Varicose Veins; Causes, Symptoms, Diagnosis, Treatment Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have pairs of leaflet valves to prevent blood from flowing backward (retrograde flow or venous reflux). Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Their valves are usually incompetent so that reflux of blood occurs, and the resulting venous hypertension can cause symptoms. Varicose veins are widely seen as a medically unimportant and deserving low priority for treatment. They are common, affecting nearly a third of adults in Western societies, and few people with varicose veins are ever harmed by them. However, they cause concern and distress on a large scale, most of which can be dealt with by good explanation and reassurance, or by a variety of treatments which are evolving rapidly at present. Patients can now be referred for more precise assessment and a greater range of therapeutic options than ever before. Large varicose veins can be visible, bulging, palpable (can be felt by touching), long, and dilated (greater than 4 millimeters in diameter). www.rxharun.com Small “spider veins” also can appear on the skin’s surface. These may look like short, fine lines, “starburst” clusters, or a web-like maze. They are typically not palpable. Spider veins are most common in the thighs, ankles, and feet. They may also appear on the face. The medical term for spider veins is telangiectasias. Types of varicose veins Trunk varicose veins – These are proximate to the surface of the skin and are thick; they are visible, often quite long, and look unpleasant Reticular varicose veins – Red and sometimes grouped close together in a network Telangiectasia varicose veins – Known as thread veins or spider veins, these are minute clusters of blue or red veins that sometimes appear on face or legs; they are harmless and unlike trunk varicose veins. A standardized reporting method for the clinical manifestations of varicose veins has been described by the CEAP Classification CEAP classification Clinical classification C0 No visible or palpable signs of venous disease C1 Telangiectasia or reticular veins C2 Varicose veins C3 Edema C4a Pigmentation or eczema C4b Lipodermatosclerosis or atrophied Blanche C5 Healed venous ulcer C6 Active venous ulcer Varicose Vein & Spiders vain Causes Many theories exist for why varicosities occur in veins, but the consensus is that defective/damaged valves within the veins are the cause. Deep veins, which lie among the muscles and carry about 90 percent of the blood. Surface or superficial veins, which are often visible just under the skin. Surface veins do not have the protective muscular surrounding of deep veins. This means they are weaker and more likely to become varicose. Surface veins carry blood from the skin and surface areas into the deep veins via connecting channels called perforator veins. Abnormal valve functions in the veins can be due to: Hereditary factors: Recent studies suggest that hereditary factors cause some people to have too few valves or valves that do not function properly. People with a family history of varicose veins or varicosities are at greater risk of developing the condition. Inborn errors in the valves: Some people may be born with abnormalities of the vein wall. The resulting weakness may predispose the valves to separate and become leaky. The result is that when a person with poorly functioning valves stands up, the blood flow actually reverses and flows down the superficial veins, when it should be flowing up, toward the heart. Prolonged standing can aggravate varicose veins. Pregnancy is associated with an increase in blood volume. Also, added pressure on the veins in the legs by the weight of the growing uterus and the relaxation effects of the hormones estrogen and progesterone on the vein walls contribute to the development of varicose veins or varicosities during pregnancy. Prior surgery or trauma to the leg – These conditions interrupt the normal blood flow channels. Straining – Chronic constipation, urinary retention from an enlarged prostate, chronic cough, or any other conditions that cause you to strain for prolonged periods of time causes an increase in the forces transmitted to the leg veins and may result in varicose veins. These mechanisms also contribute to the formation of hemorrhoids, which are varicosities located in the rectal and anal area. Esophageal varices are ‘varicose’ or swollen veins in the walls of the esophagus (gullet or swallowing pipe leading to the stomach). They result from the higher than normal pressure in the system of veins that arise from the region of the liver, and which are known to be affected by liver disease. Some experts think inherited problems cause some people to have too few valves or valves that do not function properly. Some people may be born with abnormalities of the vein wall. The resulting weakness may predispose the valves to separate and become leaky. The result is that when a person with poorly functioning valves stands up, the blood flow actually reverses and flows down the superficial veins, when it should be flowing up, toward the heart. When the muscles surrounding the deep veins contract, emptying the deeper veins, a build-up of pressure occurs. This causes even