Q: I’ve noticed a few varicose veins on my legs. Is there anything I can do about them?
Varicose veins are hard to ignore: These lumpy, ropelike vessels seem to bulge out the skin, and for many people, they can be deeply uncomfortable. They are most common in the legs, ankles and feet but can sometimes be found in the pelvis and elsewhere.
While up to 30 percent of adults have varicose veins, they are “not life threatening or limb threatening,” said Dr. Faisal Aziz, chief of vascular surgery at Penn State Health. A few simple lifestyle changes can ease symptoms and keep the veins from worsening, but they usually won’t make existing ones disappear.
We asked experts why they occur and when to get them checked out.
What causes varicose veins?
Arteries carry blood away from the heart, and veins bring it back. But that’s a tougher job in the legs, where blood has to travel upward, Dr. Aziz said.
So your body relies on a two-part system: As you move around, your calf muscles squeeze the veins in your legs and push blood upward, while one-way valves keep that blood from traveling back down, said Dr. Isabella Kuo, a vascular surgeon at University of California Irvine Medical Center.
Varicose veins form when these valves weaken or don’t close properly. Blood pools in the legs and pressure builds, causing the veins to enlarge.
Family history is the strongest risk factor for varicose veins, Dr. Aziz said, but aging, excess weight and jobs that require long stretches of sitting or standing also increase the odds. Women are more likely to develop varicose veins too, and while the reasons are not fully clear, hormone replacement therapy and pregnancy probably play a role, Dr. Kuo said.
Because many of these risk factors are beyond a person’s control, there is not much people can do to prevent varicose veins. But staying active, maintaining a healthy weight and taking breaks from long sedentary periods can help reduce strain.
Are varicose veins dangerous?
If varicose veins aren’t painful or bothersome, it’s perfectly fine to ignore them, said Dr. Angela Kokkosis, director of the center for vein care at Stony Brook Medicine. However, many cases are symptomatic and worth getting checked out.
For example, as blood pools in the veins, it can cause pain, tenderness and a feeling of heaviness in the legs. If the pressure stays elevated, fluid and red blood cells can seep into nearby tissue, Dr. Kokkosis said, causing swelling; itchy, dry skin; and discoloration. In rare cases, varicose veins can lead to ulcers, particularly without treatment, Dr. Aziz said.
Varicose veins are also tied to a higher risk of deep vein thrombosis, a potentially dangerous blood clot. So, sudden swelling or pain in just one leg — especially after a long sedentary stretch, like a trans-Atlantic flight — deserves prompt attention.
What can you do about varicose veins?
Varicose veins can’t be cured, but doctors recommend starting with some simple changes to help slow their progression.
The goal is to help blood move back up the legs, Dr. Kokkosis said. Taking a short walk or flexing your feet at your desk — at least every hour — can help keep your calf muscles engaged. When sitting or lying down, doctors also recommend elevating your legs for about 15 minutes at a time.
Wearing compression stockings during the day can help as well. They apply external pressure to the legs, thus helping counteract gravity and reduce blood pooling. Compression stockings are one of the best tools for symptom relief, Dr. Aziz said, but can be uncomfortable, especially in hot weather.
But there are ways to make them more manageable. Most people don’t need the strongest, thigh-high versions; knee-high stockings with moderate compression typically work well, he added. And if you have trouble wearing them every day, at least do so on days when you’ll be sitting or standing for long stretches, Dr. Kokkosis said.
There are no over-the-counter medications approved by the Food and Drug Administration for treating varicose veins. However, some studies suggest that supplements like micronized purified flavonoid fraction and horse chestnut seed extract can ease leg pain, heaviness and swelling, Dr. Kuo said, although they’re not a replacement for lifestyle changes.
If you’re dealing with pain and other symptoms after three to six months, or you develop complications like skin discoloration or ulcers, then it’s worth talking to a vein specialist, Dr. Aziz said. After ruling out related problems, the doctor can close the problematic veins with heat, adhesive or a medical solution — or surgically remove them. This can both improve the cosmetic appearance of varicose veins and meaningfully improve heaviness and aching.
Just remember that varicose veins are a chronic condition. Treated veins can occasionally reopen, and an operation doesn’t erase the body’s tendency to form new varicose veins down the road.
“Many times, people who have veins treated come back many years later to get more veins treated, and then many years later to get that treated as well,” Dr. Aziz said. “There is no cure.”
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