Varicose veins: symptoms, treatment, causes and what to expect

Varicose veins do not always need treatment. A GP may refer you to a specialist if you have troublesome symptoms or complications such as leg ulcers. The NHS says treatment to improve how the veins look is not usually available on the NHS if they are not causing other problems, though you may be able to pay for it privately.

For endothermal ablation and foam sclerotherapy, the NHS says you can go home the same day, may need to wear compression stockings for about a week, and may have some pain and bruising but should be able to return to most usual activities straight away.

After ligation and stripping surgery, the NHS says you can usually go home the same day, moving around may be uncomfortable for a few days, pain and bruising can last a few weeks, you may need 1 to 2 weeks off work, and your leg will be tightly bandaged or you will need compression stockings for about a week.

The NHS says compression stockings work by putting pressure on the lower legs, which improves blood flow and can help with swelling and pain. They are only offered for varicose veins if procedures or surgery are not suitable, or if you do not need other treatments, and are not suitable if you have problems with arterial blood flow. It is best to wear them during the day and remove them at bedtime.

Some people have no symptoms beyond the look of the veins. Others notice a group of leg complaints. The NHS lists pain, aching or a feeling of heaviness, skin changes such as itching, colour change or dry scaly skin, and swollen ankles or legs.

Symptoms are often worse after standing for a long time and ease when you rest with your legs raised. Many people notice that the legs feel heavier by the end of the day. This pattern is a useful clue when you describe the problem to a doctor.

• See a GP if the veins cause pain, itching or swelling, if they are getting worse, or if you have a sore on the leg that has not healed after 2 weeks (NHS advice).

• Ask for an urgent GP appointment or call NHS 111 if a varicose vein is bleeding.

• Tell the doctor about any sudden painful, hard or red vein, or a swollen, painful calf, because clots can sometimes form.

The direct cause is failure of the vein valves. The NHS says anyone can get varicose veins, but they are more likely if you are a woman, are older, are overweight, are pregnant, spend a lot of time standing or sitting, have relatives with varicose veins, or have had a deep vein thrombosis.

NICE CKS lists the same set of risk factors: increasing age, family history, female sex, pregnancy, obesity, prolonged standing or sitting, and a history of deep vein thrombosis. Family history is a common thread. You cannot change your genes, but weight, activity and long spells in one position are things you can influence.

Veins carry blood back towards the heart. In the legs they work against gravity, so each vein contains small one-way valves. These valves open to let blood move upwards and close to stop it sliding back down.

When a valve does not close properly, blood leaks backwards and collects in the vein below it. Pressure builds up, and the wall of the vein stretches. Over time the vein becomes wider and twisted, and you can see and feel it under the skin.

NICE Clinical Knowledge Summaries describe varicose veins as dilated, tortuous, superficial veins that most often affect the legs, and as a sign of weak return flow in the veins near the surface. The NHS points out that they are different from spider veins or thread veins. These are small red, blue or purple veins that are usually harmless.

A GP will usually ask about your symptoms, look at your legs and ask what is worrying you. CKS tells clinicians to ask about warning features unrelated to the veins, such as weight loss, bleeding, bowel or urinary changes, pelvic pain or night sweats, and to check for skin changes and ulcers.

If you are referred to a specialist, the NHS says they will usually do a duplex ultrasound. This is a scan that shows how blood is flowing through the veins and which valves are failing. The result guides which treatment, if any, is suitable.

NICE guideline CG168 covers diagnosis and management of varicose veins in adults and sets out when people should be referred to a vascular service for assessment.

The NHS says varicose veins do not always need treatment. A GP may refer you to a specialist for tests and treatment if you have symptoms such as pain, heaviness, swollen legs, itching or skin changes, or complications such as leg ulcers.

Treatment to improve how varicose veins look is not usually available on the NHS if they are not causing any other problems, though you may be able to pay for it privately. NICE guideline CG168 covers diagnosing and managing varicose veins in adults, including when to refer people to a vascular service for assessment.

On the private route, ask which treatment is proposed and why, what the alternatives are, what recovery looks like and what the risks are. A clear written plan is a good sign.

Varicose veins may get worse without treatment, but the NHS says this usually happens very slowly, over several years. Possible complications include bleeding, varicose eczema, slow-healing venous leg ulcers, clots in surface veins and clots in the deeper veins of the leg.

In pregnancy, compression stockings may help, but the NHS says procedures or surgery are not usually recommended during pregnancy. Varicose veins often get better or go away after the baby is born. CKS gives the same message and tells clinicians to reassure pregnant women that the veins usually improve considerably afterwards.

The NHS suggests keeping to a healthy weight, putting your legs up when you can, exercising regularly with activities such as walking or running, and using a moisturiser if the skin is dry, flaky or itchy. It also advises trying not to injure your legs, to reduce the chance of bleeding.

On the other side of the list, avoid standing or sitting for long periods unless your feet are raised, and avoid smoking, because smoking damages the veins. These steps will not remove existing varicose veins, but they may ease how the legs feel.

See a GP if you have varicose veins with symptoms such as pain, itching or swelling in your legs, a sore on your leg that has not healed after 2 weeks, or veins that are getting worse. The NHS says to ask for an urgent GP appointment or get help from NHS 111 if a varicose vein is bleeding.

NICE CKS says that if varicose veins are bleeding, first aid should be offered and admission arranged to a vascular service. Complications the NHS lists include varicose eczema, venous leg ulcers, blood clots under the skin that cause hard, painful veins and blood clots deeper in the leg (DVT). Get medical advice quickly for a sudden painful, hard or red vein, or a swollen, painful calf.