Varicose and spider veins are very common in the general community and affect about 50% of the population. There are three common types, which are frequently seen in combination. Spider veins are the finest and are usually fed by larger Reticular veins, which are under the skin. Varicose veins are the largest, often bulge above the skin surface and are normally due to a weakness in the vein wall.

There are many symptoms associated with varicose veins, which include heaviness, burning, aching, stinging, throbbing, swollen ankles, restless legs and leg cramps. Other problems such as bleeding, ulcers, cellulitis (inflammation of the skin and underlying tissue), clotting and eczema or itching can also be associated with varicose veins.

It is generally well known that spider veins are being successfully treated with injection sclerotherapy. However, in the past surgery was the only method for the treatment of large varicose veins. Time has proven that varicose vein surgery is plagued with a higher incidence of complications when compared to newer non-surgical treatment methods.

Why do abnormal veins develop?

An exact cause is not known, however a strong family history suggests that some people inherit veins that are more likely to deteriorate. In women, oestrogen may play a role as the onset of puberty, pregnancy and taking the oral contraceptive pill can give rise to vein abnormalities. In pregnancy, the enlarged uterus can restrict blood flow from the legs and promote the development of varicose veins. Spider veins and varicose veins can also be associated with obesity. However, losing and gaining weight repetitively can be more of a problem than keeping to a steady weight. Occupations involving prolonged standing and sitting tend to increase the likelihood of veins to develop. Bone fractures and soft trauma can cause localized vein abnormalities.

What is the mechanism by which veins develop?

Blood in the legs normally travels upwards to the heart. Due to gravity blood tries to flow back down towards the feet. However, normal veins have valves, which close to prevent the abnormal flow towards the feet. It is believed the first step in the development of abnormal veins is a weakness in the vein walls. This allows the vein wall to expand and bulge, producing a varicose vein. This process is usually associated with the breakdown of the valves inside the veins, leading to abnormal flow patterns, which in turn leads to increased pressure inside the vein. This further contributes to the development of the varicose vein. There can also be a reduced number of valves in the vein congenitally (from birth) which can predispose to the development of varicose veins.

Varicose veins serve no useful function to the body’s circulation. Our body has the ability to establish alternative pathways to bypass the abnormal varicose veins. When varicose veins are closed down the circulatory system improves, as do many of the symptoms.

It is important to understand that varicose veins can be a progressive condition and that totally new veins can develop with time. Maintenance treatment is likely for most patients.

Can vein problems be prevented?

If you are prone to vein problems, it is advisable to keep to a healthy diet and lifestyle, to maintain normal weight and exercise regularly to minimize the likelihood of further problems. Wearing specialised venous support stockings may ease symptoms and slow the progression of abnormal veins, however no specific preventative treatment exists. Crossing your legs does not cause varicose veins.