(February 2012) by Dr Kate Baddock

Well that’s a question isn’t it? I’m sure we all have, or know someone who has, unsightly veins. Whether they are on the nose, the cheeks or the legs. Perhaps the ropy ones that look like snakes curling up and down your legs, or the ones that look like spiders – usually on the face. Or the networks of blue veins just under the surface of the skin – particularly on the thighs or around the ankles.

They are very common, and yet the reason they appear is somewhat complex and confusing. Veins become varicose for a number of reasons – the main one being heredity. We know that if your parent had varicose veins then, more than likely, you will too (some 10-15% of men and 20-25% of women will have varicose veins). If you become pregnant, the extra oestrogen circulating can contribute to their development, as can being on the combined contraceptive pill (but to a very much lesser extent). Other factors include excess weight and a lack of exercise.

Whatever the contributing cause, when the blood pools in the veins they become stretched and varicose. The blood may pool because the valves that are within the veins (particularly the deep veins) leak, and don’t do their job properly in helping move the blood back toward the heart; or the blood may pool because the walls of the veins are weaker and stretch.

Once you have them, how can you get rid of them? Well, the first thing to be aware of is that they do recur so getting rid of them will give you some respite for a number of years – but they do tend to come back. For the large tortuous ones in the legs, it is important to deal with the incompetent valves (the ones that are leaking) and often they are the large ones right at the top of the thigh. This involves surgery where the incompetent valve is tied off and then the vein lower down is stripped. Spider veins or telengiectasiae, can be injected (sclerotherapy) or treated with laser therapy. For those less severe varicose veins, compression stockings can be a real comfort and support.

Varicose veins often do not require treatment, but they can be unsightly. They do need managing when they create problems with the skin – eczema and ulceration, or symptoms such as aching, swelling and tiredness.