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Varicose veins

Varicose veins. Information from Bupa about varicose veins including prevention, diagnosis and treatment options.

Varicose veins are swollen veins that you can see and often feel, lying under your skin. They usually affect your legs. Varicose veins affect at least one in four of us. They’re more common in women and you’re more likely to get them the older you are.

Although they can be unsightly, for most people varicose veins don’t cause problems. If you do have symptoms there are a range of procedures that can help your legs to look and feel better.

How varicose veins form
Varicose veins are swollen veins that lie under the skin

Details

  • About About varicose veins

    Varicose veins develop when blood doesn’t flow properly through the veins in your legs. There are two main types of veins in your legs: superficial veins near the surface and deep veins within your muscles. In healthy veins blood flows from the superficial veins to the deep veins, and from there back up to your heart. The superficial veins are connected to the deep veins inside your legs by perforator veins.

    One-way valves inside all these veins make sure that your blood goes in the right direction. If one or more of these valves leaks then blood can sometimes go the wrong way, from your deep to your superficial veins. This happens because the blood deep inside your leg is under more pressure than the blood in the surface veins. The blood flows back into your superficial veins and collects there, making them swell and bulge – these are varicose veins.

    See our section on causes of varicose veins for more information about who gets them and how they may happen.

    An image showing the superficial veins of the leg 

  • Symptoms Symptoms of varicose veins

    Symptoms of varicose veins can vary. Some people don't have any symptoms at all. If you do have symptoms, they may include:

    • aching or heaviness in your legs
    • itchy or burning feeling in the skin over the veins
    • restless legs
    • swollen feet and ankles – especially after standing for a long time
    • cramps in your legs – usually at night
    • lumps or bulging veins
    • changes in the skin colour, and skin ulcers

    Large varicose veins don’t always cause more symptoms than smaller ones.

    You may find your symptoms are helped by putting your leg up. If you’re a woman you may find that your symptoms are worse during your periods, or when you’re pregnant.

    These symptoms may be caused by problems other than varicose veins. If you have any of these symptoms, contact your GP for advice.

    An image showing large varicose veins on the leg below the knee, with lumps and blue/purple colouring

    Varicose veins

    Bupa On Demand: Varicose vein treatments

    Want to talk to a Bupa consultant about varicose vein treatment? We’ll aim to get you seen the next day. Prices from £250.

  • Diagnosis Diagnosis of varicose veins

    Your GP will ask about your symptoms and ask to examine you, including while you are standing up. They may also ask you about your medical history.

    If your symptoms are severe or you have complications, your GP may refer you to a vascular surgeon (a doctor who specialises in blood vessels).

    Varicose veins are usually easy to see in your leg. However, to work out the position and extent of any valve damage, your doctor may suggest that you have an ultrasound scan (duplex). This uses sound waves to produce an image of the veins inside your leg. It allows your doctor to see your deep veins in more detail, and examine the structure and function of your varicose veins.

  • Treatment Treatment options for varicose veins

    There are a number of treatment options for varicose veins, as described below. Which treatments your doctor offers you will depend on your personal circumstances. Your doctor will discuss these with you so you can make a decision that’s right for you. See our pros and cons section for more information which will help. 

    If your varicose veins don’t cause you any discomfort, you may decide not to have any treatment. Most varicose veins don’t cause any long-term health problems or cause any threat to your circulation.

    It’s worth knowing that, even after treatment, your varicose veins may come back. You may be offered a further procedure if this happens. Ask your doctor what the chance of recurrence might be in your case.

    Self-help

    Your doctor may suggest some self-help measures you can take to relieve your symptoms. These may include losing any excess weight and doing light to moderate physical activity, such as swimming or walking. Try not to stand for long periods of time as this may make your symptoms worse. If you rest with your legs up, it may ease any discomfort. 

    Non-surgical treatments

    There are a number of non-surgical procedures available to treat varicose veins. If you have complications of varicose veins, you may be able to have these treatments on the NHS. If you want treatment for cosmetic reasons, it’s unlikely you will be able to have this on the NHS. However, you can choose to pay for treatment privately. 

    Endothermal ablation

    Endothermal ablation means heating the inside of your varicose vein to make it close off. Your doctor uses either radiowaves (radiofrequency ablation) or a laser (endovenous laser ablation) to create the heat. 

    Endothermal ablation procedures are less invasive alternatives to traditional surgery for varicose veins and so your doctor will now usually offer them to you first. They can be carried out under local anaesthetic which means you’ll be awake but your doctor will numb the area around your vein. Your doctor will make a tiny cut in your vein and insert a fine tube (catheter) into the vein. A device at the tip of this tube will then create the heat and your varicose vein becomes closed off. You’ll usually be encouraged to be up and about afterwards, and home the same day.

