Varicose (Spider) Veins: Causes, Symptoms, and Treatments

Varicose veins are swollen, twisted blood vessels that bulge just under the skin’s surface. They are blue or purple and usually appear in the legs, feet and ankles. They can be painful or itchy. Spider veins may surround varicose veins. Spider veins are smaller red or purple lines that appear close to the skin’s surface.

Although they can be unsightly and uncomfortable, varicose veins aren’t dangerous for most people. In some cases, severe varicose veins can lead to serious health problems, such as blood clots. You can relieve most varicose vein symptoms at home. Or your healthcare provider can treat them with injections, laser therapy and surgery.

Varicose veins

What are veins?

A vein is a blood vessel that carries blood to your heart from tissues throughout your body. When a vein works as it should, valves (flaps that open and close) inside the vein keep blood flowing in only one direction — toward the heart.

Veins can be damaged by disease and injury. During the aging process, veins naturally lose elasticity and become less flexible.

What is the difference between varicose veins and spider veins?

Varicose veins and spider veins are both types of venous disease, but they look different. Spider veins are smaller and thinner than varicose veins. They look like a red or blue spider webs or branches of a tree, and they are close to the skin’s surface.

Spider veins aren’t usually painful. They can appear anywhere on the body, most often behind the knee, on the feet or on the face. Varicose veins usually appear on the feet and legs.

Who is likely to get varicose veins?

Anyone can develop varicose veins, but women are more likely to have them than men. Certain factors increase your chances of developing varicose veins, including:

• Age: During the aging process, vein walls and valves don’t work as well as they used to. Veins lose elasticity and stiffen.
• Gender: Female hormones can allow the walls of the veins to stretch. Women who are pregnant, taking the birth control pill or going through menopause have a higher risk of varicose veins because of changes in hormone levels.
• Family history: The condition is inherited (runs in families).
• Lifestyle: Standing or sitting for long periods decreases circulation. Wearing restrictive clothing, such as girdles or pants with tight waistbands, can decrease blood flow.
• Overall health: Certain health conditions, such as severe constipation or certain tumors, increase pressure in the veins.
• Tobacco use: People who smoke are more likely to develop varicose veins.
• Weight: Obesity and excess weight put pressure on blood vessels.

How common are varicose veins?

Varicose veins are very common. Around one-third of all adults have varicose veins. They are more common in women than in men.

What causes varicose veins?

Varicose veins occur when the walls of veins become weakened. As blood pressure in the vein increases, the weakened walls allow the vein to get bigger. As the vein stretches, the valves in the vein can’t work like they should. Sluggish blood backs up or pools in the vein, causing the vein to swell, bulge and twist.

Vein walls and valves can become weak for several reasons, including:

• Hormones.
• The aging process.
• Excess weight.
• Restrictive clothing.
• Pressure inside the vein due to standing for long periods.

What are the symptoms of varicose veins?

The most recognizable sign of varicose veins is a gnarled, blue or purple vein just under the skin’s surface. Symptoms include:

• Bulging veins: Twisted, swollen, rope-like veins are often blue or purple. They appear just below the surface of the skin on the legs, ankles and feet. They can develop in clusters. Tiny red or blue lines (spider veins) may appear nearby.
• Heavy legs: Muscles in the legs may feel tired, heavy or sluggish, especially after physical activity.
• Itching: The area around the varicose veins may itch.
• Pain: Legs may be painful, achy or sore, especially behind the knees. You might have muscle cramps.
• Swelling: The legs, ankles and feet can swell and throb.
• Skin discolorations and ulcers: If left untreated, varicose veins can cause brown discolorations on the skin. Venous ulcers (sores) on the skin can result from severe varicose veins.

Where do varicose veins usually appear?

Most often, varicose veins develop on the lower half of the body, usually on the calves, ankles and feet. They can also develop in the pelvic area (pelvic congestion syndrome), especially in women who have had children. Varicose veins in the testicles (varicocele) can lead to infertility in men.

How are varicose veins diagnosed?

Varicose veins are close to the surface of the skin and easy to see. Healthcare providers can diagnose the condition during a physical examination. Your provider will feel the veins and examine them while you’re sitting and standing.

