Varicose Veins

Varicose veins are swollen, twisted veins that lie just under the skin and usually occur in the legs.
Overview

Varicose veins are a common condition caused by weak or damaged vein walls and valves. Varicose veins may form whenever blood pressure increases inside your veins. This can happen because of pregnancy, constipation, a tumor, or overweight and obesity.

This health topic focuses primarily on varicose veins in the legs, but sometimes varicose veins form in other parts of the body. Hemorrhoids are a type of varicose vein that develops in the rectum. Varicoceles occur in the testicles and may be linked to infertility in men. Varicose veins can also develop in the esophagus, stomach, or liver. Other vein problems that affect smaller blood vessels are telangiectasia and spider veins.

Veins have one-way valves inside them that open and close to keep blood flowing toward the heart. However, weakened or damaged valves or walls in the veins can cause blood to pool and even flow backwards. This is called reflux. The veins may grow larger and become distorted, resulting in varicose veins. Visit How the Heart Works to learn more about blood flow to and from the heart.

You may be at increased risk for varicose veins if you are older, sit or stand for long periods, have an inactive lifestyle, have overweight or obesity, or have a family history of varicose veins or deep vein thrombosis, a type of venous thromboembolism. Pregnancy and childbirth, especially multiple births, also increase a woman’s risk.

Signs and symptoms of varicose veins include bulging, bluish veins; swelling; aching pain; a feeling of heaviness in the legs and feet; itching; changes in skin color; and nighttime leg cramps. Sometimes varicose veins can limit your activities. Your symptoms may get worse when you sit or are on your feet for long periods, and they may get better when you lie down or put your feet up.

To diagnose varicose veins, your doctor will do a physical exam and ask about your symptoms, family history, activity levels, and lifestyle. Your doctor may assess the health of your leg veins using an ultrasound or other imaging tests, such as an X-ray or computed tomography (CT) scan.

Depending on your symptoms, your doctor may recommend lifestyle changes, a procedure to remove or close varicose veins, compression therapy, or medicines. The goals of treatment are to relieve symptoms, improve appearance, and prevent complications such as serious skin ulcers or sores, deep vein thrombosis, skin color changes, and bleeding. Bleeding from varicose veins is a medical emergency. Seek immediate help if this happens.

Treatment - Varicose Veins

Treatments for varicose veins in the legs include lifestyle changes, medical procedures to remove or close them, compression therapy, and medicines. Depending on your symptoms, your doctor may recommend a combination of treatments or no treatment at all. There is a chance that new varicose veins may form even after treatment, or you may need to be treated more than once.

If you are pregnant, your doctor may recommend compression therapy and pain medicine to relieve symptoms of varicose veins, such as pain or heaviness in the legs.

Lifestyle changes
- Varicose Veins

Your doctor may recommend adopting lifestyle changes to help relieve symptoms or prevent varicose veins from getting worse. These may include:

  • Aiming for a healthy weight. This will improve blood flow and ease the pressure on your veins.
  • Avoiding standing or sitting for long periods. When sitting, elevate your feet so your legs are raised above the level of your heart.
  • Being physically active to help blood move through your veins. Strenuous or vigorous exercise might make varicose veins worse. Before starting any exercise program, ask your doctor about what level of physical activity is right for you.

Procedures
- Varicose Veins

Your doctor may recommend a procedure based on the results of ultrasound or other exams showing which of your veins are affected and how well they are working. Most procedures for varicose veins do not require a long recovery.

Options for medical procedures include:

  • Endovenous ablation to close off a varicose vein. The procedure uses lasers or radiofrequency energy to heat the inside of the vein and close it off. It is usually done in a doctor’s office with ultrasound to guide the treatment. Your doctor numbs the area around the vein so you do not feel pain during the procedure. Bruising, pain, and changes in skin color are common after endovenous ablation. More serious complications, including numbness, venous thromboembolism, and skin burns, are rare.
  • Sclerotherapy to close off a varicose vein. Your doctor injects liquid or foam chemicals into the vein to seal it closed. Sclerotherapy is done in your doctor’s office with ultrasound guidance. Liquid sclerotherapy is often used for spider veins. Complications of foam sclerotherapy may include skin color changes and, rarely, venous thromboembolism, nerve damage, serious allergic reaction, or stroke. Some people may have temporary vision problems, headaches, or confused mental states.
  • Surgery to remove severe varicose veins. Your doctor may make small cuts to remove smaller varicose veins near the skin’s surface. For larger, deeper veins, your doctor may use tools to tie off and remove them in a procedure called vein ligation or stripping. Surgery can often be done on an outpatient basis, but you may need medicine to help you sleep during the procedure. Because surgery may involve more pain and a longer recovery time, this option is usually only for people who are not candidates for endovenous ablation or sclerotherapy. Surgery complications may include infection, nerve damage, bruising, pain, and changes in skin color. Severe complications are rare.