    As with any treatment for varicose veins, you may need to have further treatment if your varicose veins come back. 

    There’s more information about the benefits, side effects and complications of radiofrequency ablation and endovenous laser ablation in our pros and cons section below. You can ask your doctor to explain these.

    Foam sclerotherapy 

    If endothermal procedures are unsuitable for you, your doctor may recommend you have foam sclerotherapy. This treatment involves injecting special foam into your varicose veins. A chemical in this foam inflames the lining of your veins and makes them close up.

    Foam sclerotherapy may help to get rid of your varicose veins, although you may need two or three sessions of treatment. Like the endothermal procedures, it’s less invasive than surgery and can be done under local anaesthetic. However, there’s a possibility that your varicose veins may come back and you may need further treatment. 

    Your doctor will talk to you about the benefits and risks of this procedure, and there’s more information in our pros and cons section below. 

    Surgery

    If less invasive procedures are unsuitable for you, your doctor may suggest you have varicose vein surgery. In varicose vein surgery, your surgeon will remove any superficial veins that have become varicose veins. Your deep leg veins will take over the role of the damaged veins so the blood flow from your leg won’t be harmed.

    The most common technique for varicose vein surgery is called ligation and stripping. This is usually carried out under general anaesthesia which means you’ll be asleep during the procedure. In this operation, your surgeon will tie off the faulty vein (ligation) to stop blood flowing through it. They’ll then remove it with a long wire (stripping). Or you may have a procedure called phlebectomy to remove the smaller surface veins that lie under your skin. In this operation, your surgeon will use hooks to pull out your varicose veins through small cuts in your leg. 

    You’ll usually go home the same day after varicose vein surgery, although occasionally an overnight stay in hospital is needed. Your leg may feel sore and uncomfortable for up to two weeks after your operation. You may need to be off work for between one and three weeks. Your doctor can advise you what’s best in your particular circumstances.

    Although many people won’t need any further treatment after surgery, it’s possible that new varicose veins can form. If you want to know more about the risks of varicose vein surgery ask your doctor, and see our section on pros and cons below. 

    Compression stockings

    If the treatments above aren’t suitable for you, or you choose not to have them, your doctor may suggest you try compression stockings. They may also offer these to you after having a procedure or surgery, or if you’re pregnant. The stockings may relieve the swelling and aching in your legs. However, doctors aren’t sure yet whether they really help to stop your varicose veins getting worse, or more varicose veins from developing.

  • Varicose vein treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including varicose vein treatment.

  • Causes Causes of varicose veins

    We don’t completely understand yet why people get varicose veins. They are probably caused by a number of different factors which may act together. These include a raised pressure within your veins, and your vein walls being unusually thin and weak. This causes the valves in your veins to expand and separate, which means they can’t work properly. Blood can’t travel up your veins as well or as easily as it should, and instead flows into the relatively low pressure superficial veins. This makes those superficial veins enlarge into varicose veins.

    We do know that you’re more likely to develop varicose veins:

    • if you’re female
    • as you get older (because your veins lose their elasticity with age)
    • if you’re pregnant (because your hormones affect the walls of your veins to make them more pliable)
    • if other members of your family have them
    • if you’re very overweight (also because of the increased pressure on your veins)
    • if you’ve had damage to your legs veins, or a blood clot in the past
    • if you stand for long periods of time in one position, for example you stand all day at work

    If you get varicose veins during pregnancy the good news is that they usually get better within three to 12 months of your baby being born.

  • Complications Complications of varicose veins

    Varicose veins can get worse over time, but this usually happens slowly over a period of years. Complications of varicose veins include the following.

    • Thrombophlebitis – your superficial veins can become painful and red due to a blood clot forming in the vein.
    • Bleeding – your varicose veins can bleed if you cut or bump your leg. This will stop with firm pressure but your vein may need to be treated to stop it happening again.
    • Skin changes – these are usually seen in your lower leg or ankle and are caused by high pressure in your veins. Your skin may become brown or purple and you may develop a rash (varicose eczema). These skin changes may develop into a venous ulcer, especially if you injure your skin.
    • Deep vein thrombosis (DVT) – this can sometimes happen if you have treatment for varicose veins. Your calf may swell and become painful, and you should seek medical attention right away.

    If you have any of these complications, see your GP.

  • Prevention Prevention of varicose veins

    Although there are no scientifically proven ways to prevent varicose veins, the following suggestions may be useful.

    • Don’t stand or sit still for long periods of time.
    • Take regular exercise, such as walking.
    • Maintain a healthy weight.
    • Put your feet up from time to time.
  • Medicines for varicose veins Are there any medicines that my doctor could prescribe to treat my varicose veins?

    No, there’s no evidence that creams or medicines are effective at treating varicose veins.