more blood to flow the wrong way from the deep to the superficial veins through faulty valves in the perforator veins. This increases pressure in the superficial veins and causes varicosities. Pregnancy is associated with an increase in blood volume. Also, added pressure on the veins in the legs by the weight of the growing uterus and the relaxation effects of the hormones estrogen and progesterone on the vein walls contribute to the development of varicose veins during pregnancy. Prolonged standing Obesity or distended belly Straining: Chronic constipation, urinary retention from an enlarged prostate, chronic cough, or any other conditions that cause a person to strain for prolonged periods of time causes an increase in the forces transmitted to the leg veins and may result in varicose veins. These mechanisms also contribute to the formation of hemorrhoids, which are varicosities located in the rectal and anal area. Prior surgery or trauma to the leg: These conditions interrupt the normal blood flow channels. Age: Generally, most elderly individuals show some degree of varicose vein occurrence. The symptom of Varicose Vein Common chronic symptoms legs feel heavy, especially after exercise or at night Leg heaviness Exercise intolerance Pain or tenderness along the course of a vein Pruritus Burning sensations Restless legs Night cramps Edema Skin changes Paresthesias Common symptoms of telangiectasia include the following Burning Swelling Throbbing Cramping Leg fatigue Aspects of symptoms include the following Subjective symptoms usually are more severe early in the progression of the disease, less severe in the middle phases, and worse again with advancing age Symptoms do not correlate with the size or extent of visible varices or with the volume of reflux Not all symptomatic patients are aware of their symptoms, because the onset may be extremely gradual; after treatment, patients are often surprised to realize how much chronic discomfort they had accepted as normal Pain associated with larger varicose veins is usually a dull ache that is worse after prolonged standing Pain caused by venous insufficiency is often improved by walking or by elevating the legs, in contrast to the pain of arterial insufficiency, which is worse with ambulation and elevation Pain and other symptoms may worsen with the menstrual cycle, with pregnancy, and in response to exogenous hormonal therapy (eg, oral contraceptives) A small number of women regularly experience pain associated with their varicose veins after sexual intercourse The inspection may reveal the following findings Ulceration Telangiectasias Atrophie blanche Interdigital mycosis Acrocyanosis Eczematous lesions Microulcers Stasis dermatitis Flat angiomata Prominent varicose veins Scars from a prior surgical operation Evidence of previous sclerosant injections Findings on palpation may include the following A firm, thickened, thrombosed superficial vein in an area of leg pain or tenderness Deep boggy or spongy pockets in the calf muscle and deep palpable bony notches, especially over the anterior tibia, caused by erosion from chronic varices Fascial defects in the calf along the course of an abnormal vein at sites where superficial tributaries emerge through openings in the superficial fascia Some patients may also experience a minor injury to the affected area may result in longer bleeding than normal lipodermatosclerosis – fat under the skin just above the ankle can become hard, resulting in the skin shrinking swollen ankles telangiectasia in the affected leg (spider veins) there may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color venous eczema (stasis dermatitis) – skin in the affected area is red, dry, and itchy when suddenly standing up, some individuals experience leg cramps a high percentage of people with varicose veins also have restless legs syndrome atrophie blanche – irregular whitish patches that look like scars appear at the ankles Bleeding Varicose Veins Blood Clots Heaviness or Fatigue Restless Leg Syndrome Skin Discoloration Skin Ulcers Throbbing, Burning, or Itching Pain. Diagnosing of Varicose Vein If you have varicose veins and they don’t cause any discomfort, you may not require visiting your GP. Varicose veins are rarely a serious condition and they don’t require treatment usually However, verbalize with your GP if: Your varicose veins causing pain or discomfort The skin over veins is sore and irritated The aching in legs causing irritation at night and disturbing your sleep Varicose veins are diagnosed by their appearance. Your GP will examine your legs while you’re standing to check for denotements of swelling. GP will additionally want to know if you’re at an incremented risk of developing varicose veins, such as: Having the family history of varicose veins Being pregnant Body Mass Index (BMI) Having deep vein thrombosis History of leg injury Further investigation Your GP may refer to a vascular specialist (a physician who specializes in veins) if you have any of the following: Varicose veins that causing pain, aching, discomfort, swelling, or itching Changes the color of the skin on the leg that may be caused by a problem with the blood flow in the leg Skin conditions affecting your leg, such as eczema, that may