Varicose veins

Your leg veins carry blood back up to the heart against gravity. Small one-way valves inside them stop the blood from falling back down. When these valves weaken, blood flows the wrong way and collects in the lower leg. The veins near the skin then stretch, swell and twist. These are varicose veins.

For some people they are only a cosmetic worry. For many others they cause heavy, aching legs, ankle swelling, itching and night cramps.

They matter because, left for years, the extra pressure can damage the skin around the ankle. The skin may darken, harden or break down into a slow-healing wound called a venous ulcer. Treating the faulty veins early helps prevent this.

Varicose veins are very common, and there is rarely a single cause. The main things that raise your chance of getting them are:

A family history — they often run in families

Long hours standing or sitting still at work

Pregnancy, which increases the blood volume and pressure in the leg veins

Getting older, as vein walls and valves lose strength

Being overweight

A previous clot in the leg veins (deep vein thrombosis)

Women are affected more often than men, but men tend to come later, when symptoms are more advanced. You cannot change your genes, but staying active and keeping a healthy weight help your veins.

At your visit the doctor asks about your symptoms, your work, pregnancies and any previous clots or vein treatment. Your legs are then examined while you stand, because that is when the veins fill.

The key test is a duplex Doppler scan of the veins (an ultrasound that shows both the vein and the direction of blood flow). It takes about 15–30 minutes, is painless and is usually done in the same visit. It shows exactly which valves are leaking and where the problem starts, which is often a vein you cannot see from the outside.

Wear loose trousers or a skirt, and bring any previous scans or reports. Treatment is then planned on the scan results, not only on what the veins look like.

Treatment is matched to your scan and your symptoms, starting with the simplest option:

Medical compression stockings: they support the veins and ease aching and swelling, but do not cure the leaking valves.

Foam sclerotherapy: a medicine mixed into a foam is injected into the vein through a fine needle, which makes it close and fade over time.

Endovenous laser or radiofrequency ablation: a thin fibre or catheter is passed into the faulty vein through a needle, and heat seals it shut from the inside. It is done under local anaesthesia and usually takes 45–60 minutes.

Ambulatory phlebectomy: remaining bulging veins are removed through tiny nicks in the skin that usually need no stitches.

These methods are often combined. Blood simply finds its way through the healthy veins.

Most patients walk out of the clinic the same day, and walking is encouraged straight away. You will usually wear a compression stocking for a short period, as your doctor advises.

Mild bruising, a pulling feeling along the treated vein and some tenderness are common for one to two weeks. Most people return to desk work within a few days, and to more physical work and the gym a little later.

The treated veins fade over several weeks. A follow-up visit, often with a short scan, checks that the vein has closed and that there is no clot.

Treatment fixes the faulty veins, but it cannot stop new ones forming in the future. Staying active and keeping a healthy weight help protect the result.

Book a visit if your veins cause aching, heaviness, swelling or night cramps, if the skin around your ankle is itchy, darker or harder, or if you simply want to know your options.

See a doctor promptly if you have:

A wound near the ankle that is not healing

A varicose vein that becomes hard, red, hot and painful (a clot in a surface vein)

Seek emergency care if:

A varicose vein bleeds heavily: lie down, raise the leg and press firmly on it while you get help

One leg suddenly becomes swollen and painful, which may be a deep vein clot

You have sudden breathlessness or chest pain