    More information

    Over the years, many different medicines and creams have been tested for the treatment of varicose veins. However, there’s no evidence to suggest that any of these work.

    Forty years ago there was a small clinical trial in women with varicose veins. This showed that a medicine called rutoside can reduce symptoms such as night cramps and feelings of tiredness. However, more research would be needed in more people before we could say if it’s really effective.

    There’s no evidence to suggest that herbal creams, lotions and other medicines for poor circulation are effective for the treatment of varicose veins.

    Always ask your doctor or pharmacist for advice. If you do decide to take medicines or use creams, read the patient information leaflet that comes with your medicine carefully.

  • Preventing varicose veins with lifestyle changes What changes can I make to my diet and lifestyle to reduce my risk of developing varicose veins?

    Although there’s probably no way to completely prevent varicose veins, there are things you can do to make them less likely to develop. For example, don’t sit or stand still for long periods of time, lose excess weight, take regular exercise and put your feet up when resting.

    More information

    Regular exercise is a great way to improve your circulation and general health. If you’re unsure, ask your GP for advice on the best types of exercise for you.

    If your job involves a lot of standing, try to change position frequently and move around as often as you can. Gently moving your feet will help to stretch your calf muscles and help your circulation. When you sit down, don’t cross your legs because this can restrict your circulation. Try to take regular breaks throughout the day and, if possible, keep your legs raised on something comfortable while you’re resting. Ideally, raise your legs above the level of your heart.

    If you’re overweight, it can increase your risk of getting varicose veins so try to lose excess weight by eating healthily and taking regular exercise. This will take any extra pressure off your circulatory system and your heart will find it easier to pump blood around your body. Ask your GP for advice on the best ways to lose weight.

    If you’re pregnant and have developed varicose veins, they will often improve after you give birth. Compression stockings may also help to relieve any swelling and aching in your legs.
  • Varicose veins and DVT I have varicose veins. Does this mean I’m more likely to develop a deep vein thrombosis (DVT)?

    If you have varicose veins you may be at increased risk of developing a blood clot in a deep vein (deep vein thrombosis, DVT). However, most people with varicose veins won’t develop this complication.

    More information

    Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a deep vein, normally in your leg. This can lead to serious complications. There are a number of risk factors for DVT. These include having previously had a DVT, having cancer, getting older, being overweight or obese, smoking and being immobile for long periods.

    Having varicose veins has also been linked with an increased risk of developing a DVT in some studies. However, if there is a risk it appears to be very small compared with other risk factors. Getting a DVT can also be a complication of procedures and surgery for varicose veins.

    If you have varicose veins and are worried about your risk of developing DVT, talk to your doctor.

  • Solutions for dry and itchy skin I’ve got varicose veins and my skin has become dry and really itchy. What can I do?

    If you have varicose veins you may find that after a while your skin, especially near your ankle, becomes dry, scaly and very itchy. You can ease the itchiness and discomfort by applying emollients (special moisturisers) regularly. If your skin becomes inflamed your GP may prescribe a steroid cream. You’ll also need to be careful not to knock or damage your skin, as this could cause an ulcer to start. Ask your GP whether treating your varicose veins would be a good option for you. 

    More information

    If you have varicose veins the pressure within these veins can cause fluid to seep out of them into your tissues. This may eventually lead to changes in your skin. These might include dryness, changes in colour, flaking and scaliness, inflammation and itching. This is called varicose eczema (also known as venous eczema). 

    You can reduce your risk of getting varicose eczema. Make sure you don’t stand in one position for too long, keep active and by lose excess weight. And when you’re resting, try to put your feet up so that they are a little higher than your heart. See our FAQ on lifestyle changes for more information.

    Emollients are special medical moisturisers which you can get over-the-counter from your pharmacy or from your GP. Apply these to the skin of your legs twice a day to help keep your skin soft and supple. This will help stop the skin breaking down. Try to avoid using soap and bubble bath as these can dry your skin out. You can get emollients to put in your bath, but be careful as these make the bath slippery. 

    If your skin becomes very sore and itchy your GP may prescribe creams with steroids in. You should apply these just to the inflamed area. Always follow your GP’s advice about when and where to use steroid creams.

    It’s important to avoid damaging your skin if you have skin changes. That’s because a break in your skin may lead to an ulcer – this is called a venous ulcer. Venous ulcers can take a long time to heal. 

    If your affected skin becomes hot and inflamed, or you get a high temperature and feel unwell, see your GP. You may have an infection and might need antibiotics.

    Ask your GP whether having your varicose veins treated would be a good option in your circumstances. See our treatments section above for more information.

  • Pros and cons Pros and cons

    The table below summarises the benefits and risks (pros and cons) for each of the treatment options for varicose veins. When looking through these, think about what matters most to you. Your doctor will discuss these with you to help you make a decision that’s right for you.

