Varicose Veins
Reviewed by Dr Amit KumarSclerotherapy
New patient guide: getting the most from compression stockings
Graduated compression helps the calf muscle pump move blood upward and can ease the aching and swelling of venous reflux — when it is worn correctly and for the right reasons.
Medical terms
Tap a term for a plain-English definition.
What is this
Varicose veins are veins — usually in the legs — that have become swollen, twisted and visible under the skin. Inside a healthy leg vein, small one-way valves keep blood moving in one direction: upward, back towards the heart, against gravity. When those valves weaken and stop closing properly, blood can slip back down and pool in the vein. Over time the vein stretches and bulges, and that is what you see and feel.
They are very common — about 20% - 30% of men and 30% - 40% of women develop them at some point in life. For many people they are mainly a cosmetic concern. For others they cause genuine symptoms, and in a smaller number they lead to changes in the skin that need medical attention. Part of the purpose of this page is to help you tell which situation you are in.
Having varicose veins does not mean something is dangerously wrong, and most people never develop a serious complication. But they are worth understanding, because on the occasions when they do matter, acting earlier is usually simpler than acting later.
Symptoms
Varicose veins do not always cause symptoms, but when they do, these are the kinds of feelings they describe:
- Aching, tired or heavy legs, especially after standing for a long time
- A feeling of heaviness or throbbing that builds through the day
- Cramping, often at night
- Itching or a restless feeling around the veins
- Visible rope-like or cord-like veins, or clusters of finer “spider” veins
- Mild swelling around the ankle by the evening
Symptoms often ease when the legs are raised or after walking, and tend to be worse in hot weather or after a long day on your feet.
The most important section
When to seek an opinion
Most varicose veins are a comfort-or-appearance matter, and it is entirely reasonable to live with them. But certain changes suggest the pressure in the veins is starting to affect the skin and tissues — and these are the situations where an assessment genuinely matters. If you notice any of the following, it is worth being seen:
- Skin changes around the ankle — brown or rust-coloured staining, hardening, or dry eczema-like patches
- Swelling in the leg that does not settle overnight
- An open sore or ulcer near the ankle that is slow to heal, or skin that has broken down
- Bleeding from a vein — even a minor knock can cause surprising bleeding from a surface varicose vein
- A vein that becomes hot, hard, red and tender, which can mean a clot has formed in it (superficial thrombophlebitis). This can rarely, but possibly be associated with a DVT and should be seen by a physician relatively urgently.
- A sudden increase in pain or swelling in one leg, which needs prompt medical assessment to rule out a deep-vein clot (DVT). This requires an immediate visit to the doctor for assessment with an ultrasound.
Is any of these you?
Draft — pending clinical reviewTap the picture closest to what you see on your own leg.
Seek help straight away if you notice
Who gets them, and why
Several things make varicose veins more likely, and most are outside your control. They run in families, so heredity plays a large part. Pregnancy commonly brings them on or makes them worse, though some improve in the months after delivery. Jobs that involve long hours standing, and simply getting older, both add to the risk, and carrying extra body weight can contribute as well. None of this means you did anything wrong.
How it’s assessed
Assessment is straightforward and painless. It begins with a conversation and an examination of your legs — usually while you are standing, so the veins are easy to see and feel.
The key test is a duplex ultrasound: the same harmless sound-wave scan used in pregnancy. It shows how blood is flowing through the veins and pinpoints exactly which valves are leaking. It takes a little time but involves no needles and no discomfort. That map is what guides treatment — it is why two people with similar-looking veins can need quite different approaches.
More about the scans you might have is on the Tests page.
Treatment options
There is a sensible order to treatment, and it usually starts with the simplest measures. What is right for you depends on your symptoms and, above all, on what the ultrasound shows.
Start here — conservative measures
Compression stockings
Graduated stockings that squeeze gently — most firmly at the ankle — to help the leg muscles pump blood upward.
- What it involves:
- Worn during the day and taken off at night. They can feel warm in a hot climate, and getting the right fit matters.
- What to expect:
- They ease aching and swelling and are often the first step, but they manage symptoms rather than curing the veins.
Elevation, movement and lifestyle
Simple everyday measures — raising the legs when resting, walking regularly, and keeping active.
