Veins that are dilated and tortuous are called varicose veins. Such veins may occur in the arms, in the gullet, in the anal canal (where they are called hemorrhoids), or in the legs.
By common usage, the term varicose veins has become widely used in relation to the legs, and it is in this location that the disease will be discussed.
The function of normal veins
It is the role of veins to carry blood back to the heart after it has passed through the arterial system and supplied oxygen to the tissues.
Once the blood arrives in the leg veins, it has to move vertically upwards. This is achieved by contraction of the powerful muscles of the leg, which squeeze the blood in the veins in the direction of the heart. This is known as the muscle pump. A series of valves, along the vein, prevents blood from running back into the leg.
Basis of varicose veins
From this description it can be appreciated that sound leg musculature, normal vein walls, and normal valves are necessary if we are to have a normal venous system. A deficiency of any one of these three vital components of the system may lead to varicosities.
Varicose veins, one of the commonest diseases of the Western world, affect probably 1 in 5 women and one in 15 men over 45 years of age. The condition is rare in the African black people, but common in the American black people; the reason for this difference being blamed by many observers on diet.
Prolonged standing, without adequately contracting the muscles of the leg, may allow back pressure of blood, which will eventually destroy the valves, or weaken the vein walls, and so separate the valves.
Ultimately, it is failure of the valves that leads to varicosity.
Pressure on the veins in the pelvis may cause quite severe back pressure, which will have a similar effect to that described with muscle failure. Such pressure is common in pregnancy and it may occur in the presence of large pelvic tumors.
Natural history of varicose veins
As a result of the continuing head of pressure of blood on the vein wall, varicosities become elongated and tortuous and produce an unsightly appearance of the leg. If the veins are untreated, the condition gradually progresses, and complications may arise which threaten the patient’s general health.
Some people are fortunate enough to have no symptoms at all.
The commonest complaint is that of heavy, aching, or tired legs, associated with excess fatigue by nightfall. In many women, the symptoms are accentuated at the time of their menstrual periods or during pregnancy. Other symptoms are usually associated with complications of the disease.
Perhaps the commonest complication of varicose veins is an alteration of the overlying skin.
The skin may become slightly bruised in appearance wherever clothes rub on the veins, and may even become deeply pigmented around the ankle. When the skin is so affected, it may become scaly and very irritable and develop into varicose eczema.
The dilated veins are frequently very thin-walled, and even a mild knock or other slight trauma may cause acute hemorrhage. Fortunately simple pressure and elevation is usually a sufficient manoeuvre to control the bleeding.
Clots may occur in the vein and cause severe pain, with thickening of the vein, which is usually visibly reddened along its whole length. Such inflammatory change in the superficial veins is unpleasant, but if it should spread to the deep veins of the leg there is risk of more serious complications.
With the advance of time, untreated varicose veins undermine the nutrition of the skin of the affected limb, and ulcers may develop. Varicose ulcers may cause serious physical disability and reduce the capacity of the patient to work.
While varicose veins cannot always be prevented, it is likely that with care the severity of the disease can be reduced.
Physical exercise in childhood, combined with good nutrition, tends to produce a healthy individual with normal muscles. Children should not be overfed with farinaceous (floury) foods, which tend to make them obese and lazy and to weaken the “muscle pump” so vital to a normal circulation.
Those people who show early signs of varicose veins would do well to wear a supporting stocking, which will give assistance to the “muscle pump” and prevent blood from pooling in the legs. There are now available a number of very good, aesthetically acceptable supporting stockings for everyday use. Adequate physical exercise also should be taken.
During pregnancy a period of time each day with the legs elevated is of considerable assistance and should be accompanied by pumping action of the legs to improve venous return to the heart.
If clots (phlebitis, thrombosis) appear, early medical advice should be sought.
In fact, for varicosities of the legs, surgical treatment is probably the best therapy, and there are a number of satisfactory procedures available. The one most commonly used is tying and stripping the veins, although tying alone, or with injections, may be used. Competent, careful surgery improves the appearance of the involved limb, alleviates symptoms, and prevents complications.
It should be stressed, however, that even if an operation is done, although the patient is not likely to develop more varicosities, over a long period of time some new veins may appear and require treatment. To the writer’s knowledge, no medication cures or prevents varicose veins.
In short, varicose veins are an unpleasant by-product of civilization. Although adequate exercise and support may assist the early sufferer, the natural course of the disease is to proceed through various complications, and these are best prevented by early treatment.