🦵 Varicose Veins: Causes, Stages, Prevention, and Symptom Relief

Varicose veins are one of the most common vascular conditions. According to statistics, various forms of varicose veins affect 25–30% of adults in developed countries, with women affected 3–4 times more often than men. The condition not only causes cosmetic discomfort but, as it progresses, can also lead to serious complications, including thrombosis and venous ulcers.

Anatomy of the Leg Venous System

The venous system of the lower limbs consists of three components: deep veins located within the muscles; superficial veins running directly beneath the skin; and perforating veins connecting the two. Blood from the legs must travel upward—against gravity—to the heart. To make this possible, veins contain special valves that allow blood to flow in only one direction and prevent it from flowing backward.

Blood flow is assisted by the so-called “muscle pump”: each time the calf muscles contract, they compress the deep veins and push blood upward. This is why prolonged immobility—whether standing or sitting—is so harmful to the veins: without the muscle pump working, blood flow slows and pressure in the veins increases.

What Happens with Varicose Veins

Varicose veins develop when the venous valves no longer close properly. Blood begins to flow downward (reflux) and pool in the lower parts of the legs. Under the pressure of the accumulated blood, the walls of the superficial veins stretch, becoming twisted, bulging, and visible through the skin, forming characteristic “cords” and “knots.” Over time, impaired blood flow leads to chronic inflammation, tissue swelling, and poor skin nutrition.

Risk Factors

The development of varicose veins is determined by a combination of several factors:

• Heredity — weakness of the connective tissue and venous valve apparatus is genetically inherited; if both parents have varicose veins, the child’s risk reaches 90%
• Sex — female sex hormones (estrogen and progesterone) relax the walls of the veins; oral contraceptives and hormone replacement therapy increase the risk
• Pregnancy — the growing uterus compresses the pelvic veins, blood volume increases, and hormone levels change; each subsequent pregnancy raises the risk
• Standing or sedentary work — salespeople, hairdressers, surgeons, office workers, and drivers are at increased risk
• Excess weight — increases the strain on the veins and pressure within the abdominal cavity
• Age — over the years, vein walls lose elasticity and valves wear out
• Sedentary lifestyle — without the muscle pump working, venous return deteriorates

Stages of the Condition

Varicose veins develop gradually and progress through several stages:

Initial Stage (C1)

Small “spider veins” (telangiectasias) and reticular veins—thin, bluish lines—appear on the skin. They are primarily cosmetic but indicate impaired venous return. Mild heaviness in the legs toward evening and temporary swelling may occur.

Varicose Vein Stage (C2)

Characteristic enlarged, twisted superficial veins—“cords” and “knots”—become visible to the naked eye. Heaviness and a feeling of fullness in the legs increase, along with nighttime calf cramps, swelling toward evening, and itching of the skin over the affected veins. Symptoms worsen with prolonged standing and improve when lying down.

Swelling Stage (C3)

Swelling of the lower leg and foot becomes persistent and does not completely disappear after a night’s rest. The legs tire quickly, pain intensifies, and quality of life declines noticeably.

Skin Change Stage (C4–C6)

Chronic blood pooling disrupts skin nutrition. Pigmentation (darkening of the skin around the ankle), eczema, and hardening of the subcutaneous tissue (lipodermatosclerosis) develop. In the later stages, venous ulcers form—open skin lesions that heal very poorly and tend to recur.

Complications of Varicose Veins

Without treatment, varicose veins can lead to serious consequences:

• Thrombophlebitis — inflammation of an enlarged vein with blood clot formation; it causes pain, redness, and hardening along the vein
• Deep vein thrombosis — a dangerous condition in which a blood clot forms in a deep vein; it may be complicated by pulmonary embolism
• Venous ulcers — long-lasting wounds that fail to heal, usually around the inner ankle
• Bleeding — from a varicose vein if it is injured; it may be severe

Diagnosis

The main method of diagnosing varicose veins is duplex ultrasound scanning of the veins. This painless, noninvasive examination makes it possible to assess valve function, detect reflux, evaluate deep vein patency, and identify blood clots. The examination is performed by a vascular surgeon (phlebologist).

The initial assessment includes inspection and palpation while standing, when the veins are at their fullest. The physician notes the location and diameter of the enlarged veins, as well as the presence of swelling, skin changes, and pigmentation.

Compression Therapy

Wearing compression hosiery is one of the main conservative treatment methods. Special stockings, knee-highs, or tights provide graduated pressure: it is greatest around the ankle and decreases upward. This helps the valves close, accelerates venous return, and reduces swelling.

Compression hosiery is divided into pressure classes: Class 1 (18–21 mmHg) is used for prevention and early stages, Class 2 (23–32 mmHg) for pronounced varicose veins, and Class 3 for trophic changes. The class and size should be selected by a physician. Compression hosiery should be put on in the morning before getting out of bed, when swelling is minimal.

Lifestyle and Prevention

Lifestyle modification is an essential component of both the prevention and treatment of varicose veins:

• Movement — walking, swimming, and cycling activate the muscle pump; avoid prolonged standing or sitting; if you have a sedentary job, stand up and walk every 30–60 minutes
• Vein exercises — roll from heel to toe, rotate your feet, rise onto your toes, and do “bicycle” movements while lying down; these exercises can even be performed while seated at work
• Elevating the legs — while resting, place your legs on a pillow above heart level for 15–20 minutes; sleep with the foot of the bed elevated
• Weight management — every extra kilogram increases the strain on the veins
• Diet — consume enough fiber to prevent constipation (straining increases pressure in the veins); vitamin C and rutin strengthen blood vessel walls; limit salt, which promotes fluid retention
• Footwear — avoid high heels (over 5 cm) and completely flat soles; the optimal heel height is 3–4 cm
• Clothing — do not wear tight waistbands, belts, or stockings with elastic bands that constrict the veins
• Contrast showers — alternating warm and cool water on the legs helps train vascular wall tone

Varicose Veins During Pregnancy

Up to 40% of women first develop varicose veins during pregnancy. The growing uterus compresses the inferior vena cava, progesterone relaxes the vein walls, and the increased blood volume creates additional strain. Prevention includes wearing Class 1 compression hosiery from the first trimester, taking daily walks, resting with the legs elevated, and managing weight gain. The condition of the veins often improves after childbirth, but the risk of progression increases with subsequent pregnancies.

When Surgery Is Needed

Surgical treatment is considered for pronounced varicose veins with reflux, recurrent thrombophlebitis, and trophic skin changes. Modern methods include endovenous laser ablation, radiofrequency ablation, and miniphlebectomy—all are minimally invasive, performed on an outpatient basis, and allow a rapid return to normal life. Sclerotherapy (injecting a special medication into the vein) is used for “spider veins” and small varicose veins. The treatment method is selected by a phlebologist based on the results of duplex ultrasound scanning.

Common Myths About Varicose Veins

• “Varicose veins are only a cosmetic problem” — as the condition progresses, it can lead to serious complications, including pulmonary embolism
• “Exercise is prohibited with varicose veins” — on the contrary, moderate exercise such as walking and swimming is essential; weightlifting and long-distance running are not recommended
• “Ointments and creams will cure varicose veins” — topical products may relieve symptoms but do not eliminate the cause: valve insufficiency
• “Only older people develop varicose veins” — the first signs may appear as early as age 20–30

Varicose veins are a chronic condition that requires ongoing attention. Early diagnosis, regular use of compression hosiery, an active lifestyle, and timely consultation with a phlebologist can slow progression and help prevent dangerous complications. If the first symptoms appear—heaviness, swelling, or “spider veins”—do not postpone seeing a specialist.