American Medical Association Family Medical Guide - American Medical Association [357]
Varicose Veins
Varicose veins are veins directly beneath the skin that have become stretched and twisted over time. This condition usually occurs in the legs when veins lose their elasticity and widen, causing the edges of the valves inside the veins to separate. The veins are then unable to return blood to the heart, causing blood to collect in the veins, widening them further.
Varicose veins are often visible because they lie directly under the skin. Although they are often unsightly, varicose veins seldom cause serious symptoms or health problems. Some people inherit a tendency to develop severe varicose veins. Varicose veins in the legs often result from excess pressure caused by standing for long periods. In severe cases, blood can clot on the inflamed, roughened walls of varicose veins, which can lead to thrombophlebitis (see next page), a more serious condition.
Blood flow in normal veins and in varicose veins
Varicose veins occur when the valves in the veins are no longer able to close properly, which interferes with the ability of the veins to return blood to the heart. Blood flows backward through the open valve, increasing pressure inside the vein and causing it to widen and stretch.
Symptoms
Varicose veins usually appear bluish and swollen and are more prominent when you are standing. They usually occur at the back of the calf or on the inside of the leg between the ankle and the groin. Varicose veins can also occur in the rectal area (see page 777), in the vagina during pregnancy, or where the esophagus meets the stomach in advanced cases of cirrhosis of the liver (see page 790).
A varicose vein in the leg may gradually enlarge. The vein may become tender to the touch, and the skin above it or at the ankle may begin to itch. The entire leg may ache, especially when you stand for long periods. Your feet may become swollen after standing for a short period and your shoes may seem very tight by the end of the day. During pregnancy, varicose veins may worsen because of increased pressure in the abdomen. Symptoms usually do not worsen if only superficial veins are affected. But when deep veins are also involved, circulation can be impaired, causing persistent leg swelling and a brownish skin discoloration, especially near the ankles. An itchy rash may develop near the affected vein.
In some people, varicose veins can significantly reduce the supply of blood to the tissues, causing the skin to break down and form an ulcer. A varicose ulcer will not heal until the vein has been treated successfully.
Diagnosis
Because varicose veins are frequently visible under the skin, a doctor can usually detect them during a physical examination. To determine the exact location of the veins that have damaged valves, he or she may apply an elastic tourniquet to your leg (see illustration).
Treatment
Your doctor may recommend that you wear elastic support stockings to help improve circulation. You will need to put the stockings on every day, before you get out of bed. Ask your doctor or a nurse to show you the correct way to put them on. Some people find the stockings uncomfortable, especially during hot weather. If your varicose veins are causing discomfort or pain, sit or lie down with your legs elevated above the level of your chest. This will help the blood flow back toward your heart from your ankles and feet.
If you cut the skin over a varicose vein and it begins to bleed, lie down as quickly as possible (no matter where you are), raise the affected leg, and keep it raised. The bleeding should slow immediately. Then, using a clean cloth, place moderate pressure on the wound. After the bleeding has stopped, seek immediate medical attention to have the wound cleaned and bandaged.
Do not attempt to treat a varicose ulcer