Compression therapy
- Varicose Veins

Your doctor may recommend compression therapy as a treatment alone or after a procedure to remove or close off varicose veins. Compression therapy involves special elastic stockings or compression bandages that put gentle pressure on the legs to help prevent swelling.

For some people, especially those who have to sit or stand for long periods, compression may help relieve pain, swelling, and other symptoms, such as a feeling of heaviness in the legs. If you are pregnant, your doctor may recommend compression hose.

Compression therapy only relieves symptoms. Most doctors now recommend procedures to correct the reflux problem that is causing your varicose veins.

After you have a procedure to remove or close off your varicose veins, your doctor will probably recommend compression stockings for at least one week. Compression stockings may also help heal leg ulcers or sores that are a complication of varicose veins. Because vein problems are chronic, your doctor may suggest that you continue to wear compression stockings.

Some people find that compression stockings cause discomfort, itching, skin irritation, or swelling.

Medicines
- Varicose Veins

Your doctor may recommend medicine to help relieve the pain of varicose veins. Diosmiplex is the only available medicine approved for varicose veins. This plant-based medicine may help with some varicose vein symptoms and complications, including swelling, ulcers, and changes in skin and tissues of the legs.

It may take several weeks before you notice any improvement. Side effects may include gastrointestinal problems and rashes, but these are usually minor.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including varicose veins. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Varicose Veins

Learn about the following ways the NHLBI continues to translate current research into improved health for people who have varicose veins and related conditions. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.

  • Establishing Vascular Centers in the United States. In 1991, we announced the first program to help set up educational, clinical, and research programs in medical schools to focus on vascular diseases. By 1998, 15 medical schools had received NHLBI grants to set up vascular centers. The centers have promoted research to develop new treatments, provided education in vascular medicine, and helped people across the nation access the care they need for conditions affecting blood vessels.
  • Learning About Signs, Symptoms, and Risk Factors in People Who Have Varicose Veins. An NHLBI-funded study found that varicose veins were in two main categories: either near the surface of the skin without any blockages or valve problems or in deep veins along with valve problems or blockages. More women than men reported symptoms. The main symptom of varicose veins was aching, reported by 18 percent of participants. The scientists also confirmed the presence of risk factors for varicose veins based on age, sex, height, weight, activity levels, smoking, number of childbirths, and other factors.
  • Comparing Recurrence of Varicose Veins After Different Procedures. NHLBI-funded research showed that varicose veins reappeared in about one out of five treated legs, whether doctors performed endovenous ablation or surgery. The causes of recurrence differed with the two methods—a finding that has important implications for treatment.
  • Discovering Genes and Risk Factors for Varicose Veins. Using data from nearly half a million people, NHLBI-supported researchers conducted the largest-ever study of possible genetic and clinical factors related to varicose veins. The researchers identified 30 gene associated with varicose veins. The genes are mainly related to blood pressure and blood vessel development. In addition, the researchers identified new risk factors for varicose veins, including taller height.
  • Developing New Approaches to Treating Problems With Blood Vessels. Our Vascular Interventions/Innovations and Therapeutic Advances (VITA) Program is a translational research program that supports and accelerates early-stage development of promising diagnostics and treatments for conditions of the blood vessels. A VITA project supported the development of vessels grown in the laboratory that were derived from human cells and could replace injured blood vessels. Visit Bioengineered blood vessels that mimic real vessels move step closer toward clinical use for more information.

Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.

Advancing research for improved health
- Varicose Veins

In support of our mission, we are committed to advancing research on blood vessel disorders in part through the following ways.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies on varicose veins. See whether you or someone you know is eligible to participate in our clinical trials.

More Information

After reading our Varicose Veins Health Topic, you may be interested in additional information found in the following resources.

Non-NHLBI resources
- Varicose Veins