Health Tips

Noticed bulging “nerves” on your lower limb? They are actually varicose veins. Varicose veins are dilated, elongated and prominent veins, usually at lower limbs. It is a common condition, affecting 3 in 10 adults in Western population. Many patients lack the knowledge, and seek medical attention only when complications occur. The veins mainly cause cosmetic concern for the patients.

This article will explain the causes and risk factors of varicose veins, symptoms, diagnosis of varicose veins, and how to prevent or treat the condition.

What causes them?

Varicose veins happen when the valves in the vein fail to work properly, causing ineffective blood circulation and accumulation of blood in the lower limb. Valves open as the blood flows toward the heart, and close to prevent blood from flowing backward. If these valves are weak or damaged, blood can backflow and pool in the vein, causing the veins to stretch or twist.

Who is at risk?

1. Old age: The risk of varicose veins increases with age. Aging causes wear and tear on the valves. Eventually, this causes some blood to flow back into the veins, causing varicosities.

2. Female: Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation or menopause may be a factor, due to the effect of female hormone. Hormone treatments, such as birth control pills, may also increase the risk of varicose veins.

3. Pregnancy: During pregnancy, the volume of blood in the body increases. This is necessary for the growth of the fetus, but can also cause enlarged veins in legs. Hormonal changes during pregnancy may also play a role.

4. Family history: There is a greater risk of developing varicose veins if it is present in other family members.

5. Obesity: As a result of being overweight, extra pressure is put on the veins.

6. Manual workers, labourers that stand for long hours: Long hours of standing and sitting causing inadequate flow of blood. When we remain in that position for long hours, our calf muscles are not pumping well, as a result pooling of blood occurs.

Symptoms and complications of varicose veins

Varicose veins may not cause any pain. Signs you may have varicose veins include:

• Colour change- Dark blue or purple colour seen over the veins

• Appearance of spider veins. They are smaller and found closer to the skin surface, often in red or blue. They can be precursor to varicose veins

• Veins that appear twisted and bulging; they are often like cords on your legs

• Veins are most prominent at the end of the day, after a long day of work

When painful signs and symptoms occur, they may include:

• An arching, muscle cramping like pain in the leg, often relieved by elevation

• Worsened pain after sitting or standing for a long time

• Itching around one or more of your veins (Eczema)

• Skin discoloration around a varicose vein, turning bluish

Complications of varicose veins occur in up to 7% of all cases. These include bleeding, ulceration, eczema and inflammation, requiring immediate medical attention.

Diagnosis of varicose veins

Your doctor will examine your legs and visible veins while you’re sitting or standing. They may ask you about any pain or symptoms you’re having. Some physical tests may be performed, such as lifting your leg, tying a tourniquet, to check the location of the problem.

In some situation, imaging studies might be involved to diagnose the condition:

• Ultrasound, to allow visualisation of blood flow in veins

• Venogram, where special dye is injected and X-rays are taken, to check blood flow

Imaging studies such as ultrasounds or venograms help ensure that another disorder like a blood clot or a blockage isn’t causing the pain and swelling in your legs.

Prevention and treatment of varicose veins

Unfortunately, we can’t prevent varicose veins from developing especially in high risk individuals, such as pregnant women, manual labourers. However, there are a few measures we can take to prevent it from worsening. 

1. Don’t sit/ stand for too long. Contraction of calf muscle pumps venous blood from leg to the heart. Long periods of inactivity causes blood to be stagnant and accumulates in the vein. Move away from your working desk once in a while.
2. Wear compression stockings. Compression stockings can help to keep vein valves in the right position. This makes it easier for the veins to function properly and reduces blood pooling, swelling, and pain. They can be worn by pregnant women as well.                                                                                                                                                  
3. Lifestyle modification. Obesity is a risk for developing varicose veins, other than the known link with cardiovascular diseases. Active weight control plan has to be done for obese individuals. Exercise, at least 5 times in a week, for 30 minutes each session. Even going for a walk helps!
4. Daily examination of the condition. Have a daily skin care routine- use of a mild soap and lukewarm water followed by the application of a petrolatum based moisturizer on the overlying skin. If complications like bleeding, ulceration, inflammation develop, seek medical opinion immediately.
5. Suitable clothing. Avoid wearing constrictive clothing, such as knee-high or panty hose stockings. These can restrict the flow of blood in the lower extremities.

Treatment

For varicose veins without symptoms, first line treatment is lifestyle modification and application of compression stocking, as described.

If the condition has not improved, or the varicose veins are causing significant pain or affecting your well-being, interventional treatment may be required. Common treatment modalities include endothermal ablation, endovenous laser treatment, sclerotherapy and surgery. Consult your doctor if this condition is troubling you.

Cover image credit: https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-spider-varicose-veins

Image credit:

1. https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-spider-varicose-veins

2. National Heart Lung and Blood Institute

3. https://www.freepik.com/premium-photo/doctor-white-uniform-with-diagnostic-equipment-performs-ultrasound-using-device-legs-female-patient-surgeon-man-phlebologist-working-moder-clinic-medical-tools-hospital_7418339.htm#page=1&query=varicose%20vein&position=45

4. https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-spider-varicose-veins

Source:

1. Healthline. Outlook of varicose veins. https://www.healthline.com/health/varicose-veins#outlook

2. Healthline. How to prevent varicose veins. https://www.healthline.com/health/how-to-prevent-varicose-veins

3. MyHealth KKM. Varicose veins. http://www.myhealth.gov.my/en/varicose-veins/

4. Medical news today. What can I do about varicose veins. https://www.medicalnewstoday.com/articles/240129#causes

5. Mayoclinic. Varicose veins-Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/varicose-veins/symptoms-causes/syc-20350643

6. TheStar. Vein trouble! Article published on 2nd December 2007. https://www.thestar.com.my/lifestyle/health/fitness/2007/12/02/vein-trouble

Written by

Mr Chen Wen Hao