous insufficiency, varicose veins, and spider veins. It works by altering metabolic pathways in the body to reduce inflammation that may contribute to the formation of these vein changes.

All of the interventional procedures below involve removing the veins or causing scar tissue to form, which blocks the vein and causes it to fade. Afterward, blood flow to the heart from the limb where the procedure was performed continues through other veins. Success rates vary.

Sclerotherapy: This approach uses an injected foam solution to seal off the varicose vein.

Radiotherapy: For this procedure, your healthcare provider will use ultrasound to guide a catheter into the vein. Heat will then be applied to damage the vein, leading to scar tissue.

Laser therapy: This approach uses a small incision and a catheter (thin tube) with ultrasound guidance to direct light energy to the varicose vein. The light shrinks the enlarged vein and causes scar tissue to form.

Ligation and vein stripping: Your healthcare provider will surgically tie off (ligate) the varicose vein. Larger veins may also be stripped (removed through an incision). Depending on how accessible your varicose veins are, these operations could be performed as open procedures or as minimally invasive (endoscopic) ones.

Phlebectomy (microphlebectomy, stab avulsion): Small cuts are made in the skin in order to remove affected veins. This is usually done along with another procedure, if done at all.

Treatment of Complications

Aching pain associated with varicose veins may improve with over-the-counter or prescription pain medicines. 

If you develop serious complications like infections or clots, you will need urgent evaluation and treatment. An infection may need to be treated with antibiotic medication and/or surgery. Blood clots may be treated with blood thinner medication and/or surgery.

Summary

Nearly half of all adults experience varicose veins. Though normally harmless, these enlarged veins can be bothersome for cosmetic reasons and sometimes even cause complications, such as infection. Seek medical attention if you experience burning, or throbbing near a varicose vein, or if your legs feel achy or heavy even after elevating them.

Simple lifestyle changes—like exercise, losing weight, and wearing compression stockings—can help make your varicose veins appear smaller.

Your healthcare provider can also help you identify procedures that can make them go away or minimize their appearance.