Why Do Varicose Veins Hurt?

Question: What causes varicose veins, and why do they hurt? Why do they get thicker and spread? Does this mean we should get rid of them?

Dr. Hibberd's Answer:

Varicose veins are distended blood vessels that carry blood from the tissues back to the lungs for re-oxygenation. Our superficial veins have check valves to prevent backflow in this normally low pressure blood return system. Its blood return is enhanced by external muscular contraction as we walk around with our daily activities.

Normally, blood return is unimpeded, and the veins are not dilated or distended. When the check valves have become blocked or damaged, swelling may develop as our veins dilate and distend. As a result, other check valves become incompetent as a result of vein wall distension. Failure to return blood effectively leads to tissue swelling, which in turn sets us up for an inflammatory cascade often seen in those with peripheral venous insufficiency. Our veins, distend, dilate, and phlebitis (an inflammatory condition of the vein) may develop. Once the backup into our venous system persists, we are at risk for clotting resulting from stasis and slow flow ... and the stage is set for blood clots.

This explains why the walls become thicker and inflamed. Normally, it is best to correct the underlying reason for venous stasis, but when the check valves have been damaged by phlebitis or infection, selective vein removal may be necessary to prevent recurrent swelling, pain, and phlebitis.

You can minimize venous insufficiency by remaining active with adequate muscle tone. Also, avoid long trips in sitting position without frequent breaks to minimize risks for clot (DVT). Elevate legs when they are swollen and take the pressure off the venous return system, allowing it to return to its normal function. If your problem is chronic, consider wearing support hose that go all the way to your waist. It is not usually wise to use knee high support hose, as this usually blocks return at the knee level.