be caused a problem with blood flow in the leg varicose veins that are hard and painful that may be caused by the problem with blood flow in a leg Healed or unhealed leg ulcer below the knee In most cases, a duplex ultrasound scan will be carried out. This is a type of scan that is high-frequency sound waves to engender a picture of the veins in your legs. The picture shows the blood flow and avails the vascular specialist locate any damaged valves that might be causing your varicose veins. Doppler test – an ultrasound scan to check the direction of blood flow in the veins. This test also checks for blood clots or obstructions in the veins. Color duplex ultrasound scan – this test provides color images of the structure of veins, which helps the doctor identify any abnormalities; it can also measure the speed of blood flow. The CEAP classification system of venous reflux is used to assess the clinical severity of symptoms: C0 no visible or palpable signs of venous disease C1 telangiectasies or reticular veins C2 varicose veins C3 edema C4a pigmentation and eczema C4b lipodermatosclerosis and atrophy Blanche C5 healed a venous ulcer C6 active venous ulcer Initial diagnosis is by clinical evaluation of swelling, discoloration, and skin ulcerations. Treatment of Varicose Vein Self-management There are some self-care measures that take to decrease the discomfort that varicose veins can cause. These measures can help prevent or slow the development of varicose veins, as well. They include: Exercise – Get moving. Walking a great way to increase blood circulation in legs. Your physicians can recommend an appropriate exercise for you. Weight and diet- Excess weight takes unnecessary pressure off your veins. A low-salt diet prevents swelling caused by water retention. What you wear-Always avoid high heels. Low heel shoes work calf muscles more, which is better for veins. Try to avoid wear tight clothes around your waist, legs or groin because these garments can reduce blood flow. Elevate your legs – That improve circulation in your legs, take several times in daily to elevate your legs above heart level.In an instance, lie down and your legs resting on three pillows. Avoid long periods of sitting or standing- Make a point of transmuting your position frequently to encourage blood flow. Never sit with your legs crossed. Some physicians believe this position can increment circulation problem. Compression stockings – Wearing compression stockings in all day long is often the first approach to before moving other treatments. They squeeze your legs, availing veins and leg muscles move blood more efficiently. The amount of compression varies by different type and brands. Supplemental Procedures – In addition to treating the venous reflux within the saphenous veins, many patients will also have visible superficial veins including reticular veins (1 mm to 3 mm diameter) and telangiectasias (under 1 mm diameter). Collectively these may be referred to as “spider veins” in lay terminology. In addition to being unsightly, may also be painful to local pressure. Liquid sclerotherapy involves the injection of a dilute medication (sclerosant) into the superficial telangiectasias and reticular veins. Phlebectomy involves the removal of larger superficial varicose veins through small 2 mm to 3 mm incisions. Compression Therapy – Patients with milder symptoms of venous reflux disease may obtain adequate symptomatic relief with compression stockings. Compression stockings should at the minimum reach the level of the upper calf. Thigh high compression stockings are preferable if tolerated. After most treatments for venous reflux and its stigmata, compression stockings are recommended, although exact guidelines for duration and strength of compression are not available. A common compression strength after ablation is 20 mmHg to 30 mmHg. Recommended length of compression therapy may range from several days to 2 weeks, depending on the severity of symptoms and type of treatment (Nazarko 2017). Some patients with more severe lower extremity swelling may benefit from a longer period of compression therapy, with possible adjunctive home based pneumatic compression (Lurie 2017). Medications Analgesic – Prescription-strength drugs that relieve pain but not inflammation. Antidepressants – A Drugs that block pain messages from your brain and boost the effects of eorphins (your body’s natural painkillers). Corticosteroids – Also known as oral steroids, these medications reduce inflammation. Muscle Relaxants – These medications provide relief from spinal muscle spasms. Neuropathic Agents – Drugs(pregabalin & gabapentine) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling. Opoids – Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision. Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin. NSAIDs – Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve). Anti-platalete Drug – to increase blood flow & thinning blood Diosmin/hesperidin – and other flavonoids. Topical gel application – helps in managing symptoms related to varicose veins such as inflammation, pain, swelling, itching, and dryness. Topical application (noninvasive) has patient compliance. There are various alternatives to the surgical removal of varicose veins In radiofrequency ablation, heat generated by electromagnetic waves (radio waves) is used to close off the veins. This procedure involves inserting a thin radiofrequency ablation (RFA) probe into the vein through a small incision. The RFA probe contains a catheter that heats the vein until it is closed off. A treatment known as endovenous laser ablation also involves closing off the vein from the inside using heat. The procedure is very similar to radiofrequency ablation, but lasers are used to generate heat instead of radio waves. In transilluminated powered phlebectomy (“Trivex”), a tiny rotating blade is inserted into the vein to cut it, and the vein tissue is then removed using suction. The vein is illuminated from the outside through the skin so that it can be seen by the surgeon. This approach is only considered as a treatment option for people whose “great saphenous vein” is healthy. Treatments for More Severe Varicose Veins If not well respond to self-care or compression stockings, or condition is more rigorous, your medico may suggest one of these varicose vein treatments: Sclerotherapy– In this procedure, your physicians inject small and medium-sized varicose veins with the solution that scars and closes those veins. In few weeks treated varicose veins should fade. In some cases the same vein may need to inject more than once, sclerotherapy is efficacious if done correctly. Sclerotherapy doesn’t require anesthesia and done in your physician’s office. Laser surgery– Physicians are also using new technology in laser treatments to close off small varicose veins and spider veins. Laser surgery works by sending vigorous bursts of light onto the vein, which makes the vein gradually fade and vanish. In this procedure, no incisions or needles are used. Endovenous laser treatment (EVLASER) – EVLASER uses laser energy delivered via a 600 μm (400–750 μm) laser fibre to obliterate the vein. Steam bubbles generated from boiling the blood in the lumen cause heat injury to the vein wall.[rx] Lower wavelengths have a shallower depth of penetration and are better absorbed by blood causing lesser damage to surrounding non-target tissue and better homogeneous heating of the vein.[rx] The procedure is usually performed under perivascular tumescent local anaesthesia. The GSV or small saphenous vein (SSV) is cannulated at the ankle or just below the knee either by needle puncture or via a cut down. Injection sclerotherapy – this is used in all types of varicose veins and a microinjection technique may be used for thread veins. It may not be as effective as other techniques for larger varicose veins. RFA (RadioFrequency Ablation) – this is a newer method of treating the source of the varicose veins. It is a replacement for the stripping part of the operation but may need supplementary treatment either with injections or minor avulsions to the visible veins. High ligation and vein stripping- In this procedure involves tying off a vein before it joins a deep vein and abstracting the vein through minute incisions. This also an outpatient procedure for most people. Ambulatory phlebectomy (fluh-BEK-tuh-me)– Your physicians remove more minute varicose veins through a series of minute skin punctures. Only the components of your leg that are being picked are numbed in this outpatient procedure. Scarring is generally minimal. Endoscopic vein surgery- In this operation only in an advanced case involving leg ulcers and if other techniques fail. Your physician used a thin video camera inserted in your leg to visualize and close varicose veins and then abstracts the veins through minute incisions. This procedure is also performed in an outpatient procedure. Foam sclerotherapy – injecting a sclerosing (irritating) agent directly into the varicosed veins, causing an inflammatory response that closes off the vein. This is done under ultrasound guidance to ensure the foam does not enter the deep venous system and only requires a local anaesthetic. Thermal ablation – which involves heating the vein from the inside (via radiofrequency or laser catheters), causing irreversible damage to the vein which closes it off. This is done under ultrasound guidance and may be performed under local or general anaesthetic. This is often performed with multiple avulsions of visible varicose veins. Additional treatments for more-severe varicose veins If you don’t respond to self-care or compression stockings, or if your condition is more severe, your doctor may suggest one of these varicose vein treatments Sclerotherapy – In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn’t require anesthesia and can be done in your doctor’s office. Foam sclerotherapy of large veins – Injection of a large vein with a foam solution is also a possible treatment to close a vein and seal it. This is a newer technique. Vein stripping – Two incisions (cuts) are made: One at the top of the leg just below the groin and one behind the knee joint or at the ankle. The vein is then tied or clamped off at the top incision using a technique called vein ligation. A long wire is sent through the lower incision up through the vein, and at the lower end, a button-like cap is attached to the wire. This allows the entire vein to be pulled out through the incision