What Are Varicose Veins?
Varicose veins are dilated blood vessels which are abnormally prominent, often tortuous and bulging. They have a red or bluish colour and vary in size from barely visible surface veins, to large varicose veins. These veins can become unsightly and may produce a dull aching or burning sensation of the legs after prolonged standing, which can, in many cases be quite severe.
The leg veins normally have one-way valves in them so that when the muscles contract and squeeze the veins, the blood can only go one way, and that is up the leg, in normal veins. In varicose veins the valves are not functioning properly (which is usually inherited [familial], and much less frequently following damage to the valves by trauma), so that, in these veins, in the upright position, gravity causes blood to reflux and accumulate in the legs.
This causes increased pressure within the varicose veins, which causes further stretching of the walls of the veins, (as well as fluid to collect in the lower leg,) which produces pain, and causes nearby normal valves to also stretch and not function, which, in turn, causes the varicose veins to continually worsen.
This incompetence of the valves in the veins commonly affects the superficial or saphenous veins (just deep to the skin) which are not essential for the blood to circulate properly in the legs, much more frequently than the deep veins (which are the most important), within the muscles in the legs.
As these varicose veins are abnormal and in fact allow the blood to flow in the wrong direction down the leg (instead of directing blood flow up the leg), the swelling and aching of the legs is worse at the end of the day and in fact is found in at least half of the adult female population (and 20% of men), who have this common problem.
Generally varicose veins are not dangerous but may cause the following problems;
- The cosmetic appearance may cause embarrassment when the legs are exposed.
- Painful symptoms such as dull throbbing, heaviness and tiredness, aching pain, cramping, burning, itching or restless leg syndrome may occur. However, these symptoms may also be due to other conditions, and not necessarily associated to the varicose veins.
- Skin changes of bluish discolouration, discomfort of warmth, itchiness and varicose eczema, and pigmentation (due to haemosiderin from extravasated red blood cells) may occur. In severe cases the tissues underlying the skin can become damaged, pigmented and woody (lipodermatosclerosis). In a small number of cases, the skin may break down causing long standing, difficult to heal varicose ulcers.
- Bleeding may occur not uncommonly, especially from very superficial varicose veins and can occur unexpectedly as this may be painless and just due to minor trauma. Blood loss can be considerable unless direct pressure is applied and maintained.
- Blood clotting may occasionally occur, in the superficial varicose veins themselves, or quite rarely, in the deep veins of the leg, which can cause the potentially serious complications of a deep vein thrombosis.