What Are Varicose Veins?

A Very Common Cosmetic Problem

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Varicose veins are fairly common and affect between 30 and 50 percent of adults. They are veins that typically look bluish underneath the skin, and may bulge out a bit. While varicose veins can produce an unwanted cosmetic appearance, they rarely cause health issues.

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Things You Might Not Know About Varicose Veins

Typically developing on the lower legs, varicose veins form when the valves inside the veins weaken, a process that often occurs with normal aging. Sometimes, complications like infection can develop. If this happens, you may need to have diagnostic tests or have your varicose veins treated.

There are a number of treatments used to treat varicose veins—for cosmetic and therapeutic purposes—with 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 have complications.

elderly woman shows varicose
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Varicose Veins Symptoms

Generally, varicose veins appear on the lower legs below the knee. They can also develop on the thighs or arms, but this is less common. Varicose veins often remain stable, but they can enlarge, or you could develop more of them over time. If you've been sitting or standing for long periods of time, you may notice that your varicose veins seem larger or look more obvious.

Varicose 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.

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

You can have one or several varicose veins and they might not all be the same exact size or appearance. 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.

Pain is not necessarily correlated with the size of a varicose vein.

Varicose Veins vs. Spider Veins

Spider veins are a cluster of tiny veins appearing directly below the skin’s surface. They are generally smaller than varicose veins and look like a web of tiny red or purplish vessels.

They are similar to varicose veins in that they are visible, but they usually don’t bulge out. Like varicose veins, spider veins are not dangerous.

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. Medical 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 

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. 

Symptoms of some other conditions, like deep vein thrombosis (DVT, a blood clot in a deep vein) or peripheral neuropathy (nerve disease), can mimic the signs of varicose veins.

Causes

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, but veins have valves that help move the blood back to the heart. When these valves are not functioning well, blood can move slowly, or even pool down in the veins due to gravity.

One of the reasons that varicose veins develop is due to the weakening of the valves inside veins. 

Varicose veins occur more frequently in women. Other risk factors include:

  • Older age 
  • Pregnancy 
  • Obesity 
  • Family history of varicose veins 
  • Chronically standing for hours at a time 
  • Chronic constipation 
  • A history of a DVT

Many of these common risk factors can be managed by making lifestyle changes and can help you prevent varicose veins from developing.

Risk of Complications

If you have varicose veins, you may have a higher risk of complications if you have 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. If you have symptoms, such as pain or discomfort, your doctor will evaluate you to determine whether your varicose veins are the cause of your symptoms.

Since varicose veins don’t usually cause symptoms by themselves, your doctor might also examine you to rule out other medical issues that could be causing concerns. 

Physical Examination

Your diagnosis will include a physical examination. Your doctor will inspect your visible or enlarged veins and the area around them for evidence of swelling, warmth, or redness—which can all occur with an infection or a blood clot.

Your doctor 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.

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.

Diagnostic Tests

Sometimes, tests can also be helpful when your doctor is diagnosing your varicose veins. An ultrasound can be used to evaluate blood flow, and it can 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 doctors examine the area of concern. 

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

Differential Diagnosis

Several medical problems can mimic symptomatic 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. Common conditions that can mimic varicose veins include:

Deep Vein Thrombosis (DVT)

A blood clot in a vein can form in the same areas of the body where 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 peripheral nerves in the toes, legs, or fingers. This may cause pain or burning sensations or a loss of sensation in the affected areas.

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 your symptoms.

Peripheral neuropathy and painful varicose veins can be distinguished from each other based on a physical exam. Peripheral neuropathy manifests with diminished sensation and varicose veins don't cause a change in sensation.

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 (extremities).

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 these conditions from varicose veins.

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.

If you already have varicose veins, they can become more noticeable and uncomfortable if you develop other health problems that cause swelling of the extremities or that affect your veins.

Treatment

If you have been diagnosed with varicose veins, there is a big chance that you won’t need any treatment. Since varicose veins aren't harmful for your health unless you develop complications, there is rarely any health benefit of treatment. 

Most of the time, 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 doctor 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 approaches can help make varicose veins less prominent. These approaches are more likely to be successful for prevention than for treatment. Lifestyle strategies may help make very large varicose veins appear smaller.

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

Compression Stockings: Sometimes doctors recommend compression stockings, especially if prolonged standing is causing lower leg swelling and/or pain. Compression socks fit snugly and squeeze the leg. This helps move blood up through the veins toward the heart, and prevents pooling. They are also recommended for patients with other conditions, such as DVT.

Medical and Surgical Treatment

There are several different treatment approaches that your doctor will discuss with you if you are interested in having treatment to reduce the visibility of your varicose veins. The right approach for you depends on where your varicose veins are located and how big they are.

All of the interventional procedures below can leave a surgical scar on the skin, and the success rate can vary. They involve removing the veins, or causing scar tissue to form, which blocks the vein and causes it to fade. After each of these procedures, blood flow to the heart from the limb where the procedure was performed continues through other veins.

Ligation and Vein Stripping: These surgical treatments are operations in which your doctor 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.

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

Radiotherapy: For this procedure, your doctor will use ultrasound to guide a catheter into the vein, and then apply heat to damage the vein, leading to scar tissue.

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

Medication: Vasculera (diosmiplex) is a prescription medication 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.

Treatment for Complications of Varicose Veins 

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, enlarged veins can be bothersome for cosmetic reasons, and sometimes even cause complications. Fortunately, there are simple lifestyle changes—like exercise, losing weight, and wearing compression stockings— that can help make your varicose veins appear smaller. Your doctor can also help you identify procedures that can make them go away.

A Word From Verywell

Varicose veins are common, especially with advancing age. They can become noticeable after age 40, and they can progress over time, becoming larger and increasing in quantity.

If you have varicose veins, you shouldn’t worry about a risk to your health, even if they are becoming more visibly noticeable. However, if the appearance is bothering you, there are many options you can consider for cosmetic treatment of your varicose veins.

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