near the groin. Phlebectomy: Very small incisions of just a few millimeters are made along the affected vein. A small hook is used to pull the vein out as far as possible through these incisions and then it is cut and removed in several pieces. This technique is used mainly for smaller veins that branch off of the main veins. This procedure uses the small incisions to avoid the scarring caused when larger cuts are made. Transilluminated powered phlebectomy (TIPP) – This technique involves an irrigated transilluminator, passed deep to the varicosities, and a powered suction resector, each introduced through a skin incision. On activation, the vein is sucked into the resector under direct vision, morcellated and removed by suction. Subfascial endoscopic perforator vein surgery (SEPS) – SEPS is a minimal access option to open surgery in patients with chronic venous insufficiency due to perforator incompetence. It may be performed even with active ulceration although infection is a contra-indication. Deep venous occlusion should be ruled out pre-operatively. Of the various methods available, the authors’ practice is to introduce two endoscopic ports in the subfascial plane in the calf away from ulceration. A space-maker balloon creates the initial space, which is then maintained by carbon dioxide. Under direct vision, the incompetent perforators are clipped and divided or dealt with by harmonic scalpel. Conventional surgical stripping – All management modalities for varicose veins are safe and effective at short-term and midterm follow-up.[rx] The methods to manage great saphenous veins traditionally include ligation and division of the saphenofemoral junction and its tributaries in the groin, stripping the great saphenous veins from groin to knee level. The incompetent small saphenous veins are ligated and divided, rather than stripped, close to the popliteal vein in the knee pit, because stripping small saphenous veins may potentially damage the sural nerve.[rx] It is not rare for recurrence, hematoma, and skin infection to occur after the surgical procedure. And massive bleeding due to injury to femoral veins, or even to femoral artery during surgery, and mortality from pulmonary embolism and DVT can happen, even though these are rarely reported. Subfascial endoscopic perforator vein surgery (SEPS) – SEPS is a minimal access option to open surgery in patients with chronic venous insufficiency due to perforator incompetence. It may be performed even with active ulceration although infection is a contra-indication. Deep venous occlusion should be ruled out pre-operatively. Of the various methods available, the authors’ practice is to introduce two endoscopic ports in the subfascial plane in the calf away from ulceration. A space-maker balloon creates the initial space, which is then maintained by carbon dioxide. Under direct vision, the incompetent perforators are clipped and divided or dealt with by harmonic scalpel. Radiofrequency ablation – The technique of endovenous RFA has been available since 1998; it delivers thermal energy from a bipolar catheter to the insufficient veins. RFA is an effective and safe treatment modality for incompetent veins, and it can be performed in-office as a minimally invasive procedure. The advantages of RFA include low complication rate, reduced pain, high vein occlusion rates, and early return to work and normal activities. Currently available clinical trial evidence suggests RFA and EVLA are at least as effective as surgery in the treatment of great saphenous varicose veins.[rx],[rx],[rx] Laser surgeries – Doctors are using new technology in laser treatments to close off smaller varicose veins and spider veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used. Catheter-assisted procedures using radiofrequency or laser energy – In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is the preferred treatment for larger varicose veins. High ligation and vein stripping – This procedure involves tying off a vein before it joins a deep vein and removing the vein through small incisions. This is an outpatient procedure for most people. Removing the vein won’t adversely affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood. Ambulatory phlebectomy – fluh-BEK-tuh-me). Your doctor removes smaller varicose veins through a series of tiny skin punctures. Only the parts of your leg that are being pricked are numbed in this outpatient procedure. Scarring is generally minimal. Endoscopic vein surgery – You might need this operation only in an advanced case involving leg ulcers if other techniques fail. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins and then removes the veins through small incisions. This procedure is performed on an outpatient basis. Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery. Complications of Varicose Veins / Spider Veins Most varicose veins are reasonably benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb. Pain, tenderness, heaviness, inability to walk or stand for long hours, thus hindering work Skin conditions / Dermatitis which could predispose skin loss Skin ulcers especially near the ankle, usually referred to as venous ulcers. Development of carcinoma or sarcoma in longstanding venous ulcers. Over 100 reported cases of malignant transformation have been reported at a rate reported as 0.4% to 1%. Severe bleeding from minor trauma, of particular concern in the elderly. Blood clotting within affected veins, termed superficial thrombophlebitis. These are frequently isolated to the superficial veins, but can extend into deep veins, becoming a more serious problem. Acute fat necrosis can occur, especially at the ankle of overweight patients with varicose veins. Females are more frequently affected than males. Varicose Veins With Effective Home Remedies Gentle massage Blood pooling in the veins is one major problem that exacerbates varicose veins. It causes the lax walls of the veins to expand and get twisted, impeding the blood flow further. Formation of blood clots is another risk. It always helps to keep the legs at a slightly elevated position while sitting and lying down to allow the venous blood to flow towards the heart. But massage is a more active way to increase blood circulation, although it should be administered very gently in people with varicose veins. Compression Applying uniform pressure on the legs with specially designed compression stockings is a tried and tested remedy for varicose veins. Loss of elasticity of the blood vessels and their consequent enlargement reduces the efficiency of the venous valves trying to stem the backflow of blood. The gentle, yet consistent pressure compresses the veins, reducing their diameter. Mud packs Applying a mudpack to varicose affected legs may help reduce vein enlargement. Significant reduction in pain is often reported after mud pack treatment. Fine clay such as Fuller’s earth is best for mudpacks. Mix the clay with water and apply to your legs before going to bed. In the morning, wash the clay with warm water and pat the area dry. Dietary support Research indicates that an increase in homocysteine levels in the blood can damage the lining of the blood vessels and increase the risk of thrombosis and varicose veins. Deficiency of B-complex vitamins, B6 (Pyridoxine), B9 (Folic acid) and B12 (Cobalamin) in particular, is known to elevate homocysteine levels. Alcohol consumption also has a similar effect. All vitamins should ideally be supplied to the body through food; hence, foods rich in B6, folate, and B12 can benefit people with varicose veins. Tuna, salmon, shrimp, chicken, turkey, and egg are excellent sources of these vitamins. Sweet potatoes, potatoes, sunflower seeds, avocados, bananas, broccoli, lentils, and lima beans are also good vegan sources. Increasing activity The heart pumps blood into the arteries, but its return to the heart from the legs is aided by the movement of the calf muscles. That is why sedentary lifestyles are bad for varicose veins. When you have this condition, standing and sitting for extended periods should be avoided. . Herbal Remedies for Varicose Veins There are many home remedies for varicose veins found in the plant world. Here are just a few. Horse chestnut Horse chestnut extract obtained from the bark, leaves, flower and the seeds of the plant Aesculus hippocastanum is one of the most popular herbal remedies for varicose veins and other circulatory diseases. The active ingredient is Aescin which is vasoprotective, inhibiting the enzymes that cause damage to the walls of the blood vessels. Grape seed extract The tiny seeds inside grapes contain antioxidant substances, including several types of flavonoids, linoleic acid and vitamin E. Oligomeric proanthocyanidin complexes (OPCs) are another powerful set of antioxidants with well known vasoprotective properties. They prevent free radical damage to the walls of the blood vessels. They also promote the formation of collagen, a protein that helps maintain the elasticity of connective tissues and strengthen the walls of the blood vessels. It prevents leakage of fluid from the veins and resultant swelling of the legs. Cayenne pepper Cayenne pepper is rich in vitamin C and flavonoids. They protect the walls of the blood vessels from free radical damage and promote collagen formation to keep them healthy and elastic. But the most potent substance in cayenne pepper is capsaicin which has anti-inflammatory, analgesic, and blood thinning properties. Pine bark extract Pine bark extract has been studied extensively, especially the proprietary product Pycnogenol® extracted from the bark of French maritime pine. It contains many phenolic acids, flavonoids, and proanthocyanidins that bestow a number of beneficial effects, including visible reduction of varicose veins and associatedinflammation. Pot Marigold (Calendula officinalis) Pot marigold is an age-old remedy for almost all skin problems. Although varicose veins are not really a skin problem, they can give rise to itching, dryness, eczema, dermatitis and ulcers. For quick relief of these conditions, make an infusion of the pot marigold petals in boiling water and use it for warm compresses. Or you can also soak in a warm bath to which a handful of flowers are added. Gotu Kola (Centella asiatica) Commonly known as Indian pennywort, this ground-hugging herb from the Orient has been used as a popular varicose remedy for thousands of years in India and the Southeast Asian countries. The herb extract or dried herb