Step by step, several interventions and self-care strategies have good evidence to improve patient condition. There are many possible ways to apply this approach to individualized care for patients. Therefore, it is important for doctors to understand and know the patient, their condition, and several effective interventions for varicose veins.
Unfortunately, in many cases, due to misunderstandings from patients or doctors, education and treatment about varicose veins are inadequate and not optimal. For several reasons, this condition has been underestimated, so positive intervention is needed to improve education and care for patients.
Varicose veins are not a life-threatening condition, but it is important to manage and control them for several reasons. This is a common condition that can affect middle-aged people. Unfortunately, there is a misinterpretation that varicose veins are a sign of aging and should be accepted. This view is incorrect because varicose veins occur due to an underlying cause and are related to abnormal vein function. If left untreated, they can lead to more serious conditions and other types of diseases. Therefore, it is important for patients to understand varicose vein and seek early treatment. This is especially important to prevent serious chronic venous insufficiency problems and diseases, and also to improve the health and quality of life of the patient.
Varicose veins are a common manifestation of chronic venous insufficiency, occurring in 10% to 15% of men and 20% to 25% of women. Varicose veins describe a condition in which the veins become enlarged and filled with blood, and most of the time appear twisted. Varicose veins usually occur on the posterior aspect of the lower limb, thigh, and leg, and sometimes can affect the lower part of the leg.
Understanding Varicose Veins
Venous disease is a condition caused by the malfunction of vein valves in the leg, which can result in varicose veins. Normal veins have a series of valves that assist in the return of blood to the heart. When muscles in the legs contract, they force blood through the valves upward towards the heart. Afterward, the valves close to prevent the blood from flowing backwards. A varicose vein occurs when abnormal pressure causes the vein to dilate and results in valve malfunction. This can be caused by a number of factors, including age, sex, family history, obesity, pregnancy, prolonged sitting or standing, leg injury, and previous venous thrombosis. Valves in the veins are particularly tested when standing for long periods, which may explain the high prevalence of venous disease in individuals who occupy jobs that require prolonged standing. Various physiological changes in the body contribute to a higher incidence in women, such as hormonal changes during puberty, pregnancy, or menopause. High hormone levels relax vein walls and increase vein distension. Similarly, the higher prevalence of venous disease in the elderly can be attributed to the general weakening of the circulatory system. Moreover, women who have multiple pregnancies or become obese are at a higher risk due to increased abdominal pressure, which is transmitted to the lower extremity veins. These causes are relevant to specific types of venous disease; therefore, understanding the pathophysiology of varicose veins is necessary to implement the right self-care strategies.
Causes of Varicose Veins
In order to develop a comprehensive patient-conscious description of varicose vein disease, it’s also necessary to stray into the realm of pathophysiologic hypothesis at every level. This is because many patients complain of symptoms that do not directly correlate with the size and/or site of their visible varicose veins, or leg telangiectasia or reticular vein.
This contrast between health and disease can be demonstrated by describing the pathophysiologic derangements in varicose vein disease while comparing it with the physiology. In this way, one can gain a clear picture of the therapeutic aim with each specific condition and also understand the mechanism of action of various treatment modalities.
The best way to understand venous disease is to imagine what life would be like for the patient with healthy venous circulation. More than 400 years ago, the French venous specialist Roland Delmet described the beauty, misery, and variety of the human predicament. He suggested that it is possible to create an imaginary contrast between the physiologic health and the pathophysiologic dilation and reflux of varicose veins that create chronic venous insufficiency. This is a strategy that we use again and again to help explain similar problems to our patients, who are always more interested in how these conditions affect the way they live and how they feel.
During the past four years, it’s been our privilege to study the patient’s chapter. With the benefit of insight and support from so many patients, combined with a review of the international literature on varicose vein disease and chronic venous insufficiency, we feel that we now understand more about the patient’s conscious experience, as well as the sequence of anatomical and functional events that occur in it. It’s this understanding that forms the central theme of this book, and we hope the explanations and descriptions that follow will be of interest to all.
Symptoms of Varicose Veins
– Vein-related eczema: Also known as stasis dermatitis because it occurs in areas of venous stasis, this is a red, sometimes weeping, discolored area often at the ankle which represents inflammation and tissue breakdown. It is caused by the release of iron from stagnant hemosiderin-laden macrophages and can lead to fibrosis and atrophie blanche. This is a red atrophied area that can take many years to heal and is actually a final common pathway as opposed to a separate condition. Eczema can be a debilitating problem with an intense itch, and scratching can make things worse by causing weeping and an open wound which can get infected.
– Ankle swelling: This is caused by fluid accumulating in the tissues. Chronic long-standing fluid retention can cause increased pigmentation of the skin at the ankles, and a history of this pigmentation can be an important clue in a past history of significant varicose veins.
