What are varicose veins?

Varicose veins are dilated veins that are draining blood from your skin.

What causes varicose veins?

Varicose veins are caused by the failure of valves that allow blood to travel up against gravity from your feet all the way back up to your heart.

What are the symptoms of varicose veins?

They can be many and also none. Some people have very large varicose veins with no symptoms whatsoever. Others can have very small veins that cause a lot of itching, soreness, pain, discomfort, and cramping. The commonest first symptom or sign is swelling in the ankle.

When should I worry about varicose veins?

I think you should worry about varicose veins if your skin becomes inflamed, sore or itchy or if you bleed at all.

How can I prevent varicose veins?

Simple answer is you cannot prevent varicose veins. We don't actually know the reason why people get them in the first place. We do know that little valves fail, but we don't know why that happens.

Are varicose veins painful?

About 20% of the population have varicose veins. But normally, in my practice, I see people who have painful varicose veins. That pain can be something very minor like a small ache or it can be almost excruciating if you get any complications, such as thrombophlebitis.

How can I ease varicose vein pain?

Some people use compression stockings or even flight socks and that compression can help reduce the discomfort of varicose veins. Other people use simple analgesia such as Ibuprofen or paracetamol, which can help. Both these solutions are really only short term, though.

Are varicose veins hereditary?

For the most part, they're not. Some very young people in their early teens can get varicose veins - and that is usually genetic - but most people who get varicose veins in their twenties or thirties don't need treatment until they're in their forties or fifties.

Most varicose veins are spontaneous, and no one actually knows the real cause of them. We do know the valves fail, but we're not sure if that's genetic or if it's just because we're standing all the time.

Are varicose veins dangerous?

It is unusual to have a dangerous complication associated with varicose veins. They sometimes can clot, that's a condition called thrombophlebitis. And that can be very painful. Occasionally they can bleed and that can be quite serious and quite dramatic as well. However, for the most part, varicose veins are not dangerous but they are very inconvenient.

Can varicose veins go away?

Varicose veins don't go away on their own. However, if you suffer a complication where your veins clot, this is a condition called thrombophlebitis. Sometimes they shrivel up as they heal. That is a very painful way of treating your varicose veins. And I wouldn't recommend it.

How do I get rid of varicose veins?

There are many different ways of treating varicose veins. You may well be aware of the older treatment where patients had a general anaesthetic and had cuts in their legs and veins removed by a treatment called stripping. That really is old fashioned and has been superseded by treatments where we thread small wires or lasers up the inside of the vein and deliver heat. That heat causes the vein to shrivel up and it does away with the need for pulling veins out.

How long do I need off work after varicose vein surgery?

Many people take a few days off. I would say that after varicose vein surgery, it feels like you have run a few kilometres or played your first football match of the year. I think it feels a little like a pulled muscle.

And whilst you're able to work from home the following day, I think commuting can be a little bit difficult. So, I would normally recommend that people have a light week, the first week following surgery, the second week is usually much better. And normally by the third week people are back in the gym and back to normal activity.

How should I sleep after varicose vein surgery?

You can really sleep whatever way you wish. Most people go back to their normal bed and sleep in their normal position.

Blood flows smoothly in healthy veins, where it travels to the heart and is prevented from flowing backwards by tiny valves. It’s common that these valves can become weak, leading to blood flowing backwards and collecting in the vein, so it becomes swollen and enlarged, causing the formation of varicose veins.

There’s no way to completely prevent them developing, but there are some things you can do to lower your chances of developing varicose veins.

Regular exercise and taking breaks throughout the day, particularly if your job or lifestyle requires long periods of standing or sitting, can help ease the discomfort. Try to take breaks every 30 minutes and change positions. If possible, elevate your legs to help with blood flow.

Compression tights can be purchased from most pharmacies and can help relieve the symptoms of varicose veins by squeezing the legs and helping blood flow.

Some people with varicose veins experience no physical symptoms besides their appearance on the body, commonly on the legs or feet. When side effects do appear, these can include: 

• Achy or heavy feeling in your legs
• Swelling in lower legs
• Itchy or burning feelings in lower legs
• Pain or discomfort after standing for a prolonged period
• Skin discolouration or visible veins in legs that appear twisted or bulging

While men and women are equally prone to getting varicose veins, women are more likely to visit a doctor about their veins because of the way they look, whereas men tend to put it off until the veins are more advanced and causing skin trouble or severe pain.

