Varicose veins which are widened and twisted develop when the tiny one way valves within the vessels malfunction and allow some blood to seep backwards. The most familiar are those in the lower legs, which appear bluish and bulging, but they also form in the anal area. Less often, veins in the esophagus become varicosed; this condition, usually linked to liver disease, can cause serious intestinal bleeding. In general, varicose veins are more of a cosmetic problem than a health threat. In some instances, however, they cause pain and ulcers; they also increase the risk of phlebitis, an inflammation of the veins, A predisposition for varicose veins is often inherited. Obesity and straining during bowel movements also con tribute to the condition. The hormonal changes of pregnancy that promote relaxation and stretching of connective tissue can cause varicose veins, which often disappear within a few months of giving birth. About 10 percent of men and 25 percent of women are affected by the disorder. Occupations that require standing in one place for long periods do not cause varicose veins, but can worsen them once they develop.
Other Causes of Leg Pain
Phlebitis causes inflammation, pain, and swelling in leg veins. Reduced blood flow through the leg arteries can also result in pain, especially during exercise. Nerve disorders, including the neuropathy associated with diabetes, frequently produce leg pain.
Diagnostic Studies And Procedures
A doctor can detect superficial varicose veins by sight and by palpating, or feeling, for swollen vessels while the patient stands. Other signs may include a brownish-gray discoloration of the skin and skin ulcers in the lower legs. To pinpoint the faulty valves, the doctor elevates the leg to empty the saphenous vein there and then, while applying pressure to this same vein in the upper thigh, asks the patient to stand, which will cause bulges to form over the diseased vessels. Doppler ultrasound, using high frequency sound waves, can detect less obvious abnormalities, as can venography, X ray studies of the vessels taken after injection of a dye.
Normally, varicose veins do not require treatment unless their appearance is troublesome or they are causing pain, skin changes, or ulcers. For mild cases, sclerotherapy may suffice. In this procedure, an irritating solution, such as sodium tetradecyl sulfate, is injected into the vein, foam pads are placed over it, and the leg is wrapped with a compression bandage. The solution collapses the treated veins and blood is diverted to other veins, causing the discolored bulges to disappear. The patient can resume normal activities almost immediately, although the leg will remain bandaged for three weeks or longer. Less than 10 percent of patients require surgical stripping, or removal, of the saphenous vein. In this procedure, done under general anesthesia, at least two incisions are made, one in the ankle and the other in the groin. Other incisions may be made along the vein and its branches tied off. The surgeon passes a plastic stripper up the length of the vein, which is removed through the incision in the groin. The operation takes about 30 minutes. A week later, the stitches are removed and moderate activities resumed. However, vigorous exercise must be avoided until healing is complete, which usually takes two weeks. The operation leaves a few scars, and other veins may develop varicosities. Some 2 to 5 percent of patients experience ankle numbness due to damage of nerves in the skin.
Herbalists recommend covering the diseased veins with compresses soaked in a solution of horse chestnut extract and witch hazel, herbs that are said to improve the tone of venous muscles. Applying lotion containing butcher’s broom to the bulging veins is also reputed to help. Garlic, taken fresh or in capsules, is recommended to prevent clots.
People in developing countries who eat a high fiber diet rarely have varicose veins. Consuming a diet that provides plenty of fruits, vegetables, and whole grains may prevent the problem. Losing excess weight is also important.
Elastic stockings promote blood flow by compressing varicose veins. They are most effective if you put them on before getting out of bed in the morning and wear them throughout the day. Daily exercise is a critical aspect of self treatment. Cycling, walking, and swimming are good choices. Avoid standing in one place for any length of time; if your job requires standing, walk in place every few minutes, and if possible, alternate standing on each foot with the other supported on a low stool. When resting, elevate your legs so they are higher than your heart, a position that uses gravity to increase blood flow from the legs. Hot tubs, heating pads, and saunas may worsen varicose veins; instead, apply cold compresses or ice packs.