What are Varicose and Spider veins?
Varicose veins are abnormal, dilated blood vessels (veins) caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins.
Varicose veins are sometimes surrounded by thin, red capillaries also known as spider veins.
(group of tiny blood vessels located close to the surface of the skin, also called telangiectasias) – Refer Fig 1.
Role of veins and formation of abnormal veins
Veins carry blood back to the heart and have one-way valves that prevent the blood from back-flowing. The calf muscles act as a pump by which the blood is pumped back from the legs towards the heart as shown in Fig 2.
If those valves of the veins become weak from extended periods of increased pressure and swelling, the blood can back up and collect within the veins. This causes the vein walls to weaken and bulge with blood, causing the veins to appear swollen and twisted as shown in Fig 3.
Who can get it and where does it happen?
Varicose veins and spider veins can occur both in men and women. However, women are known to be affected more than men due to their hormonal predisposition and changes during pregnancy that affect the veins.
These abnormal veins can develop anywhere, but most often appear on the legs and in the pelvic area because as compared with other veins in the body. This is because, lower limb veins work harder to carry blood back to the heart with forces from the body weight and gravity acting at the same time. This pressure can be stronger than the one-way valves in the veins.
Most varicose veins are seen on the surface of the skin as the superficial veins get swollen with blood collected in it that get raised on the surface and at times above the surface of the skin.
Signs and Symptoms
Some may not have any symptoms but may be concerned about the appearance of the veins. Symptoms usually worsen after prolonged standing or sitting as the blood pools or collects in the veins of the lower limbs.
If symptoms occur, they may include:
- Tiredness, burning, throbbing, tingling or heaviness in the legs
- Itching around the vein
- Swollen legs (Refer Fig 4)
- Muscle cramps, soreness or aching in the legs
- Brown discoloration of the skin, especially around the ankles (Refer Fig 4)
- Leg ulcers (Refer fig 4)
- Rarely varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).
Risk factors and causes of abnormal veins
Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.
They can happen due to reasons:
- Idiopathic: The exact cause of this problem is unknown.
- Heredity: A family history of varicose veins can put a person at risk of developing abnormal veins.
- Advancing age: With aging veins can lose elasticity causing them to stretch. The valves in your veins may become weak, allowing blood that should be moving toward your heart to back-flow.
- Prolonged standing or sitting.
- Being overweight puts extra pressure on your veins, which means damage to the valves, making them more prone to swell.
- Pregnancy: Pregnancy increases the volume of blood in your body but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing foetus but it can produce an unfortunate side effect — enlarged veins in your legs.
- Hormonal influences during pregnancy, postmenopausal hormonal replacement therapy and use of birth control pills can cause excessive swelling in the lower limbs that hampers blood flow through veins.
- Wearing tight clothes can put pressure on the veins which can cause abnormal blood flow.
- Injury to the veins due to trauma or accidents.
- Other health conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery or heart failure.
How is Varicose and Spider veins diagnosed?
A physical examination of the body especially the legs while the person is standing is done. A Doppler ultrasound scan can also check the blood flow in the veins near the skin’s surface and the deep veins.
When to seek medical care?
- Walking or standing becomes painful.
- Soreness develops on or near a varicose vein
- Your feet or ankles swell up very frequently.
If immediate care is not taken, symptoms may worsen. Complications may develop if there is an underlying disease in the deep veins or in the perforating veins which connect the deep and superficial veins.
- Deep vein thrombosis (DVT): Blot clot formation in the veins is known as deep vein thrombosis.
- Chronic venous insufficiency: Untreated venous problems may progress to a chronic condition of abnormal blood flow through the veins.
- Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
- Fungal and bacterial infections may occur as the result of skin problems caused by the fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
- Thrombophlebitis: Inflammation of the vein due to blood clot formation.
- Venous hemorrhage: Bleeding through the veins due to micro-tears and ruptures.
How to prevent varicose veins and its complications?
- Losing weight if you are overweight
- Exercising regularly (especially walking)
- Avoiding prolonged periods of sitting or standing
- Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
- Avoid crossing your legs while seated.
- Elevating your legs while sitting and sleeping will help.
- When you need to stand for long periods, take frequent breaks – sit down and elevate your feet.
- Do ankle pump exercises as shown in Fig 5.
If you still develop varicose or spider veins, it is best to seek medical attention to know more in details on exercises and lifestyle changes that can be personalized to your needs.