It is possible for patients with varicose veins to be entirely asymptomatic, with the exception of the varicosities. However, it is also possible for varicose veins to cause aching pain and discomfort, and other symptoms can develop. These include:
Self-Care Strategies for Varicose Veins
Physical activity and exercise improve the calf muscle tone, which is important for maintaining the efficient return of blood to the heart. Exercise also helps to control weight and reduce the risk of developing leg swelling, which is an important consideration for people with varicose veins. In obesity, the high pressure inside the abdomen is transmitted to the leg veins, where it overloads the vein circulation. This can lead to the development of varicose veins and to complications of veins with a deeper circulation, and it makes any vein problem more troublesome. Anything that reduces the presence of blood in the veins, such as diuretic therapy for heart or kidney failure, may make varicose veins and leg symptoms worse. Diuretics act by reducing the volume of blood rather than by actually reducing water in the body, and this tends to worsen any vein problem by reducing the filling of the central circulation at the expense of an increased filling of the leg veins. Because most older people are overweight and have other medical problems, very few will be suitable candidates for diuretic therapy. A better approach is to recognize the importance of regular physical activity such as walking, coupled with periods of rest during which the legs are elevated. This is the best way of using the calf muscle pump to maximize the return of blood to the heart, and it is the safest way of controlling the presence of blood in the leg veins. Both walking and weight control are in the patient’s own best interests and should not be discouraged by fear of worsening varicose veins.
Exercise and Physical Activity
The report says a further experiment compared strenuous and less strenuous non-occupational physical activity in relation to varicose veins. This was carried out on over 3000 men and women who were examined over a 7-year period. Strenuous physical activity was found to increase the likelihood of developing varicose veins, and encouragingly, the less strenuous activity was associated with a decreased likelihood of developing the smaller varicose veins. This can give even people with no symptoms of varicose veins a good reason to change to the less strenuous activity, if it does not mean it’s too late for them to make any positive changes.
One of the delicacies in such a piece of work is the explanation of the treatment of varicose veins. A physically active lifestyle is one of the primary aims for many people. By telling people how they can continue their physical activity should aid the patients to get closer to being symptom-free or, if anything, avoid any further varicose veins from developing. It also puts them in the driving seat to help prevent their disease from getting worse. The advice given from the expert US panel suggests brisk walking could be the best form of exercise. Trials will be carried out to test whether the type, duration, or intensity of exercise can affect varicose vein development or the frequency of the symptoms.
Compression Stockings
Younger patients with more mild varicose veins may not find them to be visually attractive; however, there are many new types of cosmetically appealing stockings. These come in a range of colors, materials, and styles. Successful treatment of varicose veins with any method may prevent worsening of the varicose vein problem, which may require more invasive treatment. This, however, is not certain and regardless, wearing compression stockings can help control troublesome symptoms and prevent any further varicose veins from occurring. They are safe to use during pregnancy and are often the first step in managing pregnancy-related varicose veins.
Compression stockings are a good non-invasive treatment and can be used at any stage of varicose veins. They can be particularly useful in controlling superficial thrombophlebitis. Wearing compression stockings has been shown to improve symptoms for people with varicose veins. In chronic venous insufficiency or post-thrombotic syndrome, compression stockings reduce edema and improve ulcer healing.
Compression stockings are an important component in the treatment of varicose veins. Compression stockings are tight elastic garments that are worn around the legs and apply pressure. This pressure is greatest at the ankle and gradually diminishes up the leg. It helps increase venous blood flow, which helps to control and prevent any further varicose veins. It’s important to purchase high-quality stockings that have a defined amount of pressure. Because these stockings can be tight, it’s important to have them fitted correctly so that they are the right size. Incorrectly worn stockings can cause discomfort and actually aid in worsening the varicose veins.
Elevation of Legs
Repeat the exercise at least three or four times a day, holding each position for 15 minutes. Advantages: Gravity helps the inflow of blood and it’s just one muscle action to sustain it. Best positions are: lying down with your legs resting up against the wall and seat cushion or chair (the kind at a picnic table) with your legs resting on the bench. Support tights do the same job without the effort but are less effective, they really need to be gradient compression of at least class 1 (14-17mmHg). Alternative: If you don’t have the time or patience to lie down with your legs up the wall for up to an hour, you probably won’t! If you take frequent flights long haul and suffer from swollen ankles and/or varicose veins, flight socks are a good investment although they don’t do the same job as medical compression but will reduce discomfort and swelling.
Lifestyle Changes for Varicose Vein Prevention
Avoiding prolonged sitting or standing is another important step in controlling vein development. In individuals with a strong genetic predisposition to varicose veins, this can significantly delay the onset of the problem. This is particularly beneficial in the prevention of deep vein thrombosis, a more serious condition that often results from long periods of immobility. If you have a job that requires long periods of sitting or standing, taking regular breaks to move around can dramatically reduce the stress on your veins. This is because muscle activity is essential for efficient blood circulation. When your leg muscles are inactive, they do not provide the necessary pumping action to move blood back up to the heart. This can lead to pooling of the blood and increased pressure on the vein walls. Consider doing activities such as walking during your lunch break or simply taking short walks around the house. This is an effective and effortless way to exercise your leg muscles and improve circulation.
