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WHAT IS IT?
Veins are the blood vessels that carry blood back to your heart from the rest of the body. Varicose veins form when blood collects inside, making them swell and turn dark blue. Varicose veins often develop in the legs near the skin, and they’re easy to see. The smallest type of varicose veins, called spider veins, appear on the surface of the legs. Less often, varicose veins form deeper in the legs, where they can’t be seen. Varicose veins may also form in the arms, or near the anus, where they are called hemorrhoids.Varicose veins can be unattractive and sometimes painful, but they’re usually not dangerous. Deep varicose veins can cause problems with circulation, though. In severe cases, the skin covering them can become dark, hard, and swollen. Sores may also develop, usually around the ankles.
Varicose veins are common. About 20 percent of American adults get them. They don’t get better on their own. Fortunately, there’s a lot you can do to prevent them or to treat them when they occur.
WHAT IS HAPPENING?
Veins bring blood from all over the body back to the heart. Because the heart is in the upper chest, most veins must fight gravity. To help blood return from the legs and lower body, muscles surrounding the veins squeeze the blood upward, and one-way valves in the veins keep the blood from flowing back down.
When the walls of the veins weaken and stretch, though, these valves can’t close all the way. Blood flows backward through the valves, pooling in the veins and making them swell.

Veins deep inside the leg don’t tend to become varicose because muscle supports them. Most deep veins are also larger and don’t stretch as easily as the smaller surface veins.

Varicose veins usually don’t threaten your health. But if you’re a woman with varicose veins and you take birth control pills, you may be more likely than others to get painful blood clots in your leg, a condition called thrombophlebitis. If you already have a history of thrombophlebitis, talk to your doctor about changing your form of birth control.

Anyone with varicose veins who undergoes major abdominal or orthopedic surgery, such as a kidney transplant or a hip replacement, runs the risk of developing blood clots deep in the legs; this condition is called deep vein thrombosis (a serious form of thrombophlebitis). In rare cases, these clots can break off and travel to the lungs.

Minor surgery to repair varicose veins can also cause deep vein thrombosis in women who use birth control pills or estrogen replacement therapy. The blood-thinning drug heparin, injected under the skin before surgery, can prevent this problem. Or women who use birth control pills can protect themselves by not taking their pills for four weeks before and two weeks after surgery.
WHAT CAUSES IT?
Researchers don’t know exactly why veins stretch and valves fail in some people, but they’ve found some factors that increase the risk.

THINGS YOU CAN’T CHANGE

Being a woman
For unknown reasons, varicose veins are slightly more common in women than in men.

Family history
If your mother or father had varicose veins, you’re more at risk than someone without a family history of the problem.

Age
As you grow older, the walls of your veins tend to weaken and lose flexibility.

Pregnancy
Varicose veins can develop or worsen during pregnancy because hormone changes can weaken vein walls. And the weight of the baby can press on the large vein in the abdomen, making it harder for blood to flow back up to the heart. Also, weight gain puts extra pressure on blood vessels in the legs, making varicose veins worse or more likely. Varicose veins that appear with pregnancy usually disappear soon after the baby is born.

THINGS YOU CAN CHANGE

Standing
Being on your feet for long periods of time puts more pressure on the vein walls and valves, weakening them.

Lack of exercise
The calf and thigh muscles help pump blood up the legs toward the heart, taking pressure off the veins. When you don’t exercise enough, the muscles weaken and can’t help as much, which increases the chance of varicose veins.

Obesity
Extra weight strains the blood vessels and raises a woman’s risk of varicose veins. Obese men, though, aren’t more likely than thin men to have the condition.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to prevent varicose veins, and if you already have them, you can make them feel better and keep them from getting worse. Here are some things to try:

Rest
For relief of discomfort caused by varicose veins, stay off your feet as much as possible. Take breaks often if you need to stand a long time. When you can, sit or lie down and raise your legs above chest level. Try for at least twice a day, 30 minutes at a time. Sleep with your legs raised and supported to help drain blood and reduce swelling.

