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Varicose VeinsIntroduction Varicose veins are swollen, irregular shaped veins that often develop in the legs, particularly on the calves. They occur when the vein wall weakens, causing the vein to dilate (widen). If this happens, valves in the veins that prevent blood flowing in the wrong direction (back down your legs) may stop working properly and affect circulation. Varicose veins, in the legs, affect about 30% of adults at some point in their life. They tend to be more common in older women. Varicose veins usually develop gradually, and may run in families. Although varicose veins can appear unsightly, and are sometimes painful, they do not usually cause any serious health problems. There are three types of varicose veins: Trunk varicose veins are near to the surface of the skin, and are thick and knobbly. They are usually visible, are often quite long, and they can be unsightly. Reticular varicose veins are red and are sometimes grouped close together in a network. Telangiectasia varicose veins are also known as thread or spider veins, and are small clusters of blue, or red, veins that sometimes appear on your face or legs. They are harmless, and unlike trunk varicose veins, they do not bulge underneath the surface of the skin. As well as developing in the legs, varicose veins sometimes develop in the internal organs, such as in the lower end of the gullet (oesophageal varices) and in the small veins next to the testicles (varicocele). Haemorrhoids are varicose veins around the anus. Symptoms Varicose veins look swollen and stretched all the time. If you have varicose veins, you may not have any symptoms, other than the fact that you can see them. If you do have symptoms, they will tend to get worse gradually, over several years. Symptoms that are commonly associated with varicose veins include: aching, throbbing or heavy legs which can be made worse by standing for a long time - they are also often worse at night, swollen ankles, permanent brownish-blue shiny skin discolouration around the veins, dark skin (stasis dermatitis) caused by a build-up of waste products in the legs, and in some cases, the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard. Hot weather and standing for long periods of time can make your varicose veins feel uncomfortable, and can also make them look worse. Sometimes, about a third of women with varicose veins experience increased pain and discomfort before their period each month. This is thought to be due to hormonal changes that can affect the elasticity (stretchiness) of the veins. If you have varicose veins, minor injuries to the area may bleed more than normal and take longer to heal. More severe symptoms of varicose veins are usually associated with complications such as infection, ulcers and, in rare cases, a vein may rupture, causing a large amount of bleeding. Causes Some of the veins in your legs contain valves at various points that prevent blood from flowing in the wrong direction. As there is quite a large distance between your legs and your heart, the valves in the veins need to be working properly in order to maintain a strong, upward blood flow. If the blood flow slows down, there will be a poor supply of oxygen to the surrounding tissues. Weakened vein walls Blood returning to the heart flows upwards from the legs. As the blood is moving against gravity, the veins in the legs have to work hard to pump it in the right direction. The flow is helped by a series of one-way valves in the veins that only allow the blood to move upwards. The valves reduce the pressure of blood below, by supporting it at different stages on its way up. If the walls of your veins weaken, they will be unable to maintain enough pressure to support the weight of blood, and keep it flowing strongly. The weight of the blood pressing on the walls of your veins may also cause the valves to leak and your blood to flow backwards. If the blood flows back down the veins, it will cause them to stretch, bulge and widen. As trunk varicose veins are near the surface of your leg, they are not supported by muscles. Therefore, there is nothing to stop them getting bigger as a result of increased blood pressure. As well as the veins stretching and widening, they also take on a winding shape (tortuous). However, it is only usually your surface veins that are affected because the deep veins are well supported by surrounding tissue. Risk factors It is not fully understood what causes the walls of your veins to weaken, and in many cases varicose veins occur for no apparent reason. However, there are a number of factors that increase your chances of developing varicose veins. These include: Genetics - varicose veins tend to run in families, and it is thought that there may be a genetic tendency to leaky valves. Pregnancy - the developing baby and expanding uterus (womb) can put extra pressure on your veins. Also, the hormonal changes in your body during pregnancy can cause the vein walls to relax. Women who have had several children are more likely to develop permanent varicose veins. Overweight - if you are female and overweight, your risk of getting varicose veins is increased. Age - the older you are, the more likely you are to develop varicose veins. Blood conditions - people who have conditions that affect the blood flow, such as diabetes, are more prone to varicose veins, as are people who have had a previous vein disease, such as thrombophlebitis. Complications Varicose veins stop the blood flowing properly. This can cause other conditions to develop such as a build-up of fluid in your legs, thrombophlebitis, and ulcers (an open sore that forms over the skin, particularly around the ankle). However, complications resulting from varicose veins are usually rare. Thrombophlebitis Thrombophlebitis can sometimes develop if you have varicose veins. It is like a blood clot that causes pain, inflammation and swelling around the affected vein. Mild thrombophlebitis will often get better within 2-6 weeks, without the need for treatment. However, the symptoms of thrombophlebitis can be treated by: continuing with your normal activities as much as possible, placing a hot flannel over the vein to help ease the pain, using non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, to ease the pain. However, they are not advised if you are pregnant. You can use paracetamol as an alternative, elevating (raising) your affected leg above hip level when you are resting. This will help to reduce any swelling or discomfort. In bed, you can keep your leg elevated by putting it on a pillow, and using compression (support) stockings (if your GP recommends it) if a vein in your leg is affected. This may help to ease discomfort until the inflammation settles. Occasionally, complications, such as an infection, can develop as a result of thrombophlebitis. In this case, you may be prescribed