Main
- Varicose veins — a chronic condition in which the vein walls lose tone and the valves do not keep the blood flow towards the heart.
- Early signs — heaviness and swelling in the legs by the evening, night cramps and a fine vascular network under the skin.
- Diagnosis begins with examination and palpation of the veins; the picture is clarified by ultrasound duplex scanning.
- The condition is managed by a phlebologist, or in their absence by a vascular surgeon; treatment includes compression therapy and monitoring.
- Seek urgent medical help for sharp pain in the leg, redness and induration along the vein, shortness of breath or chest pain.
What is varicose disease
Varicose disease is a condition in which the veins, most often in the legs, become dilated and lose the ability to properly carry blood back to the heart. This manifests as visibly dilated veins, heaviness and swelling in the legs, especially after prolonged standing or sitting.
What happens in the body
Varicose disease begins when the walls of the veins become weaker and their valves stop closing tightly. The valves act like flaps that let blood pass upwards towards the heart and prevent it from flowing back down. When the flaps do not close tightly, some of the blood remains in the lower limbs and presses on the vessel walls from the inside. Due to the constant pressure, the veins stretch, become wider and lose their elasticity, and their shape changes. On the outside this is visible as dilated, tortuous veins that protrude under the skin and are visible to the naked eye. The person feels heaviness, a bursting sensation and swelling in the legs, especially towards the evening after prolonged standing or sitting. If nothing is changed, the blood stagnation worsens, and over time the veins dilate more and more, while the unpleasant sensations become habitual companions of the day.
What causes it to develop
- Hereditary predisposition: weakness of the venous walls and valves is often passed down through the family line, so the risk is higher in those whose relatives have already encountered this condition.
- Prolonged standing or sitting: when a person does not change position for a long time, the leg muscles do not help push blood upwards, and it stagnates in the lower limbs.
- Excess body weight: extra weight creates additional pressure on the veins of the legs and makes it harder for blood to flow out, so the vessel walls are under constant strain.
- Pregnancy: during this period the hormonal background changes and pressure in the abdominal cavity increases, which slows venous outflow and increases the load on the vessels of the legs.
- Older age: with the years the walls of the veins lose their elasticity and the valves work worse, so the condition occurs more often and is more noticeable.
- Sedentary lifestyle: with a lack of movement the leg muscles barely help the blood flow, and stagnation develops faster, so the legs should be given exercise regularly.
Who encounters this more often
This condition is encountered more often by people whose work or daily life involves long standing or sitting in one place. In those who spend many hours on their feet behind a counter, in a workshop or in an office, the blood in the lower limbs stagnates especially noticeably. Women seek help about this more often than men, which is linked to hormonal changes at different periods of life. Heredity also plays a role: if close relatives had dilated veins in the legs, the risk is noticeably higher. Excess weight adds strain on the vessels, and with age the walls of the veins lose their elasticity and the signs become more pronounced. In people who move little and rarely walk, the leg muscles barely help to push the blood upwards. Therefore, for those who fall into the risk group, it is sensible not to postpone a visit to the doctor at the first noticeable changes in the legs.
What symptoms can occur?
Varicose disease develops gradually, and its signs are easily put down to ordinary tiredness after a working day. Let us look at what is noticed at the beginning, which symptoms occur most often and when help is needed urgently.
How it is noticed at the very beginning
In its early stages, varicose disease may produce no noticeable symptoms, so the changes often go unnoticed. By the end of the day many people feel heaviness and tiredness in the legs, although in the morning there were no unpleasant sensations. Swelling in the area of the shins and feet becomes a familiar background by the evening and subsides by the morning. Gradually, dilated tortuous veins appear under the skin, which at first look like a fine network. Night cramps in the legs interrupt sleep and are perceived as a reaction to strain or a lack of trace elements. Itching and a change in the colour of the skin on the shins appear later and indicate that the process has gone further. If such signs recur day after day, it is worth seeing a phlebologist or a vascular surgeon without waiting for them to worsen.
