Although not generally life-threatening, varicose veins can be likened to a challenging journey: lengthy, tortuous, painful, and sometimes unsightly.
Varicose veins are essentially twisted, widened veins with incompetent valves, and while they are a long-term issue, symptoms can be intermittent.
COMMON SIGNS AND SYMPTOMS
Common signs and symptoms may include throbbing, aching, cramping, swelling, or a general heavy feeling or restlessness in the lower legs, particularly after prolonged standing or sitting. Another common indication is itching or burning around the congested veins. However, if these symptoms are particularly bothersome, it may be advisable to have them assessed, as they could signal a risk of other circulatory system disorders. Skin ulcers near the ankle can indicate a severe form of vascular disease requiring immediate medical attention. The most frequent complications of varicose veins are venous insufficiency (which can lead to thrombosis), phlebitis, rupture, and venous stasis ulcers.
These blue-purple ‘road maps’ are most commonly seen in the legs, ankles, and feet, but can also manifest in the vagina during pregnancy, or around the anus as haemorrhoids, or as varicose veins of the scrotum (varicoceles). They appear blue because they contain deoxygenated blood, which is in the process of being recirculated. Essentially, they develop when veins just below the skin's surface become damaged: either due to a genetic weakness in the vein walls, an inherited weakness of venous valves, or simply through the ageing process and lifestyle-related behaviours. Gravity exacerbates the situation since blood is naturally pulled downwards into the lower extremities, whether one is standing or sitting. Anatomically, veins have one-way valves to ensure that blood flows in the correct direction and to prevent backward flow. However, when these valves malfunction, the veins tend to fill with too much blood, becoming swollen or congested; consequently, the legs can feel very heavy and painful. However, in some people, varicose veins do not produce symptoms.
WHY ARE THEY MORE PREVALENT IN WOMEN?
Although anyone can develop varicose veins, women are two to three times more susceptible than men, and there are several reasons for this. For example, women often work in occupations requiring prolonged or uninterrupted standing, such as nursing or waitressing, which can cause pressure-related damage to veins or valves. Fatigue exacerbates existing varicosities. Female hormones are additional predisposing factors, so during times of hormonal flux, such as menstruation, pregnancy, or menopause, symptoms may worsen.
Pregnancy and obesity are possibly higher-risk factors, as increased abdominal pressure may contribute to or aggravate susceptibility towards developing varicosities. Pregnancy also increases blood volume but reduces blood flow from the legs to the pelvis. Both pregnancy and obesity alter blood pressure, negatively affecting venous flow. When blood fails to flow back towards the heart normally, the propensity for it to pool in the veins increases, along with the risk of varicose veins.
Drugs such as birth control pills and hormone replacement therapy (HRT) may also increase the risk of varicose veins, so women of childbearing age, mothers with young children, and older women, especially those with sedentary lifestyles, are at higher risk. Unfortunately, varicosities tend to increase with age, embodying an element of ‘built-in obsolescence'. Since humans began standing and walking upright, pressure in the veins of the lower body has naturally increased as part of our evolution.
ONCE YOU'VE GOT THEM, WHAT CAN BE DONE?
Conventional medical treatment
A common conventional medical treatment for small varicose veins and spider veins is sclerotherapy. This procedure involves injecting a high concentration of an irritant solution into the veins. This causes thrombophlebitis, promoting obliteration of the varicosity by thrombosis and subsequent scarring, leading to the vein's disappearance. Significant varicose veins often result from great saphenous vein (GSV) reflux, and they may require more radical treatment such as surgical removal or ‘stripping', involving the removal and ligation of the affected veins. This procedure carries the usual risks associated with general anaesthesia and is not always 100% successful, as recurrence rates are high.
Another surgical procedure, ambulatory phlebectomy, involves removing veins through small skin incisions and is less invasive than classic stripping and ligation. A less invasive medical technique, with a lower risk of complications, is endovenous laser therapy. This procedure is performed under local anaesthetic, involving placing a laser into the vein under ultrasound guidance, causing thermal injury to the vein lining and allowing it to collapse and seal.
Self-help
Apart from regular exercise, elevating the legs, rest, or using appropriate support stockings or specialised elastic compression stockings, may suffice in simple cases. In about 50% of cases, the condition is hereditary, so practising preventive health care is crucial if it runs in the family. The most important self-help activity is regular exercise and avoiding prolonged pressure on the veins to maintain unimpeded blood flow.
Avoid tight elastic, such as garters, socks, panties, or any other overly restrictive garments, as well as sitting with crossed legs or wearing high-heeled shoes (which reduces calf muscle activity).
Constipation contributes to varicose veins, so eating high-fibre foods, whole grains, and plenty of fresh fruits and vegetables to promote good bowel function is essential. Smoking is another serious risk factor.
Natural medicine treatments
Natural medicine treatments include careful massage, aromatherapy, homeopathy, herbal remedies, a healthy diet with additional nutritional supplements such as bioflavonoids, and exercise therapy including swimming and yoga, among others.
Herbal remedies
Horse chestnut (Aesculus hippocastanum) is possibly the best-known herbal remedy for alleviating some symptoms of chronic venous insufficiency, including varicose veins. However, horse chestnut should be avoided by individuals with liver or kidney disease, and its internal use is contraindicated during pregnancy and lactation. Bilberries (Vaccinium myrtillus) support normal connective tissue formation and strengthen capillaries, helping prevent varicosities, while butcher’s broom (Ruscus aculeatus) acts as a venous tonic and anti-inflammatory. Herbs that strengthen blood vessels and improve peripheral circulation include gotu kola (Centella asiatica), ginkgo (Ginkgo biloba), and hawthorn (Crataegus laevigata). Spider veins may benefit from the astringent properties of witch hazel and coltsfoot when applied topically.
Research by Kiesewetter et al.1 also supports the effectiveness of standardised red vine leaf extract, which is rich in polyphenols, including anthocyanins, oligomeric proanthocyanidins (OPCs), and important flavonoids such as quercetin and isoquercitrin, serving as excellent natural venotonics.
Essential oils
Essential oils such as cypress (Cupressus sempervirens), lemon (Citrus limon), and rose geranium (Pelargonium graveolens) are excellent venous tonics. Add five drops of each to 20 ml of grapeseed oil and apply gently towards the heart. Another blend is three drops of rose otto (Rosa damascena), five drops of frankincense (Boswellia carterii), and seven drops of juniper berry (Juniperus communis) in 20 ml of apricot oil. These essential oils can also be used in compresses. Avoid massaging heavily beneath a varicose vein, especially if there is a history of thrombosis.
CONCLUSION
There is no simple cure for varicose veins, but prevention and the application of healthy self-care treatments, or consulting qualified natural health specialists, can play a significant role in managing the condition.
Reference
- Kiesewetter H. et al. Efficacy of orally administered extract of Red Vine Leaf AS 195 (folia vitis viniferae) in Chronic Venous Insufficiency [Stages I-II]. Drug Research 50 (I), 2, 109-117, 2000
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