It’s In The Vein by Dr. Eduardo Gonzales, MD
The Whys And Wherefores Of Varicose Veins

Varicose veins are enlarged and twisted superficial veins that often appear blue or purple. Veins are the blood vessels that bring blood from the different parts of our body to the heart. In the extremities where the direction of blood flow to the heart is generally upwards, the veins are provided with one-way valves that prevent the backflow of blood. If these valves are damaged, blood pools causing the superficial veins to stretch and swell, forming tortuous, cord-like and unsightly masses called varicose veins that ruin otherwise unblemished legs.

Varicose veins are quite common. They affect 15 percent of adults, women four times more than men.

Risk factors for varicose veins

Varicose veins tend to run in families suggesting a possible genetic predisposition for the condition. In women, they are more common among those who had been pregnant. In fact, varicose veins first appear in many women during pregnancy. This is because during pregnancy the blood volume expands, the blood level of female hormones increases causing the veins to relax, and the enlarging uterus (womb) compresses the veins. Another important predisposing factor for varicose veins is obesity. More body weight means more pressure on the legs, which can lead to higher blood pressure on the veins, a condition known as venous hypertension. Other risk factors for the condition are menopause, ageing (due to wear and tear on the valves), abdominal straining—as in people who are chronically constipated or carry heavy loads, and prolonged standing—as in people whose jobs require them to do so.

Signs and symptoms of varicose veins

Varicose veins worsen with time—they become more prominent, engorged and swollen—but aside from being unsightly, they usually present no other signs or symptoms and most patients who seek treatment do so for cosmetic reasons.  When symptoms occur the more common ones include fatigue, aching, and edema or swelling of the legs especially in the afternoon and after prolonged standing; itchiness and/or discoloration—usually hyperpigmentation—of the skin that overlies the varicose veins; irregular whitish patches that look like scars on the ankles; and, occasionally, ulceration of the skin (i.e., a wound appears). Varicose veins may also bleed and become inflamed, albeit very rarely.

Incidentally, the severity of the symptoms has nothing to do with the number or size of the veins that are involved. Some patients have severe symptoms even if only a few veins are affected.

How to prevent varicose veins

The best way to prevent varicose veins is by maintaining desirable body weight and by moving around—rather than sitting or standing still for hours—to get the blood flowing throughout the body and promote healthy circulation.

In pregnant women, varicose veins can be prevented by always lying on the left side with the legs elevated on a pillow when resting or sleeping. This prevents the enlarged uterus from pressing on the leg veins.

Treatment options for varicose veins

In people whose veins are just beginning to varicose, the veins together with the symptoms may disappear or at least improve with regular exercise (e.g., walking), avoidance of prolonged standing, and intermittent rest during the day with the feet up. Additionally, elastic stockings that compress and provide support for the veins may be worn. There are also many over-the-counter topical creams and emollients that can help soothe pain and improve the appearance of varicose veins.

In people with severe symptoms or very unsightly lesions, several modalities are currently available to remove or destroy the involved veins. It is OK to remove superficial veins because they play a minor role in returning blood to the heart. It is the deep veins that perform most of these functions.

One very popular procedure is sclerotherapy, which involves injecting small and medium-sized varicosities with a sclerosing solution. Another popular effective procedure is vein stripping. This is a surgical procedure that involves pulling out of the varicosed veins through a small skin incision. Also becoming popular is the use of ultrasound or laser in burning away the veins.

The above-mentioned modalities are generally effective in affecting a permanent cure in the treated vein. Still, it is not uncommon for new varicosities to appear in other veins after some time.

This article originally appeared on Manila Bulletin Lifestyle.

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