As a person ages, blood vessels (venules) within the calves and thighs expand in diameter. Varicose veins are larger vessels that range in color from flesh-toned to dark blue and often have a bulging, cord-like appearance.  Varicose veins are veins in the lower legs that are distended, widened, and in some cases, twisted. The veins most commonly affected by this problem are the ones just under the skin, called superficial veins. Besides the obvious swelling of the veins, symptoms are aching legs, muscle cramps and a feeling of heaviness in the legs. Because of bruises, blood may leave the veins and ulcers on the leg may appear. Varicose veins may also appear around the anus, and are called hemorrhoids. This situation, which is described in more detail in our section on hemorrhoids, is caused by constipation, improper diet, and sitting too long in a seat without enough padding.

Doctors have a nebulous catch-all phrase, chronic venous insufficiency or CVI, to describe vein circulation problems. All this means is that a person's vein circulation system is failing and blood is backing up either in the tissues or the veins. When blood backs up in the tissues, it produces edema (swelling). When it pools in the veins it is called varicose veins. Symptoms of CVI include nighttime leg swelling, leg pain and cramping.

Causes

Hereditary predisposition, obesity, prolonged standing, hormonal changes, and pregnancy are contributory factors, and over 50 percent of women are affected.  The primary cause of varicose veins is a breakdown of the valve system in the veins. Blood carrying nutrients to the cells is pumped from the heart through the arteries to the legs. The depleted blood then returns to the heart through the venous system - veins having one-way valves. If one or more aggravating factors are present, the swollen, distorted veins, which are called varicose veins, may develop. Age and extra weight, especially in the hips and waist regions, are some of the contributing factors. With age, the valves and veins become weaker, and muscle mass and tone tend to decrease, thereby impeding the return of blood to the heart and increasing the risk of developing varicose veins. These factors may cause the valve to leak or fail, allowing blood to accumulate in the veins, causing them to stretch.

Any activity that may add strain to the circulatory system or constrict the flow of blood may be a contributing factor. Prolonged standing or sitting, lifting heavy weights, long-distance running, lack of exercise and obesity are some of the factors to be considered. Wearing tight fitting clothing or boots are other possible causes. Aging, pregnancy, hormonal changes, and dietary deficiencies are also contributing factors.

Clothing that is too tight, including shoes or boots, will restrict circulation and may be the cause of your varicose veins by not allowing the blood to properly flow through your body. Snug fitting girdles, pantyhose, belts, and boots and shoes, especially high-heels, cut off circulation, thus forcing blood to seek alternative routes or causing back-pressure on the veins. Support hose, on the other hand, helps promote circulation. Make sure it is the kind that is tighter at the ankles, gradually decreasing the pressure as they get higher up the leg. If you can't find a good over-the-counter brand, they can be medically prescribed.

An unusual form of varicose veins affects over 200,000 women who suffer from chronic pelvic pain. See our Chronic Pelvic Pain section for more information.

The most common treatment is called sclerotherapy; it entails injection of the offending vessels with a sclerosing agent administered through a tiny needle. The procedure is accomplished without local anesthesia, and discomfort is usually momentary and minimal. When performed by an experienced health care provider, complications are infrequent and not serious; at times bruising may result, but this gradually fades. Common sclerosing agents include sodium tetradecyl sulfate, polidocanol, and hypertonic saline (concentrated salt solution). Following injection, a compression bandage should be applied for twenty-four hours. A successful injection produces dissolution of the dilated vessel over a three- to six-week period.

Laser therapy is a more costly solution and works best on those vessels of tiniest diameter. Minute bursts of intense light are directed into the veins, and when the procedure is successful, fading gradually ensues. Although somewhat painful, laser treatment appeals to some individuals because it allows them to avoid needles and injections. Often two to five treatments are required for adequate cosmetic result. As with sclerotherapy, there is no downtime.

Varicose veins can be a sign of venous insufficiency. At times they may ache. Workup entails physical examination and at times ultrasound analysis. Sclerotherapy may be effective. The treated vein frequently shows signs of inflammation and clotting, both of which are not serious and respond to hot compresses.

Larger vessels may be surgically removed by phlebectomy or stripping with ligation. These procedures are best performed in a surgicenter or hospital and entail small excisions followed by dissection of the offending vessels.

A more recently developed therapy, called endovenous ablation, entails the insertion of a catheter that emits radiofrequency energy into the vein. Alternatively, laser light can be administered using a fiber. The end result is shrinkage of the vein wall.

Bear in mind that a key to the prevention or recurrence of leg veins is compression. For predisposed individuals, graduated support compression stockings are recommended for use during daytime hours.

