varicose veins overview for patients

Overview

Varicose veins are swollen, twisted veins that appear just under the skin, usually in the legs. They happen when the tiny valves inside your veins that help blood flow back to the heart become weak and stop working well.

Yes, varicose veins are very common. In the UK, about 1 in 3 adults has them, and they are more likely as you get older.

Anyone can develop varicose veins, but they are more common in women, pregnant people, and people who stand or sit for long hours at work. A family history of varicose veins also increases your risk.

Symptoms

Common symptoms

• Aching, heavy, or tired legs
• Swollen ankles and feet
• Itching or burning feeling over the veins
• A dull pain after standing for a while
• Skin discoloration around the ankles

Symptoms in children

• Varicose veins are very rare in children. If you notice unusual veins in a child, it is best to have a doctor or paediatrician check them.

Symptoms in older adults

• In older adults, varicose veins may be more pronounced and can cause skin changes, such as hardening, dryness, or sores near the ankle. The legs may also feel heavy or achy after standing.

Causes

Main causes

• Weak valves in the veins that allow blood to flow backward
• Weakened vein walls that lose their stretch
• Increased blood pressure in the leg veins from standing or sitting for long periods

Risk factors

• Age – older adults are more likely to develop varicose veins
• Gender – women, especially those who are pregnant or after menopause
• Pregnancy – extra blood volume and pressure can enlarge veins
• Obesity – excess weight puts more pressure on the veins
• Prolonged standing or sitting – such as in some jobs
• Family history – varicose veins often run in families

When to see a doctor

See a doctor urgently if:

• If you have bleeding from a varicose vein that does not stop quickly
• If you have a swollen, red, hot, and painful area that could be a blood clot
• If you develop an open sore or ulcer over a vein

Book a routine appointment if:

• If your leg pain or aching affects your daily activities
• If the appearance of the veins is very distressing
• If you notice skin colour changes, dry or itchy skin around your ankles

Diagnosis

A healthcare provider can usually tell if you have varicose veins by looking at your legs while you stand. They will check for visible bulging veins, swelling, skin changes, or sores.

Tests that may be done

• A medical and family history – the doctor will ask about your symptoms and risk factors
• A physical examination – the doctor will inspect your legs and feel the veins
• A duplex ultrasound – a painless test that shows how blood flows through your veins and whether the valves are working

What to expect at your appointment

You will be asked to stand for part of the exam, so the veins are easier to see. For an ultrasound, you will lie down, and a small hand-held device will be moved over your skin with gel. It usually takes less than 30 minutes and you can go home straight after.

Treatment

Treatment for varicose veins depends on how much they bother you. Many people find that simple self-care steps, like moving more and wearing compression stockings, are enough. If not, there are minimally invasive procedures and, in some cases, surgery.

Self-care at home

• Put your legs up on a stool or cushion when you rest – ideally above the level of your heart
• Walk, swim, or cycle regularly to help pump blood through your legs
• Wear compression stockings properly fitted by a pharmacist or nurse
• Avoid standing or sitting still for a long time – take short walks
• Keep your weight in a healthy range

Medical treatments

There are several approaches a specialist may offer. These include endovenous ablation (using heat or a laser to seal the vein shut), sclerotherapy (an injection that makes the vein collapse), and in more severe cases, surgery to remove the vein. Your doctor will explain the options and help you choose based on your health and preferences.

When is surgery considered?

Surgery is usually considered when varicose veins are large, cause significant pain, or when other treatments have not worked. It is done under anaesthetic and involves removing or tying off the affected veins. Recovery takes a few weeks.

Living with this condition

You can live very well with varicose veins by making small changes to your daily routine. Regular movement, leg elevation, and comfortable shoes can make a big difference to how your legs feel.

Lifestyle tips

• Take breaks to stand and stretch if you sit at a desk for hours
• Avoid tight clothing or high heels for long periods
• Put your feet up when watching TV or reading
• Use a footrest while sitting to keep your knees bent less

Diet and exercise

A healthy diet with enough fibre helps prevent constipation, which can raise pressure in the veins. Regular exercise, such as brisk walking or swimming, is excellent because it uses the calf muscles to push blood back toward the heart.

Mental health and emotional wellbeing

Varicose veins affect how your legs look, and it is natural to feel self-conscious or worried. Talk about your feelings with someone you trust. A counsellor or a support group can also help.

Prevention

Varicose veins cannot always be prevented, especially if they run in your family. But you can lower your risk by staying active, keeping a healthy weight, avoiding long periods of standing or still sitting, and moving your legs regularly.

Screening programmes

There is no routine screening test for varicose veins. You only need a medical check if you have symptoms or complications.

Complications

If left untreated

• Skin changes, such as darkening, thickening, or eczema
• Leg ulcers or open sores, usually near the ankle
• Bleeding from a varicose vein
• Superficial blood clots (phlebitis) that cause redness, heat, and pain
• In rare cases, deep vein thrombosis which needs urgent medical care

Long-term outlook

For most people, varicose veins are manageable. Good self-care and modern treatments are very effective at relieving symptoms and improving the appearance of your legs. It is worth talking to your doctor to make a plan that works for you.

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