Varicose veins are enlarged, swollen, and tortuous (twisting) veins, frequently linked to faulty valves in the vein. They are generally blue or dark purple.
People with bulging and/or lumpy varicose veins on their legs may experience cramping pain and heavy limbs. Occasionally, in very severe cases, the varicose veins may rupture, or varicose ulcers may form on the skin.
In healthy veins, the valves within them stop the blood from remaining stagnant or flowing back - they open and close so that the blood can only flow in one direction. If the valves are damaged or weakened, they may allow the blood to flow back and accumulate in the vein, making it varicose. Varicose simply means enlarged or swollen.
According to UK health authorities, up to 30% of all adults are affected by varicose veins. The National Institute of Health estimates that 33% of women and 17% of men in the USA are affected.
An example of varicose veins in the leg
Although varicose veins may occur anywhere in the human body, they are most commonly found in the legs and feet, particularly in the calves. Experts say that standing and walking places extra pressure on the veins of the lower limbs.
In the majority of cases, varicose veins pose no health or circulation problems; although they may not look nice, they do not usually require treatment (for health reasons).
A number of patients, however, may experience swelling, aching and painful legs. If the patient is in considerable discomfort, or if complications, such as ulcers develop, then treatment is required.
Symptoms of varicose veins
A sign is something everybody can detect, such as a rash or bloodshot eyes, while a symptom is something only the patient can feel and describe, such as pain or ringing in the ears.
In the majority of cases, there is no pain.
Signs and symptoms of varicose veins may include:
- Veins can be seen as twisted, swollen and lumpy (bulging); some people have described them as cords
- The veins are blue or dark purple
Some patients may also experience:
- The legs aching
- The legs feel heavy, especially after exercise or at night
- A minor injury to the affected area may result in longer bleeding than normal
- Lipodermatosclerosis - fat under the skin just above the ankle can become hard, resulting in the the skin shrinking
- Swollen ankles
- Telangiectasia in the affected leg (spider veins)
- There may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color
- Venous eczema (stasis dermatitis) - the skin at the affected area is red, dry and itchy
- When suddenly standing up, some patients may experience leg cramps
- A high percentage of people with varicose veins also have restless legs syndrome
- Atrophie blanche - irregular whitish patches that look like scars appear at the ankles.
Varicose veins can appear in various parts of the body, including:
- Legs (most common)
- Uterus (womb)
Causes of varicose veins
The circulation system - arteries and veins form part of our circulation system, with blood flowing from the heart into the arteries and to tissues and organs, and coming back to the heart via the veins. The returning blood has to travel against gravity in the veins, this is done through muscle contractions and a system of valves.
The veins have one-way valves that allow blood through, but not back, so that the blood travels in only one direction. If the walls of the vein become stretched and less flexible (elastic), the valves may get weaker. A weakened valve may allow blood to leak backwards, and eventually flow backwards. When this occurs, blood can accumulate in the vein(s), which becomes enlarged and swollen.
Experts are not sure why the walls of veins stretch or why the valves become faulty. In many cases, it occurs for no clear reason.
Figure A shows a normal vein with a properly working valve; there is normal blood flow. In Figure B, the varicose vein has a faulty valve, there is abnormal blood flow, the walls of the vein are thin and stretched. The image in the middle shows where in a leg the varicose vein might appear.
Image by National Heart Lung and Blood Institute.
Protein kicks off varicose vein causing protein
Researchers from the University of Heidelberg in Heidelberg, Germany, wrote in The FASEB Journal (October 2011 issue) that transcription factor AP-1, a single protein that binds to DNA control gene function, kicks off the process that causes varicose veins.
Study author, Thomas Korff, Ph.D., said "We very much hope that our findings spur further studies focusing on the mechanisms underlying this widespread and precarious but still largely neglected venous disease, In the long run, such approaches will result in the development of a drug therapy that improves the quality of life for all people suffering from varicose veins."
On the next page we look at factors that raise the risk of developing varicose veins and the diagnosis of varicose veins. On the final page we discuss the treatments for varicose veins, including compression stockings and surgery.