antibiotics. Chronic venous insufficiency Poor blood flow in your veins can affect the way that the skin exchanges oxygen, nutrients and waste products with the blood. If this happens over a long period of time, it is called chronic venous insufficiency. Chronic venous insufficiency can cause a number of problems, such as varicose eczema (brown or purple discolouration of the skin that can become permanent) and venous ulcers (an open sore, usually around the shin or ankle, that does not heal). Bleeding A varicose vein that is near to the surface of your leg may bleed if it is bumped or cut. If a varicose vein in your leg starts to bleed, you should lie down, raise your leg, and apply direct pressure to the affected area. If it does not stop bleeding, you should seek medical help immediately. Prevention There are a number of ways that you can try to prevent varicose veins developing. They include: keeping mobile - avoid sitting or standing in one place for long periods of time, helping the blood to flow by not crossing your legs when sitting down, or sleeping sitting down in a chair, stretching when on long journeys in a car, coach or plane. Wearing compression stockings can help to lower the raised pressure in your legs. However, not everybody needs them, so you should speak to your GP or pharmacist for advice, elevating your legs (raising them up) if you have been standing still for a long time, to allow the blood in the veins to empty, not wearing tight underwear or clothes, losing weight, if you are overweight, eating a healthy diet, that is high in fibre. Foods such as bran, whole grains, fruit, and vegetables, will help prevent you getting constipated. Straining during bowel movements can increase the pressure on your varicose veins, making them worse, keeping active by taking regular exercise, and not smoking. Treatment Many people who have varicose veins do not experience any pain or discomfort, and do not require any treatment. However, if your varicose veins are painful and affect your daily activities or your sleep, your GP may suggest treatment. Treatment options depend on your general health and how severe your varicose veins are. You should discuss the various forms of treatment, and their possible side effects, with your GP. Support stockings Support stocking, also called compression stockings, are made of strong elastic, and are designed to help relieve the symptoms of varicose veins, rather than get rid of them. They come in different strengths and are tighter at the bottom than at the top. Your GP may advise you to try support stockings if your symptoms are relatively mild, or if your varicose veins ache or are swollen. Support stockings should be worn during the day, but not at night. Wearing support stockings may prevent swollen ankles or calves from getting worse. However, there has been little research carried out to determine their true effectiveness. You can buy support stockings from your pharmacist, although some types are only available on prescription. Leg elevation Raising your leg up higher than your chest, at frequent intervals, will improve your blood flow, and help prevent waste products from building up and causing pain. It also helps to re-direct blood from your surface veins into the deep veins, and stops blood from flowing back out into the surface veins. Injection sclerotherapy Injection sclerotherapy involves injecting the vein with a chemical that scleroses (closes) it completely. This technique is usually used on smaller varicose veins that are still forming. Injecting chemicals into varicose veins can improve their appearance, but your legs may still ache. Also, the treatment may not be successful long term, and new varicose veins may develop after a while. The majority of people, who have injection treatment, require further treatment within five years. After having the injections, you will need to wear pressure bandages for 3-6 weeks. Surgery Surgery is sometimes used to remove varicose veins that are painful. The operation involves ligating (tying off) the main surface vein (to cut off the blood supply) that runs from your ankle to your thigh, and removing part, or all of it, through a small incision (cut) in your leg. The procedure is known as ligation and stripping. However, it is only possible if the deeper veins are working properly because they will take over from the vein that is removed. The procedure is carried out under a general anaesthetic (you will be unconscious). In the long term, varicose vein surgery can be more effective than other forms of treatment, and the ligation and stripping procedure usually has very good results. You may be able to go home on the same day as the operation, but you will need to take some time off work to recover, and should avoid doing any strenuous activities. You may also need to take painkillers, and support your legs using pressure bandages and leg elevation. New treatments There are a number of new treatments that have recently been developed to treat varicose veins. They include: Radiofrequency ablation is a technique that is usually carried out on larger varicose veins. A probe (thin instrument) is inserted into your vein, heating it and sealing it off. The treatment causes little or no discomfort and is carried out under local anaesthetic. It is a very successful treatment method, and 90% of people who have had it were pleased with the results. Laser treatment is carried out under local anaesthetic (the area is numbed). A thin catheter (tube) is inserted into your vein, and a laser is used to heat it up, and close it off. You may have pain and bruising afterwards. Studies carried out to date show that laser treatment is successful for most people. Transilluminated powered phlebectomy can be carried out using either a general or local anaesthetic. A special device is used to suck out bits of your vein from your leg. After the procedure, you may experience some pain, bruising and bleeding, and there is a very small risk of nerve damage. Aromatherapy treatment needs to be aimed chiefly at improving the general tone of the veins and it is best combined with dietary and other advice. One of the most important oils for strengthening the veins is Cypress which should be used as bath oil and applied very gently in carrier oil or a base cream over the area of affected veins. Lavender, Juniper and Rosemary are good alternatives to Cypress. Massage can be used above the affected area of the vein. Garlic capsules are a good way to strengthen the circulatory systems and you can also add fresh garlic to your normal diet. Vitamins E and C can be taken as supplements but it is better to make sure it is added in your diet. Gentle exercise is also necessary and yoga is well worth trying as well as swimming, walking and gentle stretching. Perseverance is necessary with varicose veins in whatever treatment you choose. |
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