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Varicose Veins


Varicose veins are enlarged, swollen veins that appear on the superficial surface of the skin. They are also known as varicoses or varicosities. They occur most commonly in the lower legs because activities like standing and walking exert pressure on them. These veins appear bluish, purplish, or reddish in color. Varicose veins do not cause pain in certain cases, but they are a cosmetic concern. In some other cases, they can cause pain and disrupt your regular activities. Varicose veins can be treated by conservative and surgical methods. 


In a normal functioning human body, veins are responsible for returning blood from the rest of the body to the heart. These veins have valves that prevent the backflow of blood. The veins in your legs have to function extra hard as they have to work against gravity to return blood. If the valves in these veins get affected due to some underlying reason, blood starts pooling and stretches the veins. This results in an enlarged, swollen appearance of veins on the skin surface. In some cases, it is difficult to identify the exact cause of varicose veins. The possible causes may include pregnancy, menopause, old age, obesity, and standing for long hours. 

Risk Factors And Epidemiology

Varicose veins usually affect people over the age of 40. Women are more commonly affected by this condition than men. Pregnancy and menopause may play a role in this case. People with occupations that require them to stand for a long period of time are particularly at risk. Positive family history of this condition also increases its risk. Diabetes and obesity can also contribute to the development of varicose veins along with other factors.

About 25% to 30% of all adults worldwide suffer from this issue. Majority of them are women. In the United States, around 4500 out of 100,000 people have varicose veins. 

Signs And Symptoms

The primary sign of varicose veins is the appearance of bluish-purple veins on the surface of the lower legs. These veins bulge through the skin surface and appear as twisted cords on the legs. They may not cause any pain during the initial stages but are a cosmetic concern. If the pain does occur, it can be felt as a throbbing sensation in the lower legs. Your legs feel heavy, and you may experience muscle cramps, especially after sitting or standing for a long duration of time. Itching is also present in some cases. You may notice that the color of veins and the skin around them may change over time. In severe cases, the veins may bleed, and ulceration can occur. 


Diagnosis of varicose veins begins with taking brief history followed by a physical examination. Your doctor will ask questions about your family history, occupation, and other factors. Physical examination involves inspecting the veins while you are in a sitting or standing position. In many cases, the clinical presentation alone is sufficient for diagnosis. Doppler ultrasound can be done to check the blood flow in the veins. A venogram and leg ultrasound can also be done to visualize the passage of blood and the presence of any blood clot. 

Differential Diagnosis

Although varicose veins have a distinguished presentation, they still can be confused with some other diseases in some cases. These diseases include femoral hernia, inguinal hernia, lipoma, femoral artery aneurysm, and lymphadenopathy in the legs. Differentiation can be done based on history, physical examination, and diagnostic tests. 


Most doctors prefer conservative treatment options for the treatment of varicose veins. This includes some lifestyle changes and a few other techniques to relieve your symptoms. It is recommended to avoid long periods of standing, elevate your legs while sleeping, maintain a healthy weight, and exercise well to improve circulation. Compression stockings are also recommended as they put pressure on your legs to prevent the blood from pooling in veins.

If conservative techniques do not work, advanced methods have been introduced to treat varicose veins. Non-surgical treatment options include sclerotherapy, micro sclerotherapy, endovenous ablation therapy, laser surgery, and endoscopic vein surgery. Majority of the cases are treated by non-invasive methods. In severe cases where every other technique has failed, a surgery called vein stripping is done. In this situation, the varicose veins are stripped and removed through incisions. It is less frequently used these days compared to other techniques.

Medications are not required to treat varicose veins. Only medicines that may be prescribed include analgesics such as aspirin or ibuprofen. Long-term use of these medications should be avoided because they can cause gastric ulcers and intestinal bleeding. 


Varicose veins may remain benign in some patients or worsen over time in other cases. It is a chronic condition that cannot be reversed. Conservative techniques and other treatment options can help relieve symptoms and reduce the risk of future complications. Immediate medical attention is required if you develop bleeding, an ulcer, or a clot in your varicose veins. 


Conservative methods used to treat varicose veins can also be used to avoid them. If your work involves sitting or standing for a long time, take little breaks to relax and stretch your legs. Maintain a healthy weight and eat a balanced diet. Exercise regularly as it improves your blood circulation and muscle activity. If you have any secondary condition such as diabetes or hypertension, try to manage it well by following guidelines as advised by your doctor. Avoid wearing high heels for long hours. 


Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 03, 2023.




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