Varicose Veins

WHEN TO SEE YOUR DOCTOR

* You also have persistent leg aches, cramping or itching.

* You also have ankle swelling or are bleeding from a vein.

What Your Symptom Is Telling You

Those blue lines on your thighs are starting to look like interstates. And the ugly bulges surrounding them make them look like they're under construction.

If your legs are a road atlas in 3-D, you probably have varicose veins.

"Twenty percent of adult Americans have varicose veins. The majority are women whose mothers had them, too," says John Hallett, M.D., associate professor of vascular surgery at the Mayo Medical School in Rochester, Minnesota.

Varicose veins develop when a vein wall weakens and stretches. That weakening affects the small valves within each vein that keeps the blood flowing toward the heart. As a result, the blood is trapped in the vein—and the vein bulges. The pooled blood can also flood the tinier "spider veins" located near the skin's surface.

Varicose veins not only look bad, they can feel bad. In severe cases, the backed-up blood can make legs that have spent too much time walking around the mall or standing at the stove feel like they're made of lead. Your legs might also itch or cramp during the night.

Women are four times more likely than men to have varicose veins, possibly because the female hormones estrogen and progesterone weaken the vein walls in some way, says Dr. Hallett. Typically, protruding veins debut in pregnancy, when the hormone surge increases blood volume, he says. The veins overstretch, pop out and may never shrink back. Birth control pills and estrogen replacement therapy can also contribute to bulging veins.

The problem can worsen with prolonged sitting or standing, excess weight, constipation or tight clothing. If not controlled, the purple bumpiness can increase with age as veins further lose elasticity.

Varicose veins aren't usually a sign of a severe health problem, says Dr. Hallett. One exception is when varicose veins develop as a result of damage to deep veins in your legs from an injury, a blood clot, inflammation or a circulatory problem such as phlebitis.

Symptom Relief

If you have varicose veins, you can't make them go away, short of having them surgically removed (which is an option). But there is plenty you can do to ease the discomfort and embarrassment.

Pump, pump, pump your legs. A 20-minute daily walk contracts the calf muscles and will help move blood out of the vein, says Robert A. Weiss, M.D., assistant professor of dermatology at Johns Hopkins University School of Medicine in Baltimore. "On long car trips, stop briefly every couple of hours and walk around your car," says Dr. Weiss. Circle your desk a few times at work or stroll up the airplane aisle on long flights. If you're stuck sitting in a lecture hall, tighten and release your calf muscles repeatedly. This immediately empties stagnant blood out of veins.

Put your feet up. Elevating your legs above the level of your heart for 15 minutes daily helps the blood move back toward your heart, says Dr. Weiss.

Cross your ankles, not your knees. "A crossed-knee position sets up a roadblock to blood flow," says Mitchel Goldman, M.D., assistant clinical professor of dermatology at the University of California, San Diego, School of Medicine.

Graduate to compressed support hose. "If you have swollen veins, wearing regular support hose could make them worse," says Dr. Goldman. "Support that's evenly distributed basically acts as a tourniquet, aggravating the vein." Instead, you should wear graduated compression stockings that are tightest at the ankle and looser as they go up the leg.

"If you put them on in bed before you stand up in the morning, the stockings help hold in the veins and drive blood back to the heart," says Dr. Goldman. What's more, wearing graduated compression stockings during pregnancy can actually prevent varicose veins from forming. Many medical supply stores and some drugstores now carry fashionable, sheer panty hose and below-the-knee hose that are graduated. These must be prescribed by a physician.

Ditch your girdle. Any clothing that cuts off circulation in the calf or thighs, such as skin-tight pants and tight knee socks, can worsen blood pooling, says Dr. Goldman.

Avoid high heels. High heels keep calf muscles contracted and put extra stress on leg veins, says Dr. Weiss. "If you must wear spikes, slip them off periodically and pump your calves," he says.

Lose pounds. The more weight you carry around, the more pressure is put on leg veins, says Dr. Hallett.

Trade fatty foods for fiber. If you want to know what's causing your bulging veins, look at what you're putting in your belly, says Glenn Geelhoed, M.D., professor of surgery at George Washington University in Washington, D.C. "A modern diet that's generally low in fiber and high in fats, sugar and salt causes constipation and increases abdominal pressure. This forces more blood into the lower extremities," he says. "In countries where high fiber diets are the norm, varicose veins are virtually unknown."

Dr. Geelhoed's advice: Adopt a high fiber diet packed with fruits, vegetables and grains. This will help bulk up and soften your stool and may reduce pressure in the veins.

Give your veins a shot. Smaller varicose veins can be removed with an office procedure called sclerotherapy. A solution is injected into the vein, which that irritates the lining, causing it to contract and shrivel. Eventually, the vein closes down entirely and the scar tissue it leaves behind is re-absorbed into your body. But sclerotherapy is not a cure, says Dr. Hallett. Additional veins can start to bulge, which may require additional injections.

Consider surgery. In severe cases, you may need surgery to partially or totally remove a bulging vein. Treatment with a laser can help erase the smallest spiders. "You should talk to a dermatologist or vascular surgeon who specializes in treating varicose veins to discuss your options," says Dr. Hallett.