Varicose veins on the lower half of a leg.

 M y patient, a math teacher and mother of three who spent 30 years standing in front of a classroom, gestured to her legs.

“What do you mean, ‘Live with it?’” she said, referring to the prominent veins on her upper calves. “I’m ashamed to wear shorts and wouldn’t think of going to the beach.”

She was, of course, commenting on my unintentionally insensitive advice.

More on Leg and Foot Pain

Her legs bore witness to the fact that she had a venous disorder—which can include spider veins (thin, reddish-blue squiggly lines that resemble a spider’s web) and varicose veins, those twisted, gnarled, bluish, distended veins of variable lengths, just under the skin’s surface.

Varicose veins are mostly seen on the legs from the knees down, and can also be found in the scrotum (varicocele) and in and about the anus (hemorrhoids).

They can exist without causing symptoms for years, although a recent report in the Journal of the American Medical Association did link varicose veins to an increased incidence of deeper vein clotting, which poses a threat of pulmonary emboli (blood clots in the lungs).

How Veins Become Varicose

Our venous system is an extensive network of channels, varying from large to tiny, that carries oxygen-poor blood from the body’s tissues and organs back to the heart and lungs. The reoxygenated blood is then delivered to the needy organs by our arterial system.

Because we spend a lot of time in the upright position, fighting the forces of gravity, the veins in our legs are equipped with valves that allow blood to flow upward toward the heart. By closing shut, these valves prevent backflow.

But an estimated 10 to 30 percent of the population—aided and abetted by heredity, occupations that involve an inordinate amount of time standing or sitting, old age, pregnancy, a sedentary lifestyle, obesity, and smoking—have valves that malfunction and begin to permit backflow.

The increased pressure of gravity distends those veins and thins their walls, especially the veins just under the skin (known as superficial). This creates the characteristic appearance of superficial varicosities.

Finding Fixes for Varicose Veins

Varicose veins are common; about 20 to 25 million people in this country have them. Most are “silent,” that is, they appear without symptoms such as swelling, aching, or heaviness, and exist only as an eyesore.

When the symptoms are mild, the mainstays of treatment are simple. Elevating the legs to about heart level several times a day can help in the battle against gravity, but it’s not always practical.

You may find wearing compression knee-high stockings or exercising more manageable. Stockings minimize superficial venous distension and help diminish edema, or swelling.

Exercise, such as walking and movements that include ankle flexion, helps propel the blood upward and diminishes backflow.

Some attention has focused on the use of dietary supplements, such as horse chestnut seed extract, for the relief of varicose veins. According to UpToDate, an online decision-making tool for doctors, this may help with swelling related to blood backflow.

But as with all dietary supplements marketed in this country, regulatory oversight is spotty, and what’s on the label isn’t always what’s in the bottle.

Can varicose veins ever be more serious? In some cases, backflow can initiate a devastating cascade of events, resulting in seepage of fluid with swelling. With prolonged seepage, the skin takes on a brownish color. In addition, the skin can break down, forming very painful, shallow, typically slow-healing leg ulcers that require professional wound care.

When push comes to shove, several invasive treatments are available. They include sclerotherapy (the injection of a solution that scars and closes the vein), laser therapy, vein ablation (which closes off the vein using heat), and surgical excision.

A Happy Patient

As for the math teacher, I referred her to a vascular surgeon who specialize in sclerotherapy. When I saw her a few months later, all that were left of her varicose veins were one or two barely discernible whitish lines.

She looked forward to wearing a bathing suit, and I became less demeaning to the cosmetic needs of my patients. 

Editor’s Note: This article also appeared in the June 2018 issue of Consumer Reports On Health