Signs that occur most often
- Heaviness and tiredness in the legs by the end of the day: a feeling of fullness and weakness increases after prolonged standing or sitting and usually subsides by the morning.
- Swelling in the area of the shins and feet: by the evening shoes become tight, the skin on the shin feels stretched, and after a night's rest the swelling goes down.
- Dilated tortuous veins protruding above the skin: the vessels lose their usual shape, become noticeable and prominent, and over time their outlines become more pronounced.
- Night cramps in the legs: sudden painful muscle contractions wake a person and prevent proper rest, recurring at varying frequency.
- Itching and a change in the colour of the skin on the shins: dryness, darkening or a brownish tint appears, which indicates impaired blood outflow.
- Pain during prolonged standing or sitting: unpleasant sensations intensify in a motionless position and ease when walking or raising the legs.
When to seek help urgently
Examinations and tests
Examination for varicose veins begins with a conversation and a physical examination, and instrumental methods only clarify the picture. Below is a breakdown of what exactly the doctor assesses and what information is worth bringing with you.
How the examination begins
Diagnosis of varicose veins begins with an examination and collection of complaints, and this sets the direction for all further investigation. The doctor examines the veins on the legs, assesses their visible tortuosity, skin colour and swelling of the lower legs. Palpation helps to feel the density of the venous wall and areas of local tenderness along the vessels. Separately, it is clarified when the first changes appeared and how they changed over time. The doctor asks about heaviness in the legs towards the evening, cramps and swelling after prolonged walking or standing. These observations allow an understanding of how pronounced the process is and whether there are signs of impaired outflow. Based on the conversation and examination, it is determined whether instrumental investigations are needed to assess the condition of the veins and blood flow. If the complaints appeared recently and there are almost no external changes, the examination still remains the first and mandatory step.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: take all previous doctors' conclusions about the condition of the veins so that the specialist can see how the picture has changed over time.
- Images and reports: bring the results of previous ultrasound investigations, if they were carried out, with the dates they were performed.
- Observations: write down when heaviness, swelling or cramps appear and what makes them worse — this helps to assess the condition more accurately.
- List of questions: formulate in advance what you want to clarify with the doctor so as not to forget anything important during the conversation.
- Comfortable clothing: choose items that are easy to take off your legs so that the examination goes smoothly and without unnecessary delays.
Which doctor should I see?
This section explains which doctor to consult for varicose veins and what happens at the first appointment. It also covers what areas of care are involved and which part of the result depends on regular follow-up.
Which specialist manages this condition
Varicose veins are managed by a phlebologist, or, in their absence, by a vascular surgeon. The phlebologist examines the legs while standing, assesses swelling, changes in skin colour and enlarged veins. A vascular surgeon manages such cases in clinics where there is no dedicated phlebologist. At the first appointment, the doctor takes a history of complaints, clarifies when the heaviness appeared and how it changes during the day. Then they perform an examination and order an ultrasound scan of the veins to see the condition of the valves and the depth of involvement. Based on the examination and scan results, they determine the stage and decide whether vascular surgery is needed or follow-up with a phlebologist is sufficient. If a specialist is not available nearby, start with a vascular surgeon: they will assess the condition and refer you further as needed.
What treatment consists of
- Compression therapy: selection of medical hosiery or bandages that reduces the load on the veins and eases heaviness in the legs.
- Selection of therapy by the doctor: the choice of measures taking into account the stage, complaints and concomitant conditions, so no two prescriptions are the same.
- Physiotherapy: methods that complement the main treatment and help relieve discomfort in the legs when used regularly.
- Sclerotherapy: injection of a special solution into the affected vein, used for certain forms and only by a specialist's decision.
- Surgery when indicated: surgical intervention is performed when conservative measures do not give the desired effect and there are grounds for it.