Support
Elastic support stockings help keep blood from pooling. They’re available at most drugstores.

Good posture
Don’t cross your legs. This increases pressure in the veins. Don’t sit or stand in the same position for long periods.

Keeping cool
Avoid direct exposure to the sun and hot water. Both cause veins to expand so that valves don’t close correctly.

Exercise
Exercise that works the legs, such as walking, biking, or jogging, strengthens your leg muscles and helps pump blood toward the heart. This prevents pooling, reduces varicose veins, and helps ease any pain. Avoid sports like weight lifting, though. These can increase pressure on the legs and make varicose veins worse.

The idea of exercising if you’ve been inactive for a long time may be a little scary. Here are some tips to make it safe and easy:

First, check with your doctor about the best way to get started.
Any exercise is better than none. Start by being a little more active each day. Take the stairs instead of the elevator or walk the dog for 15 minutes each evening; your dog and your veins will thank you.
When you’re used to being more active over a couple of months or more, slowly work up to two or three times a week for 20 to 30 minutes at a time.
Find something you enjoy-it’s much easier to keep exercising when you like to do it.
If you have any symptoms of angina or a heart attack-chest pains, tightness in the chest, breathlessness, or dizziness-stop and get help right away. Call 911.
Losing weight
If you’re overweight, start dropping those extra pounds. Excess weight is hard on the veins. Don’t go on a “crash” diet, though, because most dieters gain back any weight they lose. The best approach? Combine smart eating with exercise.

Calories put on pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 more calories than you eat. That’s because a pound of fat contains 3,500 calories. Think about what you eat: A typical fast-food lunch of a burger, fries, and a shake, for instance, packs about 1,700 calories; an apple, by contrast, has only 80.

Taking off weight may sound daunting, but it doesn’t have to be. Here are some tips for a program that works:

Take your time. It’s better to lose weight slowly-no more than 1 percent of your body weight each week. The more gradually you lose weight, the easier it is to keep it off.
Be realistic. Don’t shoot for a weight you can’t maintain.
Keep an eye on your total calories and make a point of cutting down on fats-they have the most calories of anything we eat.
Choose low-fat foods such as nonfat dairy products, fish, and lean cuts of meat. Eat more vegetables, fruits, and grains. They have what your body needs for energy and good health, and they’re low in fat and calories.
Limit sugar and alcohol. They have lots of calories but few of the things you need for good health.
Fat-free and low-fat foods can be a trap. They cut down on fat, but they often make up for it with sugar, so they still add lots of calories.
Stay as active as you can.
Vitamins
Make sure you get enough vitamin C (75 milligrams per day for women; 90 mg for men) and vitamin E (for men and women, 15 international units per day from food or 22 to 33 IU from supplements). They’re both important for good blood flow and healthy veins.
WHAT YOUR DOCTOR CAN DO FOR YOU
If your varicose veins hurt or you don’t like the way they look, you might want to think about surgery.

Surgery
A surgeon cuts and ties the upper and lower ends of each varicose vein, then takes out the swollen part. Healthy veins nearby enlarge and take over the function of the removed veins.

In a newer procedure called ambulatory phlebectomy, a surgeon can remove large pieces of vein through tiny punctures in the skin. The operation, which only works for veins near the skin surface, causes little pain and bruising. Patients can usually return to normal activities the next day.

Laser surgery
In some cases, doctors remove varicose veins with a laser. Lasers usually work only on the smallest veins, especially the spider veins that often appear on the legs. Though standard lasers can burn people with tanned or naturally dark skin (the skin’s pigment absorbs laser energy and heats up), the newest lasers work safely on any skin type.

Sclerotherapy
Your doctor injects a chemical solution into the varicose veins, which then collapse. Over time, the veins shrink to a fine thread. Nearby veins take over.

Sclerotherapy has some drawbacks. For one thing, it can leave brown splotches on the skin. Also, varicose veins usually return within five years. Once a common treatment for varicose veins, sclerotherapy is now mainly used for mopping up small veins missed by surgery.