When Should You Worry About Varicose Veins?

What Are Varicose Veins?

Varicose veins are veins that have become enlarged, swollen, and visible under the skin, often appearing as dark blue or purple lines that may bulge or twist. They usually occur in the legs, where the blood flow has to work against gravity to return to the heart. This constant pressure makes the veins in the legs particularly vulnerable to becoming varicose.

Varicose veins may not always be painful. Some people experience cosmetic concerns, while others may feel heaviness, aching, or swelling in their legs. In more severe cases, these veins can lead to complications like skin changes, ulcers, or chronic discomfort.

Around 20% of adults will develop varicose veins, which are more common in women and often affect older people, though younger individuals can also experience them, as per IQWiG publication.

The main reason varicose veins develop is due to weakened valves in the veins. Normally, these valves help blood flow upward toward the heart. However, when they don’t function properly, blood can pool in the veins, causing them to swell and become twisted. Several factors contribute to the development of varicose veins, including:

• Aging: As we grow older, veins lose elasticity, making it harder for them to function effectively.
• Pregnancy: The increased blood volume and hormone changes during pregnancy put extra pressure on the veins.
• Obesity: Carrying extra weight adds more strain on the veins in the legs.
• Prolonged standing or sitting: Jobs that require long periods of standing or sitting can worsen blood circulation.
• Genetics: A family history of varicose veins increases the likelihood of developing them.

When to Worry About Varicose Veins

While varicose veins are often harmless, there are certain signs and symptoms that suggest they may require medical attention. Recognizing these signs may help to prevent complications in the future. They are:

When Varicose Veins Cause Pain or Discomfort

If you feel persistent pain, heaviness, or aching in your legs—especially after standing for long periods—it could be a sign that your varicose veins are causing more than just a cosmetic issue. This discomfort might indicate that blood isn’t circulating properly, and seeing a doctor could help prevent further problems.

Swelling in the Legs or Ankles

Unexplained swelling in the lower legs or ankles is a red flag. When varicose veins cause fluid to pool, it can lead to swelling, which might worsen over time. If this swelling doesn’t go away or gets worse, it’s important to consult a healthcare provider, as this may indicate circulation problems.

Skin Changes Around the Veins

Changes in the skin, such as darkening, thickening, or itching around the area of varicose veins, can be a sign that the veins are affecting the surrounding tissue. This can lead to skin damage over time, so it’s crucial to monitor any changes and get medical advice if you notice these symptoms.

Bleeding from Varicose Veins

Varicose veins that are close to the surface of the skin can sometimes rupture with even minor bumps or injuries. If you experience frequent bleeding from varicose veins, it's time to see a specialist, as this could signal that the condition is becoming more serious.

Development of Ulcers or Open Wounds

In some cases, varicose veins can lead to the development of skin ulcers or open wounds, particularly near the ankles. This indicates a more advanced condition known as chronic venous insufficiency, where blood flow is severely restricted. Ulcers are painful and difficult to heal, requiring immediate treatment to prevent infection or further complications.

What Happens If Varicose Veins Are Left Untreated?

Although rare, complications of varicose veins may result if the condition is not treated. These might involve one's overall health in the legs and, when needed, must be medically treated. 

According to the Mayo Clinic, the complications include:

• Ulcers: Painful ulcers can develop on the skin near varicose veins, particularly around the ankles. These ulcers are often preceded by a discolored spot on the skin. If you notice this, it's important to see a healthcare professional right away, as ulcers can be difficult to heal and may worsen over time.
• Blood Clots: In some cases, varicose veins can lead to the enlargement of deeper veins, which can cause leg pain and swelling. This may indicate the presence of a blood clot (deep vein thrombosis). If you experience persistent leg pain or swelling, it’s crucial to seek medical help, as blood clots can lead to serious health risks.
• Bleeding: On rare occasions, varicose veins located near the skin's surface can burst, resulting in minor bleeding. While this type of bleeding usually isn’t severe, it still requires medical attention to prevent further complications.
• Leg Swelling: Long-term varicose veins can cause the legs to swell, especially after extended periods of standing or sitting. This swelling can lead to discomfort and may worsen if the condition is not addressed.

If you have varicose veins, early treatment is often advised to help prevent these complications from developing, or worsening if they already exist.

What Are the Treatment Options for Varicose Veins?

Several treatment options are available for varicose veins, depending on the severity of the condition. It’s important to discuss options with a healthcare professional.

Compression Stockings

One of the simplest and most common treatments for varicose veins is wearing compression stockings. These stockings apply gentle pressure to the legs, helping to improve blood flow and reduce swelling and discomfort. Compression stockings are often recommended for mild cases and can be used alongside other treatments to manage symptoms.

Lifestyle Changes

In addition to wearing compression stockings, the NHS suggests making certain lifestyle changes to help prevent varicose veins from worsening:

• Maintain a healthy weight to reduce pressure on your veins.
• Exercise regularly (e.g., walking or running) to improve circulation and strengthen the muscles that support your veins.
• Elevate your legs when possible, such as by lying down with your legs propped up on cushions, to improve blood flow.
• Avoid long periods of standing or sitting, as this can worsen symptoms.
• Use a moisturizing cream or lotion if your skin is dry, flaky, or itchy, to maintain healthy skin.
• Try not to injure your legs, as this can help prevent bleeding and other complications.

Minimally Invasive Procedures

For more severe or persistent varicose veins, minimally invasive procedures are often recommended:

• Radiofrequency or Laser Ablation: This procedure involves inserting a catheter into the vein and using heat to collapse and seal the affected vein. The blood is then rerouted to healthier veins. It’s a quick and effective treatment with minimal recovery time.
• Sclerotherapy: In this procedure, a chemical solution is injected into smaller varicose veins or spider veins, causing them to scar and close. This treatment is ideal for superficial veins and requires little downtime.
• Vein Glue: Another option is the use of a special adhesive to seal off the affected veins. This less invasive alternative to surgery helps close the problematic veins and redirect blood flow.

Surgical Options

In more severe cases, or when other treatments are ineffective, surgical options such as vein stripping may be necessary. This procedure involves removing the problematic veins entirely. It is typically reserved for advanced cases and is considered more invasive, but it can provide long-term relief for those with significant varicose vein issues.