Silent Signs of Varicose Veins: How to Recognize and Treat Them

Varicose veins in the lower extremities, contrary to popular belief, do not always present visible changes such as enlarged veins. So, how can you identify varicose veins and what should you do next? Dr. Dmitri Kress, an angiosurgeon, provides insights.

Recognizing Varicose Veins

According to Dr. Dmitri Kress, varicose veins can manifest through a feeling of heaviness in the legs by the end of the day, swelling, cramps in the calf muscles, and other symptoms. Even without visible changes in the veins, these symptoms should raise concerns.

There are several examinations that help establish a diagnosis. The most common and effective is an ultrasound of the lower extremity veins. This test not only confirms the presence of varicose veins but also determines the extent of the condition, which is crucial for choosing the right treatment strategy.

Who is at Risk?

Modern scientists divide the risk factors for developing varicose veins into those that can be controlled and those that cannot.

Research shows that a significant number of varicose vein cases have a hereditary factor, which cannot be influenced. If your parents or grandparents had such issues, it does not necessarily mean you will develop varicose veins, but the likelihood is higher. People with this hereditary predisposition have more elastic venous walls that can easily overstretch with venous blood, leading to insufficient resistance and incompetent venous valves, causing the disease to progress once it starts.

The second group of factors is related to habits and lifestyle, which can be influenced. One of the most common predisposing factors is a sedentary lifestyle. With technological advancements, people move less, negatively impacting the function of the lower extremity veins, which rely on physical activity for proper circulation.

Certain professions also pose a risk, including office workers who sit for long periods, as well as hairstylists, chefs, and salespeople who stand for extended times. It is recommended that these individuals take breaks every hour for five to ten minutes to lie down, elevate their legs, and promote blood flow out of the veins, reducing their diameter and relieving tension. A contrast shower can also be beneficial as it stimulates the tone of the venous walls, promoting better contraction and more intense blood flow.

Varicose Veins and Physical Activity

Dynamic exercise, which involves movement, is undoubtedly beneficial for varicose veins. It engages the muscle-venous pump: when we walk, the leg muscles contract, massaging the veins and aiding blood circulation while preventing stagnation.

Dynamic exercise is also a good preventive measure. However, static exercise, which involves lifting and holding heavy weights, is harmful for varicose veins. Static exercise increases intra-abdominal pressure due to abdominal muscle contraction, leading to venous stasis in the legs and worsening the condition. Such exercises should be limited or replaced with dynamic ones.

Walking is highly beneficial for varicose veins. The general recommendation of walking five kilometers a day also applies to this condition. However, if there are complications such as acute thrombophlebitis (inflammation of the veins with blood clots) or trophic ulcers on the legs, walking should be limited. Ulcers can be traumatized by bandages or clothing during walking, slowing their healing, and long walks can exacerbate the inflammatory process in thrombophlebitis.

What is the Best Treatment?

There are two treatment methods: conservative and surgical. The conservative approach includes two main components: wearing compression stockings and taking medication. Compression stockings compress the soft tissues, including the veins, improving the condition of their walls, eliminating stasis, and intensifying blood flow. This is a strong intervention and a very effective way to combat varicose veins.

Special medications, known as venotonics, are effective in the early stages of the disease. They stimulate the venous walls, help them contract, and improve the exchange between the walls and surrounding tissues. In advanced cases, the effectiveness of medications is lower, but they should not be neglected. Topical treatments are effective in cases of complications from varicose veins, such as inflammation and blood clots. However, their effectiveness depends on the thickness of the subcutaneous fat layer: the thicker the layer, the weaker the drug penetration and the lesser the effect.

The indication for surgical treatment, according to established guidelines, is the incompetence of venous valves and venous walls detected by ultrasound. Modern surgery for varicose veins is minimally invasive. Large incisions, blood loss, and lengthy rehabilitation are things of the past. Today, we can treat the disease with minimal trauma and no consequences for the body. Hospitalization is either short-term, lasting two to three days, or not required at all, with the patient going home on the day of the surgery.

Given the minimal trauma and high effectiveness, we can offer surgical treatment even in the early stages of the disease, without waiting for serious progression and complications. This is because complications can occur at any stage, and no one is immune to them.

Varicose Veins and Pregnancy

Pregnancy itself is a risk factor for developing varicose veins. With the onset of pregnancy, the body undergoes hormonal changes that favor the relaxation of smooth muscles, including the muscles of the uterus and venous walls. While this is beneficial for the uterus, it is detrimental to the veins. Additionally, the growing uterus increases intra-abdominal pressure, hindering blood flow from the lower extremities. Pregnancy also limits physical activity.

Therefore, even if there are no issues with the veins, it is highly recommended to wear compression stockings during pregnancy, especially if there is a hereditary predisposition to the disease. It is also advisable to rest the legs frequently in an elevated position and take contrast showers. In the second and third trimesters of pregnancy, venotonics may be used if problems arise. However, in the first trimester, according to the Mayo Clinic, it is important to consult with a healthcare provider before starting any new medication.