Varicose veins: symptoms, treatment and recovery

Veins carry blood back towards the heart. Small valves help it move in the right direction. When valves in leg veins do not close properly, blood can flow backwards and collect. Increased pressure can stretch the veins, making them enlarged, twisted or bulging.

Small thread or spider veins are fine visible vessels near the skin. They are not the same as larger varicose veins and are usually harmless. Appearance alone does not show whether larger veins need treatment.

• Bulging, twisted veins, often blue or purple.
• Aching, heaviness or uncomfortable legs.
• Swollen ankles or legs, itching or dry skin.
• Changes in skin colour, particularly around the ankle.

Symptoms may be worse after standing for a long time. Not everyone has pain. Getting older, a family history, pregnancy and excess weight can increase the chance of developing varicose veins. Previous DVT can damage vein valves and contribute to later vein problems. NHS — varicose veins · NHS inform — varicose veins

Varicose veins can cause persistent swelling, eczema, darker skin or hardened skin. Some people develop a venous leg ulcer: a sore caused by poor blood flow in the leg veins. Bleeding can happen if a vein near the surface is damaged.

Superficial thrombophlebitis is inflammation and clotting in a vein near the skin. A vein may feel hard and painful. This is different from DVT, but a new painful or swollen leg needs assessment rather than self-diagnosis. NHS — varicose veins · NICE CG168 — recommendations

For eczema linked to vein problems, read our eczema guide. Do not rely on moisturiser alone when there are ongoing skin changes or a sore.

See your GP for bothersome or worsening symptoms, pain, swelling, itching or skin changes. Also arrange GP review for a sore on the leg that has not healed after 2 weeks. Get urgent help for bleeding or possible DVT rather than waiting for a routine appointment. NHS — varicose veins

NICE recommends vascular referral for:

• Bleeding varicose veins — immediate referral.
• Varicose veins, including recurrent veins, with troublesome symptoms.
• Skin changes thought to be caused by poor flow in the leg veins.
• Hard, painful superficial veins with suspected faulty vein function.
• An active venous leg ulcer below the knee not healed within 2 weeks, or a healed venous leg ulcer.

A vascular service checks your symptoms and examines your legs. Duplex ultrasound combines a picture of the veins with information about blood flow. It confirms where blood is flowing backwards and helps plan treatment. NICE CG168 — recommendations

Cosmetic-only treatment is not usually offered by the NHS. Local referral and funding routes vary across the UK; ask your GP what applies where you live. NHS — varicose veins

For confirmed varicose veins with truncal reflux — backward flow in a main surface vein — NICE recommends this order, moving to the next option if the previous one is unsuitable:

1. endothermal ablation
2. ultrasound-guided foam sclerotherapy
3. surgery

Your ultrasound findings, general health and preferences help determine what is suitable. The intended benefit is better vein flow and relief of symptoms, not a promise that every visible vein or symptom will disappear. NICE CG168 — recommendations

Heat treatment: laser or radiofrequency ablation

A thin tube is placed in the affected vein, guided by ultrasound. Local anaesthetic is usually used, and laser or radiofrequency heat closes the vein. Blood then uses other veins. Small surface veins may also be removed through tiny cuts.

Ultrasound-guided foam sclerotherapy

Foam is injected into the vein using ultrasound guidance. It irritates the vein lining so the vein closes. The team explains whether this suits the size and position of your veins and whether further sessions might be needed.

Surgery

Surgery can tie off and remove affected veins, sometimes with smaller veins removed through short cuts. The anaesthetic and procedure depend on the treatment planned.

Risks and repeat treatment

Possible problems include pain, bruising, bleeding, infection, temporary or persistent numbness, skin colour changes and inflamed superficial veins. Less common complications include DVT. Heat treatment can affect nearby skin or nerves; foam can occasionally cause visual symptoms or headache. Ask about risks specific to the proposed procedure.

New veins can develop and treated veins can recur. More than one session or a combination of treatments may be needed, particularly for recurrent veins. Discuss likely benefits and downsides rather than expecting a permanent cure. NHS — varicose veins · NICE CG168 — recommendations · NHS England — treatment decision aid (PDF)

Compression stockings apply graduated pressure and may reduce aching and swelling. NICE recommends them when intervention is unsuitable, or for symptom relief in pregnancy. They do not repair leaky valves or cure varicose veins, and are not a compulsory trial before suitable intervention.

Ask a clinician to check suitability, measure your legs and choose the correct type and fit. Stockings may not suit some people with poor arterial circulation. Ask for help if you find them difficult to put on. Follow professional advice about when to wear them. NHS — varicose veins · NICE CG168 — recommendations

Invasive treatment during pregnancy is offered only in exceptional circumstances. Veins may improve after birth. Discuss symptom relief and reassessment with your maternity or vascular team. NICE CG168 — recommendations

• Walk and move as you are able; change position rather than staying still for long periods.
• Rest with your legs raised when comfortable.
• If appropriate, ask for support with weight management.
• Look after dry skin with advice from a pharmacist or clinician, and report sores or persistent skin changes.

These steps may ease discomfort but do not remove established varicose veins or replace assessment for warning signs. Choose activity that fits your mobility and other health conditions. NHS — varicose veins

Bruising, tenderness and some swelling can occur. Recovery differs between heat treatment, foam and surgery, and with the extent of treatment and your health. There is no single timetable for everyone.

Follow your clinic's instructions about