Varicose Veins

Varicose veins

What are varicose veins?

The term varicose veins is used to describe a condition in which the veins are permanently twisted and dilated. While this can occur in any part of the body, the most usual location for varicose veins is in the legs.

The function of veins in the body is to complete the vital process of blood circulation. They carry blood back to the heart after it has been pumped to all the vital organs of the body through tubes, which are called arteries.

Arteries are thick, elastic tubes containing muscle fibre known as smooth muscle. The smooth muscle contracts in the wall of the artery thereby propelling blood through the arterial system. This action occurs with each heartbeat.

Veins have very thin walls and no elastic fibres and are, therefore, unable to contract and push the blood flow onwards towards the heart. Unlike arteries, veins are completely dependent on the functions of the surrounding muscles and the valves inside the vein itself to push the blood in the right direction back towards the heart. The surrounding muscles squeeze the blood through the veins with each contraction of the muscle. This action is known as the muscle pump.

While varicose veins are usually associated with advancing age, they can also occur in young people. They are very often of no great inconvenience apart from looking unsightly.

How do they develop?

Veins contain one-way valves, which help to propel blood back to the heart against the forces of gravity. These valves are situated every few inches along the length of the vein. If a leak develops in any of these valves the blood falls back down the vein and causes swelling at the valve below. The veins become permanently dilated (widened) and can assume the appearance of a bunch of grapes at the back of the leg.

'Blood flows one way through the series of valves with the valve closing behind the blood after it has passed through'.

'The valve circled in red is faulty and does not close behind the blood that has passed through. The blood falls back down the vein causing swelling of the vein'.

Who is at risk?

Among the risk groups for the development of varicose veins are:

  • pregnant women.
  • those with a family history of the condition.
  • those who work in jobs which involve prolonged periods of standing, i.e. hairdressers and shop assistants.
  • people who suffer from obesity (overweight).

What are the warning signs?

Varicose veins may be first noticed as:

  • a feeling of heaviness or tiredness in the legs, especially after standing.
  • large blue veins, which are visible on the surface of the leg and can easily be seen while standing.
  • cramps in the legs, especially at night and a creeping sensation right across the skin.
  • swelling of the legs, which may become sore and painful as the condition worsens. This is known as oedema (an accumulation of fluid in the legs) and occurs where there is incomplete circulation of the blood.

How are they treated?

Many people who develop varicose veins find that they require no medical treatment at all. However, if large amounts of fluid accumulate in the legs giving rise to pain and discomfort, you should contact your local GP with a view to receiving treatment.

For mild cases of varicose veins, your doctor will probably advise you to rest frequently with your legs raised and he may also advise you to wear lightweight elastic compression stockings for a specified period of time. These will help to ease the discomfort but will not make the varicose veins disappear. They may contain the problem and reduce the risk of further deterioration.

If obesity is a problem, your GP will strongly advise you to go on a weight-reducing diet.

Some people may require surgical intervention. There are two forms of treatment that are widely practised in Ireland. One is known as injection sclerotherapy and the other is known as ligation and stripping. Sclerotherapy is an outpatient procedure and involves the injection of a special chemical into the damaged portion of vein. This effectively shuts off that section of vein and the circulation is bypassed through alternative healthy channels of veins.

Ligation and stripping involves the 'tying-off' (ligation) of the damaged portion of vein and the stripping or removal of that section. This procedure is usually performed under general anaesthesia and requires admission to hospital. Both forms of treatment are a form of bypass, in the sense that the damaged area is bypassed and the circulation is re-routed through alternative channels.

For most people, varicose veins affect only a small section of the leg. However, there are cases where the entire leg, or perhaps both legs, are filled with varicose veins.

Untreated varicose veins can lead to a number of serious problems such as:

  • leg ulcers, particularly in elderly patients
  • deep vein thrombosis, which is a potentially fatal condition
  • eczema of the leg, which may, in turn, lead to ulcers
  • phlebitis, which is recurrent inflammation of the veins.

Can varicose veins develop in places other than the legs?

Yes. Varicose veins can develop in a number of places around the body, including the pelvis, the uterus, the vagina and the anus (back passage). Varicose veins in the anal region are known as haemorrhoids or piles.

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