Do you suffer from and have seen someone with abnormally enlarged or bulging veins on their legs? You might have wondered what these are, especially if they don’t go away. These distended veins are called varicose veins.
Dr Hasham Varwani, consultant interventional cardiologist at Aga Khan University Hospital Nairobi, gives insights and how it is managed.
What are varicose veins?
Varicose veins are abnormally swollen blood vessels that usually emerge just under the surface of the skin. Usually, they appear on the lower part of the legs, and sometimes the pelvic area.
Often they are not painful in the early stages, but in advanced disease, they can lead to swelling around the ankles, discomfort, and pain.
What causes varicose veins?
Veins in the human body have valves that allow blood to flow in one direction, which is toward the heart. As you walk, and move around, muscles in the legs contract, squeezing blood upwards against gravity.
This mechanism is crucial to preventing gravity from pulling the blood back into the feet. However, sometimes the valves become incompetent, and this causes blood to be drawn back by gravity to the feet leading to distended veins - also known as varicose veins.
Are there risk factors?
There is no known cause as to why the valves can collapse, but there are known risk factors that can lead to varicose veins.
One of the risk factors is genetics. You are more likely to have varicose veins if there is a strong genetic component of the disease in your family.
Excessive weight or obesity is also a major risk factor as veins come under greater pressure.
With excess weight, veins are forced to work extra hard to circulate blood to the heart, and this pressure might lead to their collapse, leading to varicose veins.
Pregnant women are also highly likely to get varicose veins mainly because with pregnancy there is weight gain and an increase in blood volume.
This means, that just like in obesity, the valves of a pregnant woman must work extra hard to ensure that blood circulates.
Standing or sitting for long periods is also a risk factor. There is also a gender-specific risk with women being more likely to get varicose veins compared to men.
This is mainly due to hormonal changes that happen during menstruation or pregnancy, which might cause the veins to relax, leading to the pooling of blood in the veins.
What are the symptoms?
The main symptom is visible, bulging veins. These initially start as small veins called spider veins, and later enlarged in size.
Many times varicose veins are associated with the incompetence of the venous draining system – and this may be associated with swelling of the ankles.
In long-standing untreated disease, the patient will develop skin changes – darkening of the skin, and very dry skin - venous eczema.
In the most advanced cases, ulcers develop around the ankles and lower shins. These are often chronic and take a long time to heal, and are best prevented by treating the early stages of the disease.
Treatment and management
There are various options one can explore when it comes to the treatment of varicose veins. The first is exercise. Physical activity will not only help prevent varicose veins but will also help with the treatment.
Physical activity means that you increase the circulation of blood flow in the body, hence preventing the pooling of blood in the veins.
Limb elevation is also very helpful. Taking short breaks from standing and sitting and putting your feet up also helps to reduce the pressure in the veins and improve symptoms.
Your doctor may also recommend compression stockings. These squeeze the veins from the outside, aiding the blood to flow more efficiently.
Your doctor will usually also ask for a venous ultrasound or doppler. This is to check the competence of the venous drainage.
If venous insufficiency is documented in the draining veins, then the doctor may recommend a procedure to treat this.
Currently, these procedures are done using minimally invasive catheter-based techniques which use laser, heat or special glue to treat venous incompetence.
The procedure is done in the office under local anaesthesia and produces excellent results and halts the progression of the disease.
In addition, visible spider and varicose veins can be injected with a medicine that helps to collapse them so that they disappear over time – this is called sclerotherapy.
Varicose veins may be the early features of venous insufficiency. And if this goes undetected and untreated has the potential of leading to other symptoms and complications, which hurt the quality of life of the patient.