The causes of varicose veins and a dermatologist’s 5 tips to help prevent them

Cynthia Bailey, MD|February 10, 2011

Varicose veins of the legs are caused by leaky leg vein valves.

At the American Academy of Dermatology’s 2011 Annual meeting in New Orleans, one of the speakers in the sclerotherapy session (leg vein treatment) gave a very clear analogy of leg vein anatomy and I want to use it to explain how varicose and spider veins form.

If you have varicose veins, or you are at high risk for them, I think this explanation will help you to understand the problem and help you figure out how you can prevent your veins from getting a lot worse. The analogy that I liked so much: picture your leg veins  like an upside down tree. The outer tree twigs are the surface capillaries under the skin that can become spider veins.  Just like the way tree twigs lead to larger and larger branches and finally the tree trunk, the capillaries under your leg skin lead to larger and larger veins and finally into the large vein in the center of your abdomen and then back to your heart. All the moderate to large sized veins of your legs (eg. the tree branches) have one-way valves.  Damage to these valves cause varicose and spider veins! The one-way valves open to let blood pass up the veins towards your heart and then they close to prevent the blood from falling back down to your feet. Contraction of your leg muscles ‘milks’ the blood up your leg veins and back into your body. The pumping of your heart is too weak to move blood way out in your leg veins.  Your heart can move blood into the arteries of your legs, which you feel as a pulse.  Blood in your leg arteries must go through your leg capillaries before passing into your leg veins. The strong pulsing pressure you can feel in your arteries is lost in the capillaries.  This means that your leg veins depend on your leg muscles to get the blood out of your leg veins. Varicose veins happen because the valves aren’t that strong and they can break when blood pools in your veins. Pooled blood is heavy and the little valves just can’t hold it all up.  Once one valve breaks there is an even heavier amount of blood on the valve below it, so it breaks too. Spider veins form when this heavy pooled blood in the veins builds up pressure and gets pushed out into the capillaries Varicose veins happen when many of these valves are broken in the moderate and larger sized veins, causing the veins to swell outwards.  You see these as the lumpy ropes and cords of varicose veins that can run up and down your legs. Because our bodies don’t make new valves in the veins, this problem becomes permanent.  Some people have stronger veins and valves than others.

5 Tips to help you prevent varicose veins if you’re prone to them?

  1. Keep your legs moving when you’re standing or sitting.  Contraction of your leg muscles ‘milks’ the blood up and out of your leg veins.  Get up and walk, rise up on your toes numerous times, circle your ankles-anything to contract your leg muscles.  The more the better!
  2. Elevate your legs for 5 minutes or so, getting them above your hips, or even better, your heart after prolonged standing or sitting.   This allows pooled blood to drain out of the capillaries and veins.
  3. Wear compression hose if you must stand or sit immobile for long periods of time. This is especially important for you if you work on your feet, like nurses, waitresses, cashiers etc.  It’s also important for all of us when we travel and are stuck sitting for hours. Ideally I tell my patients to wear waist high support hose that provide 25mm Hg (the measure of how tight they are). (Some people should not wear support hose. Talk with your doctor to see if support hose are safe for you to use.) Many of my patients ask me if it's ok to just wear knee high hose, but leg vein valve damage can occur as high up as the groin so I tell my patients to use waist high products.
  4. Maximize your leg muscles ability to ‘milk’ the blood you of your legs.  This means:
    • Work-out to get big, fit leg muscles. Good exercise options include walking and squats.  Join a gym and ask them to give you exercises that give you kind of fit, firm muscles that make for big contractions with every leg movement during the day.
    • Wear flat shoes. Unfortunately high heels shorten the leg muscles and interfere with efficient contractile ‘milking’ of the leg veins.  As often as possible, wear flats.
  5. Avoid constricting your leg veins. Think of a leg veins like a garden hose; if you kink the hose water can’t flow.  Your leg vein blood will have a hard time flowing up and out of your leg if you constrict the vein by crossing your legs or wearing constricting stockings that bind and ‘cut into’ the leg, effectively putting a ‘kink in your hose’. If your blood can’t flow out of your legs, it pools leading to valve damage and varicose veins.

Varicose veins can also occur if you’ve had an injury or surgery that damaged your leg veins in a way that prevented blood from passing freely up your legs.  Also, a strong impact, like falling on your legs, or being hit hard on your legs can cause the blood in your veins to flow backwards, permanently damaging the one-way valves. Spider and varicose veins can be treated.  Some veins can be injected with harsh fluids to damage the veins so that the body absorbs them. It's called sclerotherapy. In my opinion, this is the treatment of choice for the smaller spider veins and for some of the larger varicose veins.  There are also laser and surgical treatments for varicose veins.  Leg vein treatments are tricky though so it’s best to find an expert physician that does a lot of cases and has a low incidence of side effects. If you found this interesting, you may want to read: Skip The Tan And Eat Your Veggies For Beautiful Skin Color Why You Might Have Broken Facial Capillaries Start The Best Anti Aging Skin Care Now and See Results In The New Year Photo: thanks and gratitude to John-Morgan

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