Varicose veins: Why they form and how to treat the pain

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Varicose veins can be unsightly and painful, and, unfortunately, roughly 20 per cent of Canadian adults will struggle with them.

The swollen, twisted veins typically appear as a bulge on the surface of lower limbs, and they occur when vein valves are damaged or don’t work well.

“Usually, veins carry blood from the extremities of the body back to the heart,” said Dr. Nikita Patel of the Women’s College Hospital Family Practice Health Centre.

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“Veins have thin valves inside of them to keep blood moving in one direction — towards the heart.”

When those valves don’t do their job, blood can pool in the legs — especially if you sit or stand for a long time without walking. This is known as chronic venous insufficiency.

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“Generally, walking helps milk that blood back up from the lower leg and up to the heart,” she said.

What causes varicose veins?

There are many reasons varicose veins develop.

The most common factor is genetic predisposition, according to Dr. Alexander Matz, the founder of Canada Vein Clinics.

He also lists “stationary jobs, being overweight and multiple pregnancies” as factors that can increase your risk of developing varicose veins.

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Patel adds that “getting older” can also contribute to their development.

“Generally, any process that increases pressure in the veins of the legs can widen the vein and result in damage to the valves within the vein,” she said.

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“It starts a vicious cycle that leads to even higher pressure, further worsening vein function… which can eventually lead to chronic venous diseases.”

Signs and symptoms

It’s very common for varicose veins to develop without any symptoms.

“Up to 50 per cent of individuals, even those with really large varicose veins, are actually asymptomatic,” said Patel.

However, when symptoms are present, varicose veins typically cause pain and a feeling of fatigue or heaviness in the legs — especially at the end of the day.

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“The actual swollen visible veins on the lower legs… usually have a dark purple or bluish colour, [and] they can appear to look like worms or bulging under the surface of the skin,” she said.

They can also cause swelling, usually around the ankles.

“This usually appears at the end of the day, when you’ve been upright [for a long time] and gravity is pooling blood and fluid in the lower legs,” said Patel.
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“You can also get a reddish-brown discolouration around the ankles from venous blood just sitting there.”

Sometimes, the swelling can also cause itching in the lower legs.

If your varicose veins cause any discomfort, you can seek treatment by a medical professional.

Are they dangerous?

Typically, these veins don’t present any major threat to your health.

“They’re usually superficial veins, as opposed to deep veins,” said Patel.

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“We have two networks of veins in the legs: superficial veins and deep veins… superficial veins run just underneath the skin.”

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This means that developing a varicose vein won’t affect any major blood flow to your heart or other extremities. However, in some cases, they can lead to serious complications if left untreated.

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“You have a 30 per cent higher risk of getting a blood clot,” said Matz.

“You may (also) develop more serious conditions, such as leg ulcers, spontaneous bleeding, superficial vein thrombosis (inflammation and clotting) or phlebitis (inflammation).”

In these cases, you should seek immediate medical attention.

Treatment options

There are two types of treatment for varicose veins, according to Patel. She calls them “conservative treatment” and “procedural treatment.”

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“(With) conservative treatment, you’re thinking about how to prevent yourself from getting more or worsening the (varicose veins) you currently have,” she said.

In this category, Patel puts walking regularly and avoiding prolonged sitting and standing.

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She also suggests raising your legs higher than your heart three to four times a day for 30 minutes at a time, and pointing and flexing the feet to help get the blood moving.

“Maintaining a healthy weight and BMI can help, (as can) keeping the skin of the lower legs regularly cleaned and moisturized to prevent ulcers,” said Patel.

Compression socks are also an effective conservative option for helping to “direct blood up towards the heart.”

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However, these are more preventative measures.

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“(This) doesn’t do a great job if you already have established varicose veins,” she said. “It might decrease them a little bit, but it won’t get rid of them altogether.”

To treat preexisting varicose veins, your doctor will likely recommend a procedural treatment — of which there are several.

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Minimally invasive methods are the “first line of treatment,” according to Matz.

“They don’t involve removal of these veins but rather sealing off (or ablation) of the veins. (They) result in less pain, faster recovery, less complications and probably better long-term results.”

There are two groups of minimally invasive procedures: thermal ablations (or sealing off veins using heat) and non-thermal ablations (sealing off veins without the use of heat).

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For the former, “a laser fibre is inserted into the vein and this closes the vein using heat,” said Matz.

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There are two non-thermal ablation methods: VenaSeal and ClariVein.

“VenaSeal seals off the veins using a special catheter with medical adhesive. The method causes no trauma to the veins and the affected veins are closed permanently,” said Matz.

“ClariVein is a unique method of administering sclerosant medication while mechanically scraping the vein wall from the inside with a special device, thereby closing the veins off and eliminating the symptoms.

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Patel notes that “treatments are generally considered cosmetic treatments, and they’re not (usually) covered by insurance companies.”

Depending on the size and number of your varicose veins, the cost of the treatment can range anywhere from a couple of hundred dollars to a number in the thousands.

“It’s important for patients to keep in mind that sometimes they need several treatments, and… if they don’t change their lifestyle, they might be at risk of creating more varicose veins.”


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