Somehow, it always seems to happen when you’re planning to wear an outfit that shows a little leg. You look down, and then you spot it. It’s blue. It’s bulging. Is that a varicose vein in your leg? How the heck did that happen? Varicose veins (not to be confused with spider veins) are one of the most common vein-related conditions in the United States. An estimated 23 percent of the population is walking around with at least one of these protruding veins. More common in women than men, they’re also an issue that’s largely kept under wraps, with thousands of embarrassed women throwing on capris, jeans, or a long skirt to cover up the bulges in their gams. All the hush hush over varicosities can send you into a panic when you find one. But do you really need to freak out? Should you call the doctor? We’ve done the legwork so you can feel confident about what to do if a varicose vein pops out.
What is a varicose vein, anyway?
First up, a little flashback to seventh grade science class. Veins are part of the body’s circulatory system. These little vessels are tubes that pump blood throughout the body. As Jonathan Weiswasser, MD, a double board certified vascular surgeon at the Plastic Surgery Center in New Jersey tells HealthyWay, “Veins are designed to bring blood in an upward direction, from the feet to the trunk, through an elaborate mechanism.” Varicose veins are trying to do the work of pushing that blood upward, but they’re what Weiswasser calls “abnormal veins” caused by changes in the circulation in your legs. “Often, the mechanism [that sends blood upward] can be disrupted, so that blood goes in the opposite direction when a person stands (called venous reflux),” Weiswasser explains. “The blood has nowhere to go but down and out, and it travels through little branches that are connected to the vein with reflux to these little veins underneath the skin that aren’t accustomed to dealing with that kind of congestion and pressure.” Because they’re not prepared for the influx of fluid volume, the veins dilate, stretching and engorging. They go from invisible little rivers under the skin to highly visible (and often painful) varicose veins that bulge out from the skin.
Deep Vein Walking
It’s estimated that varicose veins affect 22 million women and 11 million men between the ages of 40 to 80, although they can crop up when you’re younger (or older). With numbers like that, it can seem inevitable that you’ll one day have varicosities to handle. But who will actually face them is often determined by genetics, says Kurtis Kim, MD, a vascular surgeon at the Vascular Center at Mercy Medical Center in Baltimore, Maryland. If one of your grandparents or parents suffered from bulging veins in their legs, your own risk is heightened. Another risk factor? Gender. Women outnumber men by more than two to one when it comes to varicose vein diagnoses, whether it’s during pregnancy—when the sharp rise of estrogen and progesterone in our bodies can have an effect on our lower limbs—or later in life. “Certain female hormones can cause laxity in the walls of blood vessels,” Weiswasser explains. This can be a good thing. It’s why women tend to have lower blood pressure than men. “[But] in the setting of venous reflux, this can lead to a predisposition to the development of varicosities,” Weiswasser says. So when varicose veins will arrive comes down to fate, but there are risk factors that can speed their debut along. Pregnancy ups your chances of being diagnosed with varicose veins significantly, as the body’s blood volume expands and stretches our veins. The weight gained during pregnancy is concentrated in the belly and puts pressure on the pelvic veins as well, which Kim says creates limitations on the blood flow toward the heart and causes the leg swelling that’s common during pregnancy. “These ineffective venous valves allow reverse flow in the vein, causing branch veins that surface to the skin,” Kim says. Those veins become engorged and enlarged, and presto, you have varicose veins in your legs (and very rarely, your abdomen). Working certain jobs can also up your risk of waking up to a vein popping out of your leg one morning. Ironically, both sitting at a desk all day in an office or being on your feet all day as a nurse or factory floor worker can up your chances of getting varicose veins, Kim says. That’s because upright and sitting positions both put pressure on the venous flow, making it tougher for our leg veins to pump that blood upward to the heart. The fact that varicose veins tend to crop up after age 40 also lends credence to the idea that plain old wear and tear on the body can cause them to show up. “You can say that just as our gravity and weight of our body generate wear and tear to our joints that [carry] the weight, our veins [go] through degenerative changes (dilat[ing], thereby making the venous valves not effective) that create varicose and spider veins, swelling, throbbing, burning, numbness and tingling, restless leg, night cramps, and in severe cases skin changes in the ankle (stasis dermatitis), ulcers, and infections,” Kim says. “This ineffective venous valves allow reverse flow in the vein causing branch veins that surface to the skin which becomes engorged and enlarged … which we call varicose veins.”
What’s the doc to do?