It is a common misconception that weight gain causes varicose veins; data to support this belief is currently unavailable. However, it is understood that excess weight can exacerbate the condition. This is because being overweight puts additional pressure on your veins. The veins near your legs are the most susceptible to this pressure, as your body has difficulty circulating blood from your legs back up to your heart. To do this, your body must work against gravity. If the blood does not circulate effectively, it is more likely to pool or clot inside the veins. This, in turn, puts increased pressure on the vessel walls. Weight gain can also worsen the cosmetic look of varicose veins, particularly in obese individuals, as the additional subcutaneous fat masks the vein and gives the skin a mottled appearance.
Maintaining a Healthy Weight
Obesity is an important exacerbating factor in the development of varicose veins. Increased body weight results in increased pressure on the venous system in the legs. This occurs predominantly through increased pressure within the abdomen being transmitted to the veins in the pelvis. Increased weight also causes hormonal changes which can lead to vein dilation and increased vein reflux. There is sound evidence to suggest that reduction in body weight can improve the symptoms of venous disease. A 10-year longitudinal study of obese patients with varicose veins showed that those who lost weight (mean 29.5 kg over 2 years) fared better than those who didn’t, with an improvement in clinical severity score of 75% compared with 30% in the control group. Weight loss can be achieved through regular exercise, reducing caloric intake, or bariatric surgery. Venous function and quality of life scores have been shown to improve with regular aerobic exercise. Due to the importance of weight loss, advice should often be given during vein assessment on referral for specialist weight management services. Mainline treatments for obesity (caloric restriction and exercise) should be conducted after vein treatments, with the risk of worsening leg symptoms from reduced calorie intake negated by improvements in venous function.
Avoiding Prolonged Sitting or Standing
Since the nature of occupations makes complete changes in the way of standing or sitting hard to implement, the use of elastic support stockings is recommended. These stockings will provide external pressure to the leg, reducing the diameter of the vein and helping blood to return to the heart. Using these stockings can be done in conjunction with changes in sitting or standing position. But before using them, it is better to consult a doctor or visit a vein clinic to determine the severity of the condition and whether the stockings are useful or not. Steps to avoid prolonged sitting or standing have not shown maximal results as preventive actions. Research about leg muscle activity and occupations that have a high risk of varicose veins has been published. The research aims to explore the way the muscle pump affects the leg veins and causes varicose veins by comparing leg muscle activity in patients with and without varicose veins. The difference in leg muscle activity in certain types of occupations is also a concern to determine the high-risk occupations for getting varicose veins. With this research, I hope that in the future, measures can be taken to reduce the risk of occupations that have a high risk of this condition.
Muscles in the lower extremities act as a “pump” to help return blood to the heart, and the one-way valves in the veins prevent it from flowing backwards. If the one-way valves become weak, blood can leak back into the vein and collect there. This problem, if it occurs consistently, can cause varicose veins. Pooled blood makes the vein swell and causes varicose veins. It is important to manage prolonged sitting and standing to avoid worsening this condition. Prolonged sitting and standing place increased pressure on the veins in the legs. Changing the position of the legs regularly helps to prevent static blood from building up in the veins. Static blood can make it less able to drain back, causing the vein to become larger and bulge. Static positions can also cause symptoms such as swelling and pain in the lower extremities. The influence of prolonged sitting and standing is inevitable. Those who have occupations that require standing in one place or sitting for long periods are at high risk. Flight attendants and nurses are examples of occupations that can influence varicose veins. Teachers are also at high risk because they have to stand for a long time during teaching sessions. Although it is projected that avoiding prolonged sitting or standing can prevent the worsening of varicose veins, it is hard to avoid this condition because direct treatment may interfere with productivity. However, by doing simple activities such as changing leg positions or moving, it can help prevent the worsening of this condition. This applies to those who have varicose veins and also those with a minimum risk of getting the condition. So it is better to keep this in mind as a preventive action.
Taking Regular Breaks to Move Around
Regular exercise is the best way to improve your circulation and to reduce the pressure on your veins. Try to fit in regular exercise that works your calf and thigh muscles – for example walking – this will be the most beneficial. The more you exercise, the better it is for your veins. Any circumstance that causes you to strain or hold your breath when exercising (for example lifting heavy weights) has the potential to be harmful to your veins, so try to avoid this.
When you need to sit or stand for a long time, make sure that you move around. At least every 30 minutes, if you’re sitting, get up and walk around. If you’re standing, then move your legs – this will help to avoid your varicose veins getting worse. If you have any leg symptoms, regular exercise will help to relieve them. Try not to sit with your legs crossed and don’t stand for long periods of time. When sitting, avoid sitting in one position for long periods – even shifting your weight from side to side will help to pump the blood out of your legs.
Wearing Loose-Fitting Clothing
To reduce pressure on the veins and decrease the risk of blood pooling in the legs, it is important to wear loose-fitting clothes that do not constrict your waist, groin, or legs. Tight clothes can make varicose veins worse. Compression stockings may be prescribed by your doctor, and they should be put on before getting out of bed in the morning and removed before you go to bed. This can help control the swelling seen in more severe varicose veins. Special pantyhose support hose are often effective.