Similarly, though varicose veins aren’t directly caused by pregnancy, pregnancy hormones may make pre-existing varicose veins worse. The good news is that after pregnancy the veins should subside a bit, even if they don’t go away completely. 

Unfortunately, getting older can also lead to varicose veins developing. This is because veins naturally lose their elasticity which can stop valves within the veins from working as well as before.

There’s no evidence that sitting cross-legged causes varicose veins, but we’d recommend that you avoid crossing your legs to prevent restriction on the blood flow in the veins which can lead to Deep Vein Thrombosis (DVT).

It’s not clear whether varicose veins are truly caused by genetic reasons or whether they’re just very common. There may be some genetic influence, as some very young people get varicose veins, but it’s probably not the whole story.

We offer sclerotherapy as a treatment for spider or thread veins. This involves injecting a special foam or fluid into the affected veins. After a sclerotherapy procedure, treated veins tend to fade within a few weeks, although occasionally it may take longer to see the full results. You might need several sclerotherapy treatments.

Meeting your Consultant at a clinic is the first step to pain-free, healthier legs. The aim of the visit is to understand what’s wrong and agree on the best course of private treatment for your varicose veins. If you’re worried about your condition, or unsure what treatment will involve, they’re here to answer your questions and concerns. During your visit they’ll:

1. Understand the problem

Firstly, they’ll ask you about your medical history, focusing on the problems the veins are causing and any previous surgery you’ve had.

2. Assess your health

Next they’ll assess your general health by looking at your pre-existing health conditions and any medication you take. It’s worth bringing a list of your prescriptions with you.

3. Run a scan on your leg

Following that, they’ll examine and scan your leg using an ultrasound machine. The ultrasound lets them look inside your leg to find out where the veins are coming from. You might be surprised to discover that the veins you can see with the naked eye are only the tip of the iceberg!

Once they understand what the problem is, they’ll explain the structure of your veins, usually by drawing a simple diagram.

4. Talk about your treatment options

They’ll then discuss your treatment options. Surgical treatment for varicose veins has changed completely in the last 15 years, from the old style ‘stripping’ operations (requiring a general anaesthetic, and often a stay in hospital) to minimally invasive ‘walk in / walk out’ thread vein removal surgery under local anaesthetic, which is more like a trip to the dentist.

Your treatment might involve surgery, an injection (as with sclerotherapy treatment) or no surgical treatment at all. If you’re not suitable for surgery, either because of the structure of your veins, the risks involved or the likelihood of success, your Consultant will discuss this with you.

If your veins are suitable for surgery, they’ll discuss your expectations. Are you at risk of getting a venous ulcer in future? Are you concerned about how your legs will look after the surgery – or do you just want the pain and discomfort to go away?

What are the risks of surgery?

Finally, whatever option you choose, your Consultant will discuss the risks and benefits. Varicose vein surgery is very low risk and usually very successful. However, there are risks from any sort of surgery, and no treatment is guaranteed to make your leg look completely flawless, so it’s important that you have a clear and realistic understanding before starting your treatment.

5. Agree on a treatment plan

By the end of the consultation, you should be able to make an informed decision about your care. There’s a lot to take in, so your Consultant will give you an information booklet to read which will include the details of your treatment.  If you need to come back to the hospital for tests, they’ll explain what these involve and how much they might cost.

If you have any questions about what we’ve discussed, or there’s something you don’t understand, don’t hesitate to ask for clarification.

We’ll send a letter to you and your GP summarising what’s been discussed, including the next steps and who to contact if you have any concerns. 

The operation itself takes about 20 to 30 minutes. After the procedure, you might feel like you've pulled a muscle, so you may want to take a painkiller.

After your operation, we’ll apply a non-stick bandage and that stays on for between three and five days. You can go back to work the following, but most people take it easy for a day or two.

Patients were often told to walk around a lot after the old ‘vein stripping’ procedure to reduce the risk of DVT and to reduce pain after the operation. With modern laser treatment, most patients are walking normally right after surgery and there’s no need to ‘walk off’ the surgery.

This used to be very common with the old ‘high tie and strip’ operation, where up to 30% of patients would get a significant recurrence after surgery. It’s much less common now, where the recurrence rate after laser surgery is much lower.