Varicose Veins

• Family history — much the strongest factor. If both parents had them, your chances are high
• Pregnancy, which raises pressure in the pelvic veins and relaxes vein walls. Veins appearing in pregnancy often improve in the months after birth
• Prolonged standing — relevant to hairdressers, nurses, teachers, retail and hospitality work
• Obesity
• Increasing age
• Being female, though men develop them too and are less likely to seek help for them
• Previous DVT, which damages the deep veins and pushes pressure into the superficial ones

Crossing your legs and wearing tight clothing do not cause varicose veins, despite being commonly blamed.

Mostly by looking

Varicose veins are diagnosed clinically — by their appearance, where they run, and the symptoms they cause. The examination looks at the pattern of the veins, the state of the skin around the ankle, and whether both legs are affected.

The test that guides treatment

Duplex ultrasound is the investigation that matters. It combines an ultrasound picture with blood flow measurement, showing exactly which valves have failed and in which vein.

This is not done to confirm the diagnosis — that is usually obvious. It is done to plan treatment, because the technique used depends entirely on which veins are involved.

What else is considered

• Previous DVT, which causes deep venous insufficiency and changes what treatment is appropriate
• Arterial disease, checked before compression is prescribed — compression stockings are dangerous in someone with significant peripheral arterial disease, and an ABPI is checked first. This is a genuine safety step, not a formality
• Pelvic causes, where veins appear high on the thigh or in the vulval area, particularly after pregnancy

What looks similar

Thread veins and spider veins are much smaller surface vessels, cosmetic only, and not treated on the NHS. Swelling of both legs is more often heart, kidney, thyroid or a medication such as amlodipine than it is venous.

What genuinely helps the symptoms

• Elevate your legs above hip level when resting — this is the single most effective free measure, and it works within minutes
• Move regularly. The calf muscle is the pump that returns blood up the leg, so walking is directly therapeutic
• Ankle exercises when standing still — rising onto the toes repeatedly engages the same pump
• Avoid standing motionless for long periods where you can
• Weight loss where relevant reduces pressure in the leg veins
• Moisturise the skin daily. Dry, fragile skin over a varicose vein is what eventually breaks down, and this is a genuinely preventive habit

Compression stockings

They relieve aching and swelling well. Two things worth knowing:

• Get properly measured. Ill-fitting compression is uncomfortable, ineffective and abandoned within a week
• Arterial circulation should be checked first if you are older or have risk factors, because compression on a leg with poor arterial supply causes harm

Put them on first thing in the morning, before the leg swells.

What does not work

Horse chestnut extract, vein creams and gels do not remove varicose veins. Some may modestly ease aching, but nothing applied to the skin changes a failed valve.

Elevating the foot of the bed slightly is a cheap and occasionally helpful measure people rarely try.

Are varicose veins dangerous?

Usually not. For most people they are uncomfortable and unsightly rather than harmful.

They become a medical issue when the skin around the ankle starts to change — brown staining, eczema or thickening — because that path ends in an ulcer.

Can I get them treated on the NHS?

Yes, if they are symptomatic or causing skin changes — and far more people qualify than realise it.

Purely cosmetic treatment is not funded, but aching, swelling, itching and skin staining all meet the criteria.

Should I be wearing compression stockings?

They help symptoms, but current guidance does not recommend them as the primary treatment where an intervention would be suitable.

Get measured properly, and have your arterial circulation checked first if you are older or have risk factors.

Will they come back after treatment?

Some recurrence is common over the years, because the underlying tendency does not go away.

Modern techniques have lower recurrence than the old stripping operation, but no treatment prevents new veins forming.

Does crossing my legs cause them?

No. Nor does tight clothing.

Family history is much the strongest factor, followed by pregnancy and prolonged standing.

One of my veins is hard, hot and red. Is that serious?

It needs assessing. That is superficial thrombophlebitis, and while it is usually manageable, it can extend towards the deep veins.

Get it looked at rather than waiting it out.

What do I do if one bleeds?

Lie down, raise the leg high above the level of your heart, and press firmly on the spot.

Elevation is what stops it — standing up while pressing does not work. Seek medical attention afterwards.

Do creams and supplements work?

Nothing applied to the skin repairs a failed valve. Some products modestly ease aching.

Elevation, movement and properly fitted compression do more, and cost less.

Mine appeared in pregnancy. Will they go?

Often they improve substantially in the months after birth.

It is usually worth waiting several months before considering treatment rather than acting during or immediately after pregnancy.