- What it involves:
- No cost and no downside; walking in particular works the calf-muscle pump that weak valves need help with.
- What to expect:
- These help symptoms and are worth doing whatever else you decide, though they will not make established varicose veins disappear.
Procedures, if they are needed
Foam sclerotherapy
Watch: SclerotherapyA mixture of a medicine (like a medical soap) and CO2 gas, is injected into the vein, irritating its lining so the vein seals shut and gradually fades.
- What it involves:
- Done in the clinic, usually with only a topical anaesthetic; Usually requires multiple sessions depending on the extent of the veins.
- What to expect:
- Best suited for certain veins (smaller veins are the one's usually treated this way); expect some bruising and temporary discolouration afterwards. These may take upto a year to lighten to skin tone.
Thermal (laser or radiofrequency) ablation
A thin fibre is passed inside the faulty vein and gentle heat is used to close it from within.
- What it involves:
- Done under local anaesthetic, with or without sedation (as your preference), usually as a walk-in, walk-out procedure, or as a day surgery procedure. Often times accompanied with phlebectomies (removal of the large bulging veins) at the same time.
- What to expect:
- Widely used for the main trunk veins; expect some tightness and bruising along the vein for a short while - usually a few weeks.
Perforator ablation
Watch: Perforator ablationSometimes the leak is in a “perforator” — a vein connecting the deep and surface systems — which can be closed with the same heat or foam technique.
- What it involves:
- Targeted at a specific connecting vein identified on the ultrasound, often alongside other treatment and usually AFTER the main vein has been treated.
- What to expect:
- Used when the duplex scan shows a perforator is a significant part of the problem, not routinely - and requires a skilled ultrasound to be done to define this.
Surgery
Traditional removal of the vein (ligation and stripping).
- What it involves:
- A more involved procedure than the options above, now used more selectively since less-invasive techniques became available.
- What to expect:
- Still has a place for certain veins and situations; your surgeon should explain why it is or is not the right choice for you.
No single method is best for everyone, and honest expectations matter more than any marketing claim. Veins can recur over time whatever is done, so be wary of promises of a permanent guarantee.
What happens if they’re left untreated
Leaving varicose veins alone is often a perfectly reasonable choice. Most change slowly, over years, and many people never have a problem beyond appearance and mild aching.
In a proportion of people, though, the steady back-pressure gradually affects the skin near the ankle — staining, thickening, eczema, and in some cases an ulcer that is slow to heal. The features that tend to predict trouble are the ones in the “When to seek an opinion” section above: skin discolouration, swelling that does not settle, and previous episodes of bleeding or clot. If those appear, it is better to be assessed sooner rather than later — skin that has already broken down is harder to heal than skin you are protecting in advance.
Common Questions Patients Ask
Will they come back after treatment?+
They can. Treatment deals with the veins and leaking valves you have now, but it cannot stop new veins developing over time, and the tendency is partly inherited. Good diagnostics, allow correct treatment, which reduces the chance of recurrence, and any new veins can usually be treated again.
Is walking good or bad for varicose veins?+
Good. Walking works the calf-muscle pump that pushes blood up the leg — exactly what weak vein valves need help with. It is prolonged standing still, not movement, that tends to aggravate them.
Do I actually need surgery?+
Often not. Many people are managed with compression and lifestyle measures, and most procedures today are minimally invasive rather than open surgery. Whether any procedure is needed depends on your symptoms and what the ultrasound shows — it is a shared decision, not an automatic one.
Does treatment hurt?+
Pain is a relative feeling. If you are in general on the more sensitive spectrum, you will feel the needle and the medicine burning as it is being injected. Most people are able to tolerate this. Modern treatments are done under local anaesthetic or with fine needles and are generally well tolerated. There can be some bruising, tightness or aching for a short time afterwards. You will need to wear the compression stockings for several days after the injections. It is always reasonable to ask exactly what to expect before agreeing to anything.
Are varicose veins dangerous?+
Usually not in themselves. The concern is a small risk of skin damage, bleeding or clots developing over time — which is why the warning signs above are worth knowing.
Contact us
To ask about varicose veins or arrange an assessment, send the clinic a message on WhatsApp.