Varicose Veins: symptoms, causes and treatment

Varicose veins are enlarged, twisted surface veins that develop when leg vein valves do not work well.

Valves normally help blood travel back toward the heart. When they do not close effectively, blood can pool in a surface vein, stretching its walls and making it more visible. Varicose veins commonly appear on the legs and may be mainly cosmetic, uncomfortable, or associated with skin changes.

Some people have no physical discomfort. Others notice aching, heaviness, throbbing, itching or a tired feeling in the legs, often after standing for a long time. Swollen ankles are a very common presentation of varicose veins. Leg pain when walking can occur too, but it has several possible causes and should be assessed rather than assumed to come from veins.

The appearance may include blue or purple raised veins with branching lines. New one-sided swelling, warmth, redness, chest pain or shortness of breath needs urgent medical attention.

The main mechanism is weakened or damaged valves in veins near the skin. Gravity makes return blood flow from the lower legs harder, so valve problems are more noticeable there. Veins can also become more prominent during pregnancy or when pressure within the leg veins is increased over time.

Visible veins may remain stable or gradually become more prominent. Symptoms can vary from day to day and may be worse after prolonged standing or sitting. Over time, some people develop swelling or skin changes around the lower leg. An assessment can separate vein-related symptoms from circulation, joint, nerve or muscle causes.

A family tendency, increasing age, pregnancy, previous leg injury and jobs or routines involving long periods of standing can contribute. Carrying extra body weight may add pressure to leg veins. These factors raise susceptibility but do not determine whether someone will develop troublesome veins.

A clinician usually examines the legs while standing and asks about discomfort, swelling, skin changes, previous clots, pregnancy and medicines. An ultrasound scan may be used to show blood flow and check how vein valves are working. This information helps determine whether visible veins are superficial and whether a procedure is appropriate.

Management is guided by symptoms, skin health, ultrasound findings and personal preferences. Movement, calf-muscle activity, leg elevation when resting and avoiding long periods in one position can ease symptoms for some people. Compression garments may be recommended after an individual assessment; they are not suitable for every circulation problem.

Procedures may be considered for troublesome veins. These can include heat-based closure of a vein, removal of selected veins, or sclerotherapy, in which a solution is injected to close a targeted vein. A clinician explains the expected recovery, aftercare and possible side effects for the chosen procedure.

Regular walking and ankle movements activate the calf muscles, which help return blood upward from the lower leg. Take movement breaks during long journeys or desk work. Protect dry or itchy skin with appropriate moisturising and avoid scratching, as fragile skin is easier to injure.

Long-standing venous pressure can contribute to ankle swelling, skin inflammation, colour change and, less commonly, a skin ulcer. A varicose vein can bleed after an injury because it lies close to the skin. Apply firm pressure, raise the leg and seek urgent care if bleeding does not stop or is heavy.

Not every case can be prevented, especially when there is a family tendency. Keeping active, changing position regularly, and managing factors that place added pressure on the legs can support circulation. During pregnancy or after a previous vein problem, ask a clinician which measures are suitable for you.

Book a GP consultation for persistent discomfort, ankle swelling, new skin changes, bleeding from a vein, or veins that affect daily activities. Urgent assessment is needed for sudden one-sided leg swelling or pain, a hot red leg, chest pain, or breathlessness. A GP can assess the problem and arrange vascular evaluation when appropriate.