If I mentioned 'varicose veins' or her less painful cousin 'spider veins' to you, your first thought might be that they are reserved for people over 50. But that, I’m afraid to say, is far from the case.
Sanjay Patel FRCS, consultant vascular and endovascular surgeon at UK Vein Clinic, tells R29 that the reason we see varicose veins as an 'older people problem' is because lifestyle factors have had more time to influence their development, and that longer period has allowed for symptoms to become known and cause more damage. This doesn’t mean that varicose veins can’t or won’t affect you earlier in life. "The message," he says, "is not to wait until the underlying process has done the damage. Act early to prevent problems now and later in life."
So what are varicose veins? They are a very common kind of chronic vein disease which occurs more frequently in women than in men. They can appear anywhere but are more likely in the feet and legs, particularly in the calves. Sanjay tells R29: "Varicose veins are normal veins that over time have become large and twisted. They may become unsightly, throb and ache, which leads to physical harm and can potentially affect mental health. But it’s the underlying problem that causes the varicose veins that can lead to even more harm if left untreated." Spider veins are a common, milder variation which are visible below the skin but largely without the other symptoms.
Normal veins contain one-way valves that move blood against gravity and back to the heart. Over time these valves may malfunction, leading to increased pressure (called venous hypertension) which in turn leads to the development of varicose veins. "It can also lead to the development of a number of other skin changes including dark, itchy, red and brittle skin, as well as potential swelling – if left untreated this can lead to ulcers. Therefore, varicose veins are just the tip of the iceberg when it comes to vein health."
While they are more common the older you get, they can affect almost anyone at any age. Men and women are overall equally likely to develop varicose veins but Sanjay says that because of pregnancy, women are more susceptible.
"With pregnancy, 80% of women will normally develop varicose veins. This is related to the additional pressure placed on the circulatory system, caused by the baby in the uterus. The veins may disappear after childbirth and even if they don’t, many of the symptoms significantly improve or disappear."
For the most part, varicose veins are genetic, meaning there is little you can do to prevent the veins from malfunctioning. However they can be exacerbated by lifestyle factors, which is why they affect young and old. These factors include occupations that involve standing, like nursing, hairdressing or teaching; your weight; medications like birth control pills or hormone replacement therapy; a history of clots; and inactivity.
In particular, Sanjay tells R29 that "the pandemic has generally made the symptoms of unhealthy veins worse." People who have been stuck at home have been less active and exercise is not only good for your overall health but can improve varicose veins. "This is because exercise and movement increases activity in the calves, which in turn pumps blood back up to the heart and lowers the pressure in the veins." However, as Rachel Bell MS FRCS, consultant vascular surgeon and chair of the vascular charity Circulation Foundation, tells R29: "I don't think that the pandemic has changed the likelihood that you would develop varicose veins. If you were prone to getting varicose veins you were going to get varicose veins anyway, whether there was a pandemic or not."
The good news is that if you have varicose veins or think you will develop them in the future, Rachel says that for the most part, the veins themselves "aren’t dangerous, just inconvenient". They may give you lots of aching, swelling and discomfort, and (unsurprisingly) can cause low self-esteem. But luckily, getting your veins assessed and treated in a timely manner can prevent and treat the other problems caused by the underlying venous hypertension.
As for how to get them treated? There is a range of treatments and your best option is to consult with a vascular specialist to find the best minimally invasive treatment for you. Current scientific evidence points to endovenous radiofrequency ablation (EVRF) treatment as the best overall option. It can be completed under local anaesthetic, carries lower risks of scarring and post-op recovery time, and consistently delivers excellent results.
Due to the hereditary nature of varicose veins, most people's experience and understanding of treatment is through their parents or grandparents, which means you may have heard stories of harsh vein stripping, the trauma of recovery and, in many cases, the unhealthy veins returning. Happily, Sanjay emphasises that modern treatments have advanced significantly. "They are minimally invasive, walk in, walk out procedures with minimal recovery required and excellent success rates."
It’s worth noting that if you are pregnant and developing varicose veins, surgery is not recommended. Wait until after you have delivered the baby as many women have a complete resolution of their symptoms after the birth. If you are managing varicose veins, you are advised to exercise regularly, wear compression stockings and avoid standing up for long periods to alleviate symptoms.