powder is taken orally to treat venous insufficiency. It reduces leakage from veins and reduces inflammation and water retention. Other Natural Remedies for Varicose Veins Here are two more simple remedies you can try at home if you suffer from the pain and inflammation of varicose veins. Apple cider vinegar This is one of the easiest, yet effective remedies for varicose veins. Apple cider vinegar has astringent properties which help shrink swollen veins and restore their plasticity. Witch hazel This Native American herbal remedy has been helpful to many people with varicose veins. The tannins in the extract give it excellent astringent property, which helps in constricting the distended veins and restoring their natural elastic nature. Witch hazel has excellent anti-inflammatory properties too. Treating Varicose Veins with Essential Oils Essential oils are concentrates of the active ingredients found in medicinal plants. Although more expensive than aqueous extracts and tinctures, it is easy to carry around and use in any situation. A little goes a long way, so it wouldn’t be a bad idea to invest in a few essential oils that can bring relief from chronic problems like varicose veins. Essential oil of Helichrysum This oil is an excellent remedy for varicose veins. It is extracted from the flowers of Helichrysum spp., and has anticoagulant and anesthetic properties. It can prevent the formation of clots in the stagnant blood within the enlarged veins. Spot application of 2-3 drops of the essential relieves pain and reduces the swelling by improving the movement of blood through the veins. Chamomile oil Chamomile is soothing and relieves the heaviness and discomfort resulting from throbbing veins, especially after you have been on your feet for some time. Mix chamomile oil with some organic coconut oil and rub your legs before bed. Lavender and rosemary oils – Both of these essential oils have anti-inflammatory and pain reducing properties. Cypress oil – Constricts blood vessels and tightens tissue promoting the upward flow of blood. Homeopathic Remedies Arnica (Leopards Bane) Arnica is used for varicose veins that feel and look bruised, and are painful and swollen to touch. It reportedly relieves swelling and pain linked with overexertion, trauma, or surgery. A study published in Research in Complementary and Natural Classic Medicine in 2003 found that arnica was better than a placebo for patients following varicose vein surgery. Aesculus Hippocastanum (Horse Chestnut) Aesculus hippocastanum is used for distended and purple veins that cause sticking, hot pains. Symptoms will worsen from the cold weather and walking, while open air improves symptoms. Depression and irritability are also common in the person that benefits from this remedy. There may also be liver congestion with constipation. Bellis Perennis (Daisy) Bellis perennis is used for varicose veins that occur during pregnancy, and make it difficult to walk. There is also a deep bruising pain, along with swollen tissues, heavy, tired limbs, and a tendency toward bleeding. Symptoms improve with motion or rubbing; however, symptoms worsen from warmth, touch, or walking fast. Carbo Vegetabilis (Vegetable Charcoal) Carbo vegetabilis is said to be a good remedy when there is mottled skin with distended veins. The person’s leg will also feel chilly, weak, and heavy, along with a burning pain. The person also tends to be slow and sluggish both from a mental and physical standpoint. Symptoms worsen from lying down, drinking wine, and warmth, while they improve from elevating the feet. Fluoric Acidum (Hydrofluoric Acid) Fluoric acidum is used for chronic varicose veins and ulcers, especially in women who have had many children. Burning pain and weak distended blood vessels are also common. The person also feels the need to walk very fast. A cool bath will improve symptoms, while they worsen from touch, sitting, lying down, warmth, and at night. Hamamelis (Witch Hazel) Hamamelis is homeopathic witch hazel, and it is used for varicose veins of the legs and thighs with congestion, swelling, heaviness, or soreness. The remedy may improve circulation, bruising, and heavy legs. There is often chilliness, stinging, and itchiness down the legs. Lying down and motion improves symptoms; however, they worsen from jarring, warmth, touch, sitting, and pressure. Lachesis (Bushmaster Snake) Lachesis is a common remedy for the blue-red swelling associated with varicose veins. The veins may also bleed easily, and the person tends to be hot and intolerant toward heat. Pregnancy or menopause will often cause symptoms. The knotted veins are also often found behind the knee, or in the foot, leg, or arms. The person will have a suspicious, intense, and talkative personality. Symptoms will also worsen from touch, heat, alcohol, or after sleeping. Pulsatilla (Wind Flower) Pulsatilla is used for swollen veins in the legs, and may appear bluish with a stinging pain, especially during pregnancy. There may also be varicose veins in the hands, forearms, and legs, and there may be swelling in the feet. The symptoms will also worsen from heat, and improve from rubbing and fresh air. The person has a tendency toward being emotional and needy. Sepia (Ink of the Cuttlefish) Sepia