    Pros Cons
    No treatment or self-help measures only
    You don’t have to worry about getting any side-effects of treatment. Your varicose veins won’t go away on their own.
    If you’re in pain or don’t like the look of your varicose veins, this might not be an option for you.
    Radiofrequency ablation
    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to have a general anaesthetic for this procedure. Instead, you can just have a local anaesthetic which will block pain from the area you need treating.

    You’re likely to have less bruising and swelling than if you have normal surgery.

    You’ll probably have less pain in the days after the procedure than you would after normal surgery.
     

    Not everyone will be able to have this procedure. Your doctor will be able to advise you on whether this treatment is suitable or not.

    This is a fairly new treatment so we can’t be sure yet how well it works in the long term. However, so far it seems to work as well as normal surgery.

    You might get some bruising and pins and needles but this doesn’t usually last for long.

    Endovenous laser ablation
    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to have a general anaesthetic for this procedure. Instead, you can just have a local anaesthetic which will block pain from the area you need treating.

    You’re likely to have less bruising and swelling than if you have normal surgery.
    Not everyone will be able to have this procedure – but most will. Your doctor will be able to advise you on whether this treatment is suitable or not.

    This is a fairly new treatment so we can’t be sure yet how well it works in the long term. However, so far it seems to work as well as normal surgery.

    You may get some darkening or redness of your skin as well as some swelling.
    Foam sclerotherapy

    This isn’t a major operation and you’re likely to recover quicker than normal surgery.

    You won’t need to have a general anaesthetic for this procedure. Instead, you can just have a local anaesthetic, which will block pain from the area you need treating.

    You may be able to have this procedure if you’re not fit enough for surgery or other procedures. It may also be the best option for you if you’re taking blood thinning medicines such as warfarin.
     

    This is a fairly new treatment so we can’t be sure yet how well it works in the long term. However, so far it seems to work as well as normal surgery.

    You may have some bruising, swelling and notice some changes to the colour of the skin over your veins. This is common − more than half of people having this procedure get these side-effects. Other side effects may include temporary visual problems, coughing and headache.

    A few people have had serious complications after this procedure including strokes, mini-strokes or heart attacks. There may well have been particular medical reasons why this happened to them. If you would like more information about this, speak to your doctor.
    Surgery
    We know this treatment works well – it’s the most ‘tried and tested’ way to remove varicose veins. You’ll have to be put to sleep during this operation with a general anaesthetic. 

    This is an operation, so you’re likely to take longer to recover from it (one to three weeks).

    You may have some bruising, swelling and pins and needles after the operation.
     

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Varicose veins. BMJ Best Practice. www.bestpractice.bmj.com, published 2 February 2015
    • Varicose veins and spider veins. Medscape. www.emedicine.medscape.com, published 17 November 2014
    • Varicose veins. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 September 2013
    • Deep vein thrombosis. PatientPlus. www.patient.co.uk/patientplus.asp, published 31 July 2015
    • Varicose eczema. PatientPlus. http://patient.info/patientplus, published 22 September 2014
    • Varicose veins. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published May 2014
    • Varicose veins in the legs: the diagnosis and management of varicose veins. National Institute for Health and Care Excellence (NICE), July 2013. www.nice.org.uk
    • Radiofrequency ablation of varicose veins. National Institute for Health and Care Excellence (NICE), September 2003. www.nice.org.uk
    • Endovenous laser treatment of the long saphenous vein. National Institute for Health and Care Excellence (NICE), March 2004. www.nice.org.uk
    • Ultrasound-guided foam sclerotherapy for varicose veins. National Institute for Health and Care Excellence (NICE), February 2013. www.nice.org.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 4 August 2015 (online version)
    • Map of Medicine. Varicose veins. International View. London: Map of Medicine; 2013 (Issue 4)
    • Nesbitt C, Bedenis R, Bhattacharya V, et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database of Systematic Reviews 2014, Issue 7. doi: 10.1002/14651858.CD005624.pub3
    • Shingler S, Robertson L, Boghossian S, et al. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration. Cochrane Database of Systematic Reviews 2013, Issue 12. doi:10.1002/14651858.CD008819.pub3.
    • Bamigboye AA, Smyth RMD. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. doi:10.1002/14651858.CD001066.pub2
    • Varicose veins. National Heart, Lung and Blood Institute. www.nhlbi.nih.gov, published 13 February 2014
    • Varicose veins. The Circulation Foundation, www.circulationfoundation.org.uk, accessed 30 July 2015
    • Venous eczema. British Association of Dermatologists. www.bad.ork.uk, published May 2013
    • Varicose eczema (webpage and downloaded leaflet). National Eczema Society. http://www.eczema.org/varicose-eczema, published January 2015
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