Introduction:

Varicose veins -- the most common vein disorder -- are enlarged, twisted veins that are not moving blood effectively. Veins move blood from your body to your heart. When the one-way valves in your veins weaken, they may allow blood to flow backward and pool in your veins. Your veins then become enlarged.

Varicose veins usually show up in the legs and feet, because standing and walking increases the pressure on these veins. They look like bulging, bluish cords beneath the surface of your skin. Spider veins are similar to varicose veins, but they are smaller and closer to the surface of your skin.

Varicose veins are common, affecting up to 60% of Americans. Women are more likely to have varicose veins than men are. In many cases, varicose veins are just a cosmetic problem. But varicose veins can also cause pain and discomfort. In some cases serious complications, such as phlebitis (inflammation of the veins), skin ulcers, and blood clots, can occur.

Signs and Symptoms:

You may have the following signs and symptoms along with varicose veins:

• Prominent dark-blue blood vessels, especially in the legs and feet (not "spidery"-looking veins, which are smaller)
• Aching, tender, heavy, or sore legs
• A burning feeling in your lower legs
• Swelling in the ankles or feet, especially after standing
• Breaks in the skin
• Itching around the vein
• Skin ulcers near your ankle -- this is serious and requires immediate medical attention

What Causes It?:

Varicose veins develop when your veins stretch and their valves, which prevent blood from flowing backward, don' t work anymore. Primary varicose veins happen when the walls of your veins become weak. They occur commonly as we age, and also in women during pregnancy.

Secondary varicose veins are most often caused by problems with veins that are deep among the muscles, which carry about 90% of the blood returning to your heart. These problems include blood clots and can be serious.

Who's Most At Risk?:

Yoy are at risk for varicose veins if you have the following conditions or characteristics:

• Family history -- if other members of your family have varicose veins, your risk is greater
• Female -- three times more common among women
• Age -- veins fail as we age
• Hormonal changes related to pregnancy, premenstrual period, and menopause
• Standing for long periods
• Obesity
• Certain diseases
• Arteriovenous fistulas (abnormal blood flow between arteries and veins)

What to Expect at Your Provider's Office:

If you have pain, burning, or sudden swelling associated with varicose veins, you should see your health care provider. Your health care provider will do a physical exam of your legs while you are standing. Your doctor also may do tests to see how well your veins are working and to distinguish between primary and secondary varicose veins. Your doctor may also do an ultrasound test to look for blood clots.

Treatment Options:

In many cases, you can relieve pain from varicose veins on your own. This may involve avoiding long periods of sitting or standing, getting regular exercise, losing weight, elevating your legs periodically, and wearing compression stockings.

Prevention

Regular exercise helps veins work better. Weight loss and exercise lower the likelihood of getting blood clots.

Surgical and Other Procedures

• Sclerotherapy -- A doctor injects a solution into a varicose vein that scars and closes the vein, then applies a compression dressing, in order to make the vein disappear. This can be done in your doctor' s office.
• Radiofrequency ablation -- a catheter is threaded into the varicose vein to heat the vein wall, causing the vein to collapse and close.
• Laser surgeries -- a laser sends a burst of light onto the vein, which makes it eventually disappear.
• Stripping the vein -- removal of the vein through a series of small incisions.
• Vein surgery -- generally only used in severe cases involving leg ulcers.

Complementary and Alternative Therapies

A comprehensive treatment plan for varicose veins may include several complementary and alternative therapies. Generally these therapies try to prevent varicose veins from developing or current varicose veins from getting worse, not make existing veins disappear.

Nutrition

• Eat foods rich in dietary fiber that have complex carbohydrates (whole grains) and bioflavonoids (dark berries, dark leafy greens, garlic, and onions). These nutrients help keep veins healthy.
• Supplements that may help include vitamin C (500 - 1,000 mg three times per day), vitamin E (400 IU per day), and zinc (15 - 30 mg per day).
• Rutin (500 mg two times per day) is a bioflavonoid that may shore up the walls of veins and help them function better. A number of studies have shown that oxerutins, flavonoids that come from rutin, relieve swelling, aching and pain from varicose veins. Some evidence suggests that rutin might do the same.
• Oligomeric proanthocyandin complexes (OPCs) are bioflavonoids found in grape seed and pine bark. Similar flavonoids are found in cranberry, hawthorn, blueberry, and other plants. Several studies suggest they may reduce leakage in veins and swelling in the legs. Doses are 720 mg of grape seed extract per day or 100 - 120 mg of pycnogenol (Pinus pinaster) three times per day. Taking grape seed extract along with a vitamin C supplement may raise blood pressure, so check with your doctor. Grape seed extract may increase the risk of bleeding, so ask your doctor before taking grape seed extract if you take blood-thinning medication like aspirin or warfarin (Coumadin).

Herbs

Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes).

• Horse chestnut (Aesculus hippocastanum) 250 mg two times per day, standardized to contain 16 - 21% aescin. Several scientific studies show that horse chestnut helps symptoms of chronic venous insufficiency, a condition associated with varicose veins. Use only reputable brands that have been professionally formulated, because crude preparations can contain a toxic compound. Do not use if you have liver or kidney disease or take blood-thinning medication, and do not take more than the recommended dosage. People who are allergic to latex may also be allergic to horse chestnut.
• Gotu kola (Centella asiatica), 200 mg two to four times per day, standardized to contain 10% asiaticosides. Several studies also suggest that gotu kola can help relieve symptoms of chronic venous insufficiency, including swelling and leakage from veins. Do not take gotu kola if you have liver disease.
• Butcher's broom (Ruscus aculeatus), 150 mg three times per day, standardized to contain 9 - 11% ruscogenin. A few studies show that butcher' s broom reduced swelling compared to placebo in people with chronic venous insufficiency. Butcher' s broom may interact with some blood pressure medications and stimulant medication. Ask your doctor before taking butcher' s broom.
• Bilberry (Vaccinium myrtillus), 80 - 160 mg three times per day, standardized to contain 25% anthocyanoside. Do not take bilberry if you take a prescription diuretic (water pills). Bilberry may slow blood clotting and increase the blood-thinning effects of medications such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin. Ask your doctor before taking bilberry.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Arnica montana -- for people whose legs appear bruised and who have swollen veins that are painful to the touch. The legs tend to ache all over and feel worse with movement, but better when lying down.

Calcarea carbonica -- for people with painful varicose veins who are easily fatigued and have poor circulation, with cold hands and feet. There may be a tendency toward being overweight and feeling anxious when working too much. The person may have a taste for sweets.

Hamamelis -- for large varicose veins that may be tender to the touch. The legs may appear purple or bruised and may sting, and the person may also have bleeding hemorrhoids.

Pulsatilla -- for swollen veins that feel heavy and warm at night, and ache. Symptoms are worse with warmth and better with cold.

Physical Medicine

Cold compresses of witch hazel (Hamamelis virginiana) and yarrow (Achillea millefolium) tea may provide temporary relief from pain and burning.

Prognosis/Possible Complications:

Varicose vein disease is a long-lasting (chronic) condition. New varicose veins often develop after treatment.

Following Up:

Walking after sclerotherapy is important to help promote healing.

If you've had surgical treatment, contact your health care provider if you develop severe pain, tenderness, swelling, scabs, or blisters.