varicose veins that worsens lying down

Overview

Varicose veins are swollen, twisted veins that you can see just under the surface of the skin, most often in the legs. Normally, veins have one-way valves that help blood flow up to your heart. When these valves become weak or damaged, blood can pool in the veins, making them enlarge and bulge. For most people, raising the legs helps blood drain and eases discomfort. But if your varicose veins feel worse – more painful, heavy, or full – when you lie down, it may be a sign of a different problem with blood flow. This is not typical, and it is worth talking to a healthcare provider about.

Varicose veins themselves are very common. Having your varicose veins feel worse when you lie down is less common, but it happens to some people. It may be a sign that your veins are having more trouble moving blood back up to your heart.

Varicose veins can affect anyone, but they are more common in women, people over 40, those who are overweight, and people who stand or sit for long periods. A family history of varicose veins also raises your risk. Worsening with lying down can happen at any age, but it is more often noticed in older adults.

Symptoms

Common symptoms

• Aching, heavy, or throbbing feeling in the legs that is worse after standing or sitting for a long time
• Visible twisted, bulging veins – often blue or dark purple
• Swelling in the ankles or feet, especially in the evening
• Itching or burning sensation around the veins
• Muscle cramps, especially at night

Symptoms in older adults

• Same as common symptoms, but may also notice the skin around the veins becoming thin, dry, or easily bruised
• Worsening pain or fullness when lying flat, which may disturb sleep
• Hard, tender lumps near the veins (phlebitis) are more common in older adults

Causes

Main causes

• Weak or damaged valves in the veins that allow blood to flow backward and pool
• Increased pressure in the leg veins from prolonged standing or sitting, pregnancy, or being overweight
• Worsening when lying down may happen if there is a backup of blood from deeper veins (chronic venous insufficiency) or if the veins are unusually positioned (e.g., May-Thurner syndrome)

Risk factors

• Getting older
• Being female (hormonal changes, pregnancy)
• Family history of varicose veins
• Being overweight or obese
• Jobs that require long periods of standing or sitting
• History of blood clots in the legs (deep vein thrombosis)

When to see a doctor

See a doctor urgently if:

• If your leg becomes suddenly swollen, painful, or red – especially if you have trouble breathing
• If a varicose vein starts bleeding and you cannot stop it
• If you have an open sore on your leg that is not healing

Book a routine appointment if:

• If your varicose veins cause regular discomfort that affects your daily life
• If your symptoms are getting worse, including when you lie down
• If you notice changes in the skin around your veins (discoloration, thickening, or ulcers)
• Before starting any self-treatment like compression stockings

Diagnosis

A doctor or nurse will look at your legs and feel the veins while you are standing and lying down. They will ask about your symptoms, family history, and daily activities. If they want more information, they may use an ultrasound scan to see how blood is flowing in your veins.

Tests that may be done

• Physical examination – doctor checks for swelling, tenderness, skin changes, and visible veins
• Doppler ultrasound – a painless scan that uses sound waves to show blood flow in your veins and check if the valves are working
• Sometimes a special scan called a venogram (X-ray with dye) if deeper problems are suspected

What to expect at your appointment

The diagnosis is usually straightforward and can be done in a clinic visit. You will be asked to stand for part of the exam. The ultrasound is quick and painless – a gel is put on your leg, and a small device is moved over the skin. No needles or special preparation are needed.

Treatment

Treatment for varicose veins aims to relieve symptoms, prevent complications, and improve the appearance of the veins. The approach depends on how bothersome your symptoms are, especially the fact that they worsen when lying down. Many people improve with simple self-care, but if that is not enough, there are medical treatments available. Always talk to your doctor before starting any treatment.

Self-care at home

• Move your legs regularly – avoid sitting or standing for long periods. Take breaks to walk around.
• Elevate your legs above heart level for 15–30 minutes several times a day (this usually helps, but if it makes symptoms worse, discuss with your doctor).
• Wear compression stockings or socks – these apply gentle pressure to help blood flow upward. Ask your pharmacist or doctor about the right type and fit.
• Exercise regularly – walking, cycling, and swimming are especially good for calf muscle pump action.
• Maintain a healthy weight to reduce pressure on your veins.

Medical treatments

If self-care is not enough, a doctor may recommend procedures that close or remove the affected veins. These include treatments like laser or radiofrequency energy to seal the vein from inside (endovenous ablation), injecting a solution that makes the vein collapse (sclerotherapy), or in some cases, surgically removing the vein (phlebectomy or ligation). These are usually done as outpatient procedures with local anesthesia. Your doctor will explain the options based on your specific situation – the fact that your veins worsen when lying down may influence which treatment is best.

When is surgery considered?

Surgery for varicose veins is less common now because newer, less invasive treatments work well. However, surgery may be considered if the veins are very large, if there is a complication like a bleeding ulcer, or if other treatments have not helped. Your doctor will discuss the risks and benefits with you.

Living with this condition

Living with varicose veins that worsen when lying down can be frustrating, but there are ways to manage. Try to keep your legs moving during the day, and avoid staying in one position for too long. If lying down triggers pain, experiment with different positions – for example, sleeping with a pillow under your knees or slightly elevating the foot of your bed. Compression stockings can be worn during the day to help symptoms.

Lifestyle tips

• Stay active – aim for at least 30 minutes of moderate exercise most days.
• When sitting, avoid crossing your legs for long periods.
• Wear loose, comfortable clothing and avoid tight belts or waistbands that restrict blood flow.
• If you must stand for work, shift your weight from foot to foot and take sitting breaks.

Diet and exercise

A balanced diet rich in fibre (fruits, vegetables, whole grains) can help prevent constipation, which reduces pressure on leg veins. Limit salt to help control swelling. Exercise that strengthens your calf muscles – like walking, cycling, or leg lifts – helps pump blood back up to your heart.

Mental health and emotional wellbeing

Coping with chronic pain or visible veins can affect your mood and self-confidence. It is normal to feel frustrated or anxious, especially if your symptoms disrupt your sleep. Talk to your doctor about how you are feeling – they may have resources to help. If you experience persistent sadness or anxiety, consider speaking with a mental health professional.

Prevention

You cannot always prevent varicose veins, especially if you have a family history. But you can reduce your risk and stop them from getting worse by staying active, maintaining a healthy weight, avoiding long periods of standing or sitting without breaks, and wearing compression stockings if recommended. There is no known way to specifically prevent the worsening-when-lying-down pattern, but keeping your circulation healthy is always a good step.

Complications

If left untreated

• Skin changes – the skin near your ankles may become thin, discolored, or itchy
• Venous eczema – red, flaky, weeping skin patches
• Leg ulcers – open sores that are slow to heal
• Bleeding from a varicose vein
• Superficial thrombophlebitis – inflammation and clotting in a vein just under the skin
• Rarely, deep vein thrombosis (DVT) – a blood clot in a deeper vein that can be dangerous if it travels to the lungs

Long-term outlook

For most people, varicose veins are not a serious health problem, and simple measures can keep symptoms under control. With proper care, complications are uncommon. Even if your veins worsen when lying down, many treatments can help relieve your symptoms. Working with your doctor will give you the best chance of feeling better and avoiding long-term problems. There is plenty of reason to be hopeful.

Find support

Local organisations

• NHS (UK) – Varicose veins information ↗ · UK
• Circulation Foundation (UK) – Patient support ↗ · UK

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