Varicose veins, those bumpy, enlarged blood vessels, usually in the legs, occur when the valves inside the veins fail. The valves are there to keep blood from flowing backward, so when they fail, blood pools lower and lower in the leg, causing the vein to “pop” up toward the surface of the skin. Each time one valve fails, that puts more pressure on the valve below it.
“It’s like a domino effect,” said Dr. Robert Weiss, a dermatologist and director of the Maryland Laser, Skin, and Vein Institute in Baltimore. The result of the pooling blood is a less-than-optimal cosmetic appearance and an achy, fatigue-like feeling in the legs, especially in people who stand for long periods of time.
In some cases, varicose veins can also be caused by blood clots, so if you have large, painful veins, you should have an ultrasound exam to rule out clots, said Dr. Michael Jaff, director of vascular medicine at Massachusetts General Hospital.
In one sense, there’s not much you can do to prevent varicose veins. The tendency to get them run in families, and women, perhaps because of the pressure of pregnancy on leg veins, get them more than men.
But aerobic exercise like running, swimming or cycling can help, in part by building strong calf muscles help squeeze blood back up toward the heart. Weight lifting is a no-no because the increased pressure with all that straining can make varicose veins worse.
If your varicose vein problems are mild, compression stockings – the over-the-counter kind or thicker, stronger ones available by prescription – can help keep blood from pooling at the ankles.
Historically, doctors used to recommend surgery to “strip” or remove the veins in severe cases. Now, the preferred treatment is endovascular laser therapy, in which a laser is used to burn the inside of veins, causing the sides to stick together; an even newer approach, using radio frequency, is also in the works. Over time, the body absorbs the vein and other blood vessels take over the circulatory function.
Smaller varicose veins called spider veins can be treated with sclerotherapy – the injection of a medication – into the vein to make it collapse and disappear.