Tips

• Avoid standing for long periods of time. This will reduce pressure on the valves in the veins in your legs. If you are pregnant of if your occupation puts a lot of stress on your legs, wear support stockings.
• While standing, get on your tip-toes by lifting your heels off the floor. Do this twenty times, relax for a few minutes, then repeat. This exercise will strengthen your calf muscles and promote circulation.
• Your job or hobby may be the cause of your varicose veins. If you have to stand or sit too long in one position, this may cause circulatory problems. Crossing your legs may greatly enhance your problem, too. Try changing your work or sitting conditions and take the mini-breaks mentioned above. Varicose veins did not happen overnight and alleviating them will take time, too. Be patient.
• Heat dilates blood vessels so the veins are more visible after hot showers or baths. Try cool, quick showers instead of hot soaks. Cold compresses can also temporarily hide veins.
• Elevating your feet whenever possible will reduce the pressure in your legs. Use a recliner or ottoman when reading or watching TV, or if you read in bed, elevate your feet with cushions or pillows.
• Weight may also be a problem. Exercise and dietary changes to lose weight will be very beneficial to relieving varicose veins.
• Jump rope to strengthen the leg muscles and blood vessels. Begin slowly to build up tolerance; jump one minute per session and slowly build up to 5 minutes.
• Rubbing your legs with some sort of soothing lotion such as St John's wort oil, lanolin, or massage oil will relax the leg muscles and improve circulation. Gently massaging with an upward motion with your palms or fingertips and occasionally squeezing your legs will help force blood out of the veins in your legs and back to the heart.

Wellness Program

Dietary

• Constipation is one of the leading causes of varicose veins. Although it may initially be hard to see the connection, let us explain. Constipation may restrict the blood as it returns to the torso through the deep veins in the legs. Straining to have a bowel movement closes off the veins. As the blood backs up it takes another course through superficial veins, thus the blue streaks in the legs. As part of our recommended wellness program, we suggest a diet low in fats and refined carbohydrates, and high in fruits, vegetables and whole grains. This diet promotes health for the entire body, and, in the case of constipation, the high-fiber diet promotes regularity. Please see our Constipation section for an in-depth discussion of causes of and remedies for constipation.
• Eat more ginger, garlic and onions. These foods help break down the fibrin surrounding the varicose veins. People with varicose veins have a decreased ability to break down this substance.
• Some people recommend going on a juice diet one day a week to improve regularity.
• As part of dietary changes a program to lose weight will greatly help prevent or ease varicose vein problems. Carrying too much weight creates extra pressure on your heart and interferes with circulation.

Exercise

• As with any wellness program, exercise is an important component. Exercise helps promote circulation and improves muscle tone. People with varicose veins need to have moderate exercise as opposed to more strenuous forms, such as high-impact aerobics, jogging, strenuous cycling or other activities that increase the blood pressure in the veins. Walking, weight training, low-impact aerobics and swimming are a few of the preferred means of exercise, but anything that helps shift your weight or standing or sitting position will help. If you have a bad problem, take short breaks several times a day and walk around and stretch.
• As we age we lose muscle tone and the skin loses its elasticity. Veins that are undergoing pressure from some of the factors mentioned above will have a tendency to bulge out and become noticeable varicose veins. Any form of exercise that will strengthen the legs will help relieve varicose veins. Consistent exercise over several months will generally reduce the throbbing and aching often associated with varicose veins.

Supplements

As with so many diseases, there are underlying nutritional problems, that, if corrected, may well alleviate or eliminate the disease. We recommend the following supplements to help strengthen the circulatory system.

Vitamin A Intake of 25,000 IU, for skin integrity and to promote ulcer healing.

B-complex to help maintain strong blood vessels.

Beta-carotene This antioxidant is a healing nutrient.

Bromelain This nutrient aids in activating a factor that promotes the breakdown of fibrin and help prevent blood clots.

Vitamin C and bioflavonoids to aid circulation, promote healing of sores, and strengthen vein walls.

Calcium A calcium supplement will help stimulate the venous system.

Lecithin Take one tablespoon of granules (or two capsules) daily to emulsify fats and aid circulation.

Magnesium To relax the arteries and muscles in the legs.

Tissue salts Take two tablets of 6X Calcium Fluoride, mornings and evenings, to improve elasticity of blood vessel walls.

Vitamin E Take 300 to 800 IU, in gradually increased doses, to promote and improve circulation. Vitamin E may also relieve calf pain due to narrowing of the arteries.

Vitamin K cream will help strengthen the capillaries.

Zinc Take 50 mg. daily, to assist with healing and collagen formation.

Remedies