is used for congested and purplish veins that have lost their elasticity, and often becomes a problem during pregnancy or menopause. The woman is also prone to chilliness and constipation, and has cravings for chocolate, salty, and sour foods. There may also be heaviness, bleeding, stitching pains, hemorrhoids, depression, and sluggish bowels. Symptoms improve from warmth and exercise. Lycopodium (Club Moss) Lycopodium is often the go-to remedy for tearing pains felt in the legs that sometimes occur with numbness. The remedy is often used for people that worry and experience poor circulation and digestive and liver problems. Symptoms tend to worsen when the person legs cramp at night in bed, or while they keep still. Calcarea Carb In cases that are painless, Calcarea Carb is one of the best Homeopathic medicines for varicose veins. The patient is malnourished but obese. There may be burning sensation in the varicose veins. Patient is chilly. The hands and feet remain cold and may have excessive sweating. Graphites In cases where there is itching with the varicosities, Graphites is one of the best Homeopathic medicine for varicose veins. It is also very good when there are cramping pains in the legs. The patient is usually obese, constipated and may have other skin problems. Lifestyle Remedies for Varicose Veins Although all the above home and herbal remedies for varicose veins will give you relief, you will also need to bring some minor and some major changes in your lifestyle so that you may prevent this varicose veins issue once and for all. Do not sit or stand for longer periods at a stretch. If your work demands so, take breaks after every 30 minutes. Change your position, walk a little, stretch or stand for a while. Just don’t be in a same position for longer. If you sit for longer, try to keep your legs elevated by using a stool or another chair. Don’t sit with crossed legs or crossed ankles. Keep your legs elevated even when you lie down or sleep. Avoid wearing high heels. Avoid wearing tight clothes, especially those that may cut your blood circulation around your waist legs and groin area. Exercise regularly. Cardiovascular exercises and strength training all are beneficial for you. Walking too improves your blood circulation. Lose weight. Being overweight is one of the major causes of varicose veins. Have a balanced diet. Include more fiber in your meals. Fruits and vegetables high in antioxidants are good for you. Avoid alcohol as it dilates blood vessels making your varicose veins condition worse. Quit smoking as it doesn’t keep your blood circulation healthy. All these diet and lifestyle changes, as well as home remedies, will definitely make your varicose veins disappear over time. References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526945/ https://www.ncbi.nlm.nih.gov/books/NBK279246/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964550/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122628/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882360/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301287/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728303/ https://www.ncbi.nlm.nih.gov/books/NBK470194/ https://www.ncbi.nlm.nih.gov/books/NBK279247/ https://www.ncbi.nlm.nih.gov/books/NBK264166/ Show More
Medications Analgesic – Prescription-strength drugs that relieve pain but not inflammation. Antidepressants – A Drugs that block pain messages from your brain and boost the effects of eorphins (your body’s natural painkillers). Corticosteroids – Also known as oral steroids, these medications reduce inflammation. Muscle Relaxants – These medications provide relief from spinal muscle spasms. Neuropathic Agents – Drugs(pregabalin & gabapentine) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling. Opoids – Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision. Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin. NSAIDs – Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve). Anti-platalete Drug – to increase blood flow & thinning blood Diosmin/hesperidin – and other flavonoids. Topical gel application – helps in managing symptoms related to varicose veins such as inflammation, pain, swelling, itching, and dryness. Topical application (noninvasive) has patient compliance. There are various alternatives to the surgical removal of varicose veins In radiofrequency ablation, heat generated by electromagnetic waves (radio waves) is used to close off the veins. This procedure involves inserting a thin radiofrequency ablation (RFA) probe into the vein through a small incision. The RFA probe contains a catheter that heats the vein until it is closed off. A treatment known as endovenous laser ablation also involves closing off the vein from the inside using heat. The procedure is very similar to radiofrequency ablation, but lasers are used to generate heat instead of radio waves. In transilluminated powered phlebectomy (“Trivex”), a tiny rotating blade is inserted into the vein to cut it, and the vein tissue is then removed using suction. The vein is illuminated from the outside through the skin so that it can be seen by the surgeon. This approach is only considered as a treatment option for people whose “great saphenous vein” is healthy.