What depends on the patient themselves
The regularity of follow-up with a phlebologist or vascular surgeon directly affects how long the condition can be kept under control. If you come for examination at the appointed times, the doctor notices in time that the swelling has increased or new enlarged veins have appeared. If appointments are missed, changes accumulate unnoticed, and selecting suitable measures becomes more difficult. Wearing compression hosiery as recommended by the doctor and avoiding prolonged standing or sitting without movement noticeably reduce the load on the veins. Notes on when the heaviness appeared and what makes it worse help the doctor assess the dynamics more accurately at each appointment. If pain, induration or a change in skin colour appears, the visit should not be postponed, even if it was not planned. Keep a simple observation diary and come for examination at the agreed times — this way the decision on further care is made in time.
What helps prevent an exacerbation?
Prevention of varicose veins largely depends on a person's own everyday choices. Regular activity, weight control and sensible exercise reduce the risk of the disease progressing and of complications developing.
What to change in your habits
Regular physical activity supports the work of the venous valves and improves the outflow of blood from the lower limbs. Walking, swimming and cycling engage the calf muscles, which push blood upwards through the vessels. Prolonged standing or sitting, on the contrary, causes blood to stagnate and raises the pressure in the veins of the legs. Maintaining a normal body weight reduces the constant load on the vessels of the lower limbs. During rest it is useful to raise the legs above the level of the heart to make it easier for blood to return. Compression hosiery, selected on a doctor's recommendation, provides external support for the walls of the veins. If your work involves long periods of sitting, it is worth standing up every half hour and taking a few steps.
What to keep under control
- Body weight: extra kilograms increase the pressure on the veins of the legs, so it is important to keep your weight within the limits agreed with your doctor.
- Duration of static loads: standing or sitting for many hours without breaks increases blood stagnation, so such periods should be broken up.
- Regularity of activity: daily walking and feasible exercise help the calf muscles work as a pump and maintain the outflow.
- Condition of the legs: swelling, heaviness and enlarged veins by the evening show how the course of the disease responds to load and rest.
- Wearing compression hosiery: a correctly selected garment supports the walls of the veins, but it does not suit everyone, so the decision remains with the doctor.
- Routine check-ups: even when you feel well, a visit to a specialist helps to notice changes earlier than they become noticeable.
How often to see a doctor
Regular monitoring is needed even when the legs do not bother you and no external changes are visible. Varicose veins can develop gradually, and imperceptible shifts in the work of the veins make themselves felt over time. At an examination the doctor assesses the condition of the veins, compares the picture with previous observations and, if necessary, changes the recommendations. The frequency of visits depends on how pronounced the disease is, on lifestyle and on how the person tolerates loads. If swelling, heaviness or enlarged veins appear, the visit should not be postponed until the scheduled date. If the course is calm, it is enough to see a specialist at the interval they have set. Such monitoring allows habits to be adjusted in time and does not let you miss the moment when the approach needs to change.
What is worth remembering
Varicose veins are a condition in which the veins lose their elasticity and blood stagnates in the lower limbs. The discussion of it should conclude with what remains with the reader after becoming familiar with the signs, examinations and preventive measures.
Main conclusions
Varicose veins develop gradually, and at an early stage a person notices only heaviness in the legs towards the evening or swelling. The appearance of persistent dilated veins, changes in skin colour and indurations indicates that the process has gone further than it appears from the outward look. Varicose veins do not resolve on their own, and over time they can lead to trophic changes and inflammation of the vessel wall. The danger is that many perceive the cosmetic defect as the only problem and postpone a visit to a specialist. Meanwhile, it is precisely early consultation that allows gentle measures to suffice and serious complications to be avoided. Varicose veins require not a one-off visit but observation: the condition of the veins changes, and monitoring helps to notice deterioration in time. The support in addressing it is not the search for quick methods but consistency: to notice the signs, obtain a consultation, follow the recommendations and not abandon observation.
