What are varicose veins?
Normally, blood is pumped out of the legs back towards the heart, mainly by the leg muscles squeezing blood up the veins as the muscles contract and relax with movement. Normal veins have a series of “trapdoor” valves that open as the blood flows up but close when the blood falls back down (as the muscles relax). In varicose veins, these valves have been damaged, so the valve does not close properly. This allows the blood to fall back down through the valve.
As a consequence, blood return is sloppy. Being a heavy fluid, a long column of blood such as in a varicose vein, will stretch the vein causing it to become dilated and tortuous. Hence the typical appearance of a varicose veins.
Varicose veins do not occur in the arms. They can occur in the pelvis, but nearly always they are limited to the legs.
There are two sets of superficial veins just beneath the skin in the legs that can become varicose. Both return blood from the foot and leg. One system drains into the deeper veins behind the knee (the Short Saphenous system), and the other drains into the deep veins in the groin (not surprisingly called the Long Saphenous system).
Most of the blood returning from the leg does so via the deep system, which is deep within the leg and not visible. The veins under the skin can expand and contract, to allow for temperature changes. That’s why ordinary veins stand out on a hot day, they have dilated to allow the body to lose heat. That’s also why varicose veins tend to ache more on hot days.
Symptoms of Varicose Veins
Often there are no symptoms at all, even when there are complications from the varicosities. However, symptoms are related to the weight of the column of blood, so tend to be prominent after prolonged standing, and relieved by elevating the leg. Thus it is very unusual to have symptoms in bed, except possible nocturnal cramps in the affected leg.
The veins dilate on hot days, so we can lose body heat. Hence the symptoms tend to be worse on hot days.
Women also have more fluid circulating in their blood stream before their period, which explains why they often note more discomfort in their legs during the week before their period. The same situation with extra fluid occurs during pregnancy. This is compounded by the extra hormones actually affecting the blood vessels, as well as the back pressure caused by the baby squashing veins in the pelvis. Some women can develop very uncomfortable varicose veins in their genitalia during pregnancy (vulval varicosities). They usually improve or settle after delivery, and are easily treatable if they persist.
Typical symptoms are:
- Heavy tired legs when standing, particularly by the end of the day
- Visible tortuous varicose veins, often tender, especially after long standing or during hot weather
- Aching calf, or area over a visible vein
- Restless legs – both during prolong sitting and at night when trying to sleep
- Itching skin or eczema, often in the area of a varicose vein
- Patchy brown spots over lower leg
- Leg swelling
- Leg ulcers, usually on the inner aspect of the lower leg
- Tight shiny thin skin about the ankle area
- Leg cramps in bed
- Numerous spider veins, especially if located over the medial aspect of the thigh or leg
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