Leg health

Varicose veins: what they are, why they form and when to see a doctor

They are very common and usually not serious. Here is what to know, explained simply.

Reading time: 6 minutes · Based on patient information from the NHS, Italy's National Institute of Health (ISS), Mayo Clinic and Cleveland Clinic

What a varicose vein is

A varicose vein is a vein that has become wider. Under the skin it looks swollen and twisted, and sometimes it bulges out. It often looks like a cord.²

The colour is usually blue or dark purple. It can also be the same colour as the skin, depending on skin tone.³

They appear mostly on the legs and feet, but they can form in other parts of the body too. They are very common and in most cases they are not serious.¹

Why they form

Veins have one clear job: to carry blood back to the heart. In the legs they have to do this against gravity.³

They get help from two things. The first is the calf muscles: when they tighten, they push blood upwards like a pump. The second is a set of tiny one-way valves inside the veins. They open to let blood move up, then close so it cannot flow back down.^2,3

Over time the walls of a vein can lose their elasticity. The valves then weaken and stop closing properly. Some blood flows back down and collects in the vein. The pressure inside the vein rises, and the vein widens and twists.^2,4

It is not always possible to say why one person's veins weaken in this way.⁴

Who is more likely to get them

Anyone can get varicose veins. Some factors, however, make them more likely:^1,2,3,4

• Family history. The risk is higher if a close relative has them.
• Age. With the years, veins lose elasticity and the valves wear.
• Being a woman. Female hormones tend to relax the walls of the veins. This is why hormonal changes around periods and the menopause also play a part.
• Pregnancy. During pregnancy the volume of blood in the body increases, and the leg veins can widen.
• Being overweight. Extra weight puts more pressure on the veins.
• Standing or sitting for long periods. When you move less, blood flows more slowly.
• Smoking. Smoking damages the veins.
• A past deep vein thrombosis, which is a blood clot in a deep vein of the leg.

Having one of these factors does not mean you will get varicose veins. It only means the chance is a little higher.

Symptoms and typical signs

Many varicose veins do not hurt or cause any trouble.³ When they do, the most common symptoms are:^1,2

• heavy, tired or aching legs;
• swollen feet and ankles;
• a burning or throbbing feeling in the legs;
• leg cramps, especially at night;
• itching, or dry or thin skin over the vein;
• changes in skin colour near the vein.

These symptoms are often worse in hot weather or after many hours on your feet. They usually ease with walking or resting with your legs raised.^1,2

Without treatment, varicose veins can get worse. When this happens, it is usually very slow and takes place over several years.¹

Varicose veins and spider veins: the difference

Varicose veins are often confused with spider veins, also called thread veins. The medical name is telangiectasia.

When to see a doctor

Varicose veins rarely cause serious problems.^2,3 There are, however, times when it helps to get them checked.

See your doctor if:

• the veins cause pain, swelling, itching or discomfort;^1,2
• the skin over the vein is sore or irritated;²
• leg pain is disturbing your sleep;²
• the veins are getting worse;¹
• you have a small sore on your leg that has not healed after 2 weeks.¹

To check for varicose veins, a doctor usually looks at your legs while you are standing. If needed, they may ask for a duplex ultrasound: a scan that uses sound waves to show how blood is flowing in the veins.^1,2

Everyday habits the sources mention

The sources listed below mention some habits that can help with the symptoms. They help you manage them: the sources do not present them as a cure.⁴

• Move regularly, for example by walking. Movement helps blood flow.^1,4
• Take breaks if you stand or sit for a long time: get up, walk a little, change position.^3,4
• Raise your legs when you can, for example lying down with your feet on a cushion.^1,3
• Keep to a healthy weight for you, to reduce pressure on the veins.^1,4
• Do not smoke.^1,4
• Moisturise your skin if it is dry or itchy.¹
• Avoid high heels and tight stockings, apart from compression stockings recommended by a doctor.³

What treatments exist

Varicose veins do not always need treatment. If they cause no symptoms, often nothing needs to be done.^1,2 When treatment is needed, a vein specialist looks at each case and explains the benefits and risks of each option.¹ This is only an overview, so you know what the terms mean.

Compression stockings

They squeeze the leg in a graded way, tighter at the ankle and looser higher up, which helps blood move upwards. They can ease pain and swelling. It has not been shown that they stop new varicose veins from forming.² They are not suitable for everyone: circulation needs to be checked first, so it is best to ask a doctor which type to use.^1,2

Endothermal ablation

A thin tube, guided by ultrasound, delivers heat inside the vein using radio waves or a laser. The heat closes the vein and blood flows through healthy veins instead. It is usually done under local anaesthetic.^1,2

Sclerotherapy

A substance, often in the form of a foam, is injected into the vein to close it. More than one session may be needed.^1,2

Surgery

Through cuts in the skin, the vein is closed off and removed. The techniques are called phlebectomy, or ligation and stripping. Ligation and stripping is usually offered when other options are not suitable.^1,4

Varicose veins can come back, even after treatment.^2,4

Frequently asked questions