No matter when they show up, spotting a bulging vein in your leg may send you running for the phone to call your doctor. But do you really need to seek varicose vein treatment from a doctor? Or can you just walk around with them? First, you need to consider whether the vein you’ve noticed is even a varicose vein. If you spot something blue running down your calf or thigh, you may actually be dealing with spider veins, a similar condition wherein blood vessels dilate close to the skin and become visible. They don’t tend to bulge out the way varicose veins do, and they’re largely a cosmetic issue according to Weiswasser. In the medical world, spider veins are considered an inconvenience rather than a serious health condition. That said, most varicose veins garner the same reaction from the experts: They’re inconvenient, but they’re not a cause for immediate alarm. “I always tell my patients that varicose veins are completely benign,” Weiswasser says. “They are not a sign of bad health, poor circulation (in the sense that we hear about everyday), or blood clots in the leg.” He doesn’t recommend running to the doctor just because you spot something blue. But that doesn’t mean that varicose veins won’t cause pain or bother you, or that you should never go to the doctor for treatment. It’s when veins start to affect your lifestyle that you should seek a vascular specialist’s care, says Scott Musicant, MD, a board certified vascular surgeon at Sharp Grossmont Hospital in San Diego, Califormia. Musicant also warns patients who spot discoloration or wounds on their legs or feet to seek medical care immediately, as that can be a sign of other vascular disease. “Varicose veins can go on to clot, which can be painful and if associated with significant swelling may indicate involvement of the deeper veins which can be life threatening,” Musicant says, although he’s quick to note that this is not common. “Occasionally veins that are immediately below the skin can open and bleed, which is initially startling,” he adds. “But if the leg is elevated and the vein compressed, this can usually be stopped relatively easily.” Leg elevation is a treatment for varicose veins—or at least the pain they cause—in and of itself as it takes the pressure off the veins so the blood can flow unimpeded. Another consideration when deciding if you need to call the doctor now is this: The longer you walk around with varicose veins, the more extensive the treatment may be since varicose veins can worsen over time. When you show up at the doctor’s office, you can expect to undergo an ultrasound, as your doctor will need to investigate what is causing the varicosities. “I look at veins that are associated commonly with the development of varicose veins and determine whether there is reflux,” Weiswasser explains. “I can also tell from this ultrasound whether someone who is concerned but doesn’t actually have varicose veins [is] at risk for developing them in the future.” Next up? Treatment. Typical treatment for varicosities in the legs can be done in a doctor’s office under local anesthesia, allowing patients to return to work and other normal activities within a day. Most treatments are performed in less than an hour, and unlike treatments of old, today’s methods of removing varicose veins require no incisions or stitches and leave behind no scars. Vascular specialists take advantage of lasers and radiofrequency to do much of the work without damaging the skin of the leg. “The goal of treatment is to not only get rid of the varicose veins but to eliminate the reflux,” Weiswasser explains. “The treatment of reflux involves a technique called ablation, which is where we shut the refluxing vein down. When the vein is shut down, the reflux is eliminated and the congestion that is causing the development of the varicose veins goes away.” Although it can sound alarming to hear that veins are being shut down, Weiswasser says the veins aren’t necessary. Your blood will still continue to flow through your body via other blood vessels. The next step in the process involves making a series of small nicks in the skin, through which a vascular specialist will remove the varicosities. “The number of these nicks in the skin varies depending on how extensive the varicosities are, but usually we make between five and 20 nicks depending,” Weiswasser says. “The nicks require no stitches and they do not scar.” Aside from ablation, sclerotherapy is another popular treatment option used on both spider and varicose veins, says Thomas Terramani, MD, another vascular surgeon affiliated with Sharp Grossmont Hospital. “The procedure uses a needle to inject a salt solution into the vein, causing it to shrink,” Terramani explains. The procedure is simpler, but there is a drawback: It’s considered temporary because varicose veins are often a progressive condition that can develop in other veins as well. In fact, both ablation and sclerotherapy treatments are just that—treatments rather than cures, warns Kim. “This is a process that undergoes degeneration (again, just like joints after putting pressure on them for [a] lifetime), and so recurrence at a different site after initial treatment is common.” There is one piece of good news: Because varicose veins do cause pain, treatment is typically covered by most insurance plans.
An Ounce of Prevention
Although there are certain factors that increase your risk of developing varicose veins, genetic and hereditary factors make preventing them almost impossible. “There are ways to decrease the speed of progression which we call conservative management,” Kim says. His suggestions include wearing compression stockings (at least 20 to 30 mmHg), leg elevation, and exercise—which causes muscles to contract, pushing venous blood up toward the heart. Terramani suggests the following, especially if you know you’re at risk of developing varicose veins based on your family history and gender:
- Stay active—Avoid sitting for long periods of time, whether at home or work. Taking a 20- to 30-minute walk each day can help your body maintain proper venous circulation.
- Don’t smoke—Research indicates that varicose veins are more common in smokers because of the effect smoking has on regulating fibrin, a blood-clotting protein.
- Lose weight—Weighing more than 20 pounds over your ideal weight puts more pressure on your vein system.
- Put your feet up—Resting your legs on footstools when you sit or putting a pillow under your feet when you sleep are a couple of simple ways to keep your legs elevated and reduce venous pressure.