To see detailed images of the veins and check for complications, your healthcare provider may recommend an ultrasound. This safe, painless test uses sound waves to produce pictures of tissues inside the body. Ultrasounds can show blood clots and how the valves are working.

What is the treatment for varicose veins?

There isn’t a cure for varicose veins. These treatments can reduce their appearance and relieve discomfort:

• Elevation: To increase blood flow and decrease pressure in the veins, you should elevate your legs above your waist several times throughout the day.
• Elastic stockings: Supportive stockings or socks compress the veins and reduce discomfort. The compression stops the veins from stretching and helps blood flow.
• Injection therapy (sclerotherapy): During sclerotherapy, a healthcare provider injects a solution into your vein. The solution causes the vein walls to stick together. Eventually, the vein turns into scar tissue and fades away.
• Laser therapy: In a minimally invasive procedure called endovenous thermal ablation, healthcare providers use a catheter (a long, thin tube) and laser to close off a damaged vein.
• Vein surgery: During these procedures, also called ligation and stripping, the surgeon ties off the affected vein (ligation) to stop blood from pooling. The surgeon may remove (strip) the vein to prevent varicose veins from reappearing.

How can I prevent varicose veins?

You may not be able to prevent varicose veins. You can reduce your chances of developing them by living an active, healthy lifestyle. Healthcare providers recommend many of the same measures to prevent and treat varicose veins:

• Avoid long periods of standing: To encourage blood flow, take regular breaks to stretch and walk around, especially if you have a job that requires you to be on your feet.
• Elevate your legs: Raising your feet above your waist helps blood flow to the heart.
• Maintain a healthy weight: Getting rid of excess pounds reduces pressure inside your blood vessels.
• Quit tobacco use: Smoking damages blood vessels, decreases blood flow and causes a wide range of health problems.
• Stay active: To improve circulation, move frequently and avoid sitting still for prolonged periods.
• Try compression stockings: Support socks and hose compress the veins and help blood circulate, which can prevent varicose veins from getting worse.
• Wear clothes that fit properly: To encourage blood flow, make sure your waistband isn’t too tight.

What is the outlook for people with varicose veins?

Usually, varicose veins are not dangerous and don’t cause long-term health problems. Most people with the condition are concerned with the way varicose veins look. They may experience discomfort but don’t develop complications.

What are the complications of varicose veins?

Varicose veins can cause ulcers (open sores), bleeding and skin discoloration if left untreated. Severe varicose veins may be a sign of chronic venous insufficiency. This condition affects the veins’ ability to pump blood to the heart.

People who have varicose veins may be more likely to develop blood clots. It’s important to tell your healthcare provider about varicose veins. Your provider should evaluate and monitor you for clotting disorders such as:

• Superficial thrombophlebitis: Blood clots can form inside varicose veins, causing a condition called superficial venous thrombosis or superficial thrombophlebitis. Thrombophlebitis is painful but isn’t usually dangerous. It is treatable.
• Deep vein thrombosis (DVT): People with varicose veins have a higher risk of deep vein thrombosis, a blood clot in a vein deep inside the body.
• Pulmonary embolism: A blood clot in the body (usually resulting from DVT) can become lodged in the lung. Pulmonary embolism is a life-threatening condition that requires immediate treatment.

Do varicose veins return after treatment?

Although treatments are effective, varicose veins can return. They are more likely to come back in women who become pregnant after treatment. You have a higher chance of varicose veins reappearing if you are overweight or have a sedentary lifestyle.

When should I talk to my doctor about varicose veins?

Although varicose veins aren’t usually dangerous, you should visit your healthcare provider for an exam. If you’re concerned about how varicose veins look, or if they’re uncomfortable, treatments can help. You should see your provider as soon as possible if the skin or veins are:

• Bleeding.
• Discolored.
• Painful, red or warm to the touch.
• Swollen.

Millions of people live with varicose veins. For most people, varicose veins don’t cause serious health problems. Lifestyle changes and at-home remedies can relieve symptoms and prevent them from getting worse. Talk to your healthcare provider about safe, minimally invasive treatments that reduce pain and improve the appearance of varicose veins.