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Varicose veins are veins that are swollen because blood isn't flowing through them properly. Varicose veins are very common. If you have them on your legs, you can normally see them bulging and blue through your skin. Varicose veins don't often cause any serious problems. But they can make your legs ache, and many people are unhappy with how they look.

Varicose veins usually won't go away on their own. But if they are causing you problems, treatments can help your legs look and feel much better. Some treatments have side effects, so you need to consider the pros and cons when deciding what's right for you.

• Varicose veins are very common.
• You get varicose veins when the valves in certain veins are not working properly and blood collects in the veins instead of flowing up your leg.
• Varicose veins will slowly get worse if they are not treated.
• You can have varicose veins removed by surgery or you can have injections that make the veins disappear. Doctors normally use injections only for smaller veins or to get rid of any remaining veins after surgery.
• Varicose veins can come back after treatment and you may get new ones. Surgery seems to keep legs free of varicose veins for longer than injections, but surgery may have more risks.
• There are some things you can do to try to help symptoms such as aching and swelling. See Self-help for varicose veins.

Veins are the tubes (or blood vessels) that carry blood to your heart. Other tubes called arteries carry blood away from your heart and around the body.

Blood enters your veins once it has delivered oxygen and food to cells in your body. The blood in your veins looks blue through your skin because it doesn't have oxygen in it.

Veins are stretchy. Usually, they expand and tighten to let different amounts of blood pass through them. The wall of a vein has a smooth inner lining.

You have three sets of veins in your legs: deep veins, surface veins and connecting veins.

Once your blood has delivered oxygen and food to the cells in your legs, it collects in your surface veins. The blood then flows into the deep veins through the connecting veins and goes back to your heart.¹

Deep veins are the largest. You can't see them because they run deep within and between the muscles inside your legs.

Surface veins are just under your skin. You can probably see them, especially when your legs get hot: when the weather's warm or you have just gotten out of the bathtub, for example. These are the veins that may become varicose. You have two main surface veins in each leg. One runs the full length of your inside leg from your ankle to your groin. The other surface vein runs up the back of your leg from your ankle to just past your knee. Doctors call both these veins saphenous veins. Blood flows from these veins into deep veins.

Connecting veins join surface veins to the deep veins. They are small veins, and there are lots of them. Doctors sometimes call them perforating veins.

Most veins have a system of valves that help push blood back up to your heart. This is because, except for when you are lying down, the blood from the lower half of your body has to flow back toward your heart against gravity.

One-way valves in the walls of your veins make sure blood flows only toward your heart. When blood flows through a valve, the valve closes to keep the blood from flowing backward.

The muscles in your legs also help pump blood up toward your heart. When you stand, walk or make other movements, your muscles tighten and squeeze blood in the veins upward, against gravity.

You get varicose veins when the valves that normally keep blood flowing up through your legs don't work properly. This means that blood flows back down the vein instead of getting pushed up toward your heart. Blood then pools in your vein, which makes the vein bulge.

Doctors don't really know why your valves stop working properly. It may start with a weakness in the valve or a weakness in the wall of your vein. If the wall is weak, your vein overstretches. This means the valve can't close properly.^{2 3 4 5}

The most common places where valves in veins stop working are:

• In your groin, where a main surface vein meets a deep vein: If a valve goes wrong here, the varicose vein is likely to be worse than if a valve doesn't work somewhere else.
• Behind your knee, where a shorter surface vein meets a deep vein.
• In any of the small veins connecting surface veins to deep veins.

Varicose veins affect your surface veins. This is why you can see them through your skin. The surface veins usually affected are the two main ones, called saphenous veins (see above). Varicose veins often appear on the backs of the calves, or on the inside of your leg, anywhere from your groin to your ankle.

Varicose veins appear mainly on your legs. But you can have similar problems with bulging veins in and around your anus, where they form hemorrhoids. Men may also get varicose veins in their scrotum. This is the pouch that hangs behind the penis and holds the testicles. Doctors call varicose veins in the scrotum a varicocele.

Varicose veins don't look nice, but:

• They don't often cause serious health problems
• And they don't stop blood from getting back to your heart.

There are lots of veins taking blood from the surface of your legs to the deeper veins. So if one vein doesn't work properly, there are lots of other veins that can bring the blood back to your heart.²

A small number of people get varicose veins as a result of problems in their deep veins. See More serious problems in your veins.

Certain things make it more likely that you'll have varicose veins. These are called risk factors.

You may be more likely to have varicose veins if you're overweight, or if you're a woman and you are pregnant. Your family history also may be important, but researchers aren't sure. To learn more, see Are you at risk of varicose veins?

Keep in mind that even if you have a risk factor, that doesn't mean you will get varicose veins.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.