Varicose Veins: Symptoms, Treatment

Brief overview

Symptoms: Visibly protruding veins under the skin, swollen and heavy legs, feeling of tightness, itching, in late stages “open legs
Treatment: Medication, compression stockings, measures such as venous gymnastics
Course and prognosis: In the case of circulatory disorders, it often happens that more and more varicose veins form over time. Varicose veins are divided into different stages depending on their severity.
Diagnostics: Physical examination, duplex sonography, angiography
Causes and risk factors: Blood stasis in the veins due to genetic predisposition, older age, obesity, smoking, female hormones
Prevention: regular exercise, Kneipp baths, alternating showers

What are varicose veins?

There are both large and small varicose veins. Most often, varicose veins occur on the legs – but not exclusively. In principle, it is possible for varicose veins to form in all areas of the body: for example, on the thigh, shin, foot, knee and ankle, arm, hand, face, intimate area at the vagina or labia in women, and on the penis or scrotum in men.

There are different forms of varicose veins:

Varicose veins on the legs

Depending on their location and shape, there are different forms of varicose veins on the legs.

Truncal vein and side branch varicose veins

These are varicose veins of the medium and large veins. This type of varicosis is the most common and occurs mostly on the inner side of the upper and lower legs.

Perforating varicose veins

Reticular varices

Reticular varices are very small varicose veins of the legs. The diameter of these small veins is a maximum of two to four millimeters. Reticular varicose veins are mainly found on the outer side of the upper and lower legs and in the hollow of the knee.

Spider veins

Spider veins are thin, net-like varicose veins. They rarely cause discomfort. However, some people find them to be an annoying blemish. Spider veins can be sclerosed easily and without complications. Several sessions are usually necessary. Since it is a cosmetic problem, those affected pay for it themselves.

More information on this topic can be found in the article Spider Veins.

Varicose veins in the esophagus

Varicosis of the esophagus is usually caused by damage to the hepatic circulation in scarring of the liver (cirrhosis). In this case, the blood backs up into the large circulation. The bypass circulations at the esophagus, the abdominal wall or the rectum fill up with more blood. The pressure causes the veins to bulge, i.e. varicose veins.

Varicose veins: symptoms

In the early stages, mild varicose veins usually do not cause any symptoms. Especially the very fine spider veins are usually harmless. In the course of the disease, other complaints such as water retention as well as pain and the feeling of tired, heavy legs often occur.

Varicose veins: Treatment

How are varicose veins treated without surgery?

Compression stockings

The most important measure to counteract varicose veins is compression stockings. These are very tight, firm support stockings that compress the calf tissue. They are often the first choice treatment for varicose veins. The pressure of the stockings on the legs strengthens the muscle pump of the veins. The venous valves close better. The pressure from the outside also prevents fluid from leaking out of the veins into the surrounding tissue and prevents edema.

It is best to put the stockings on while lying down, as the blood quickly pools in the legs when standing. Then the stockings no longer have the same effect. It is also important that the compression stockings fit exactly. Many patients therefore have them made to measure. They are divided into so-called compression classes (classes I to IV).

How are varicose veins treated without surgery?

Compression stockings

It is best to put the stockings on while lying down, as the blood quickly pools in the legs when standing. Then the stockings no longer have the same effect. It is also important that the compression stockings fit exactly. Many patients therefore have them made to measure. They are divided into so-called compression classes (classes I to IV).

Move: Simple exercises in everyday life will improve blood circulation in the veins. Try to avoid prolonged standing and sitting. If possible, walk around a bit regularly to re-stimulate blood flow in the veins.

Vein exercises: Get the blood flow going again with simple exercises. Teeter on the tips of your toes. Lie on your back and cycle your legs in the air. Lie on your stomach, lift an outstretched leg and pull the tip of your foot forward slowly and forcefully several times. Then switch legs.

Keep your legs elevated: especially at night. This facilitates the transport of blood toward the heart. Most patients report that elevating the legs particularly improves the feeling of tension in the legs and has a significantly relieving effect.

Alternating showers: Alternate cold and hot showers on your legs at 30-second intervals. Cold water causes the varicose veins to contract, while hot water causes the blood vessels to dilate. This exercises the blood vessels and stimulates circulation. Alternating showers often reduce swelling of the legs.

Home remedies have their limits. If the symptoms persist over a longer period of time and do not improve or even get worse despite treatment, you should always consult a doctor.

To get rid of already existing varicose veins permanently, the only way is usually through invasive procedures such as surgery or laser therapy. Read more about removing varicose veins here.

Varicose veins: Course and prognosis

Depending on the severity of the symptoms, varicose veins are divided into different stages:

Initial stage (stage I)

Heavy legs (stage II)

As the disease progresses, patients with varicose veins in the legs often suffer from heavy legs and feelings of tension. Their legs become tired more quickly. Calf cramps occur more frequently at night. These symptoms usually improve when lying down and moving, as the blood flow in the veins is then stimulated.

Some patients also report a pronounced itching or that the symptoms worsen in warm temperatures. In warm weather, the veins dilate, the blood flows even more poorly and worsens the symptoms.

Water retention (edema) in the legs (stage III)

The longer the blood stasis in the veins lasts, the more strained and permeable the vessel walls become. Fluid, proteins and blood degradation products (hemosiderin) are then squeezed out of the varicose veins into the surrounding tissue.

Open leg ulcers (stage IV)

If blood stagnation persists for a long time, the surrounding tissue is no longer supplied with sufficient oxygen. Small injuries then no longer heal properly. Ulcers form on the skin and the tissue dies. This is how the so-called “open legs” (ulcus cruris) develop.

The reduced blood flow allows only very slow wound healing. The open ulcers are therefore continuously treated by a doctor to prevent the spread of bacteria.

Vein inflammation (phlebitis)

Patients with varicose veins suffer more frequently from additional inflammation of the superficial veins (phlebitis). The chronic blood stagnation increasingly strains the vessel walls, so that they easily become inflamed.

Varicose veins: Examinations and diagnosis

The right contact person for suspected varicose veins is a specialist in vascular surgery or phlebology. In an initial consultation, the so-called anamnesis, the doctor will ask about current complaints and any previous illnesses (anamnesis).

He will ask the following questions, for example:

How old are you?
Do you smoke, and if so, how much?
Do you suffer from a feeling of tightness in your legs in the evening?
Have you recently felt that your legs are very heavy in the evening?
For women: How many pregnancies have you had so far?
Do other family members suffer from varicose veins?

The physician will then physically examine the patient for evidence of varicose veins. He will look at both legs and feet side-by-side to identify any swelling, skin discoloration or ulcers.

Ultrasound (duplex sonography)

Angiography of the veins (phlebography)

If duplex sonography is not sufficient or not available, imaging of the veins with contrast medium (phlebography) is performed. Phlebography also provides diagnostic information if thrombosis of the leg veins is suspected.

For this purpose, the physician punctures a vein in the groin or at the foot and introduces the contrast medium. The contrast medium makes the veins visible in the X-ray image: a discontinuation of the contrast medium course on the X-ray image indicates a vascular occlusion.

Varicose veins: Causes and risk factors

Varicose veins develop when blood backs up in the veins. The task of the veins is to transport the blood back to the heart against the force of gravity. This work is performed by the surrounding muscles of the veins together with the elastic vascular wall. In addition, so-called venous valves in the vessels ensure that the blood does not flow back.

Doctors distinguish between primary and secondary varices (varicose veins):

Primary varicose veins

Primary varicose veins account for 70 percent of all varicose veins. They develop without any known cause. However, there are some risk factors that favor primary varicose veins:

Advanced age
Overweight
Smoking
Hereditary factors
Female hormones

Heredity

Weakness of connective tissue is also inherited and increases the risk of varicose veins. However, other risk factors such as obesity, lack of exercise or gender have a greater influence.

Hormones

Women get varicose veins more often than men. The female sex hormones (estrogens) make the connective tissue more pliable. This promotes the development of varicose veins.

Pregnancy

Lack of movement

Exercise activates the muscle pumps and improves blood flow. When standing or sitting for a long time, the muscle pump slackens and the blood backs up more easily. If the veins in the back of the knee are also bent when sitting, this further impedes the venous return of the blood. A sedentary lifestyle therefore promotes varicose veins.

Secondary varicose veins

Secondary varicose veins account for about 30 percent of all cases of varicosis. They develop when an outflow obstruction forms in the veins. This usually happens after a blood clot in the deep veins of the leg (leg vein thrombosis).

Varicose veins: Prevention

Since the genetic predisposition to varicose veins remains throughout life, it is advisable to take preventive measures:

Exercise regularly and do sports. Endurance sports such as cycling, running or swimming are particularly suitable for strengthening the calf muscles and preventing varicose veins.
Eat a healthy diet and watch your weight. Excess weight often impairs venous blood flow and promotes varicose veins.
Put your legs up more often. The blood then does not have to flow against gravity and the feeling of “heavy legs” decreases.
Avoid intense heat and prolonged standing or sitting, both of which promote and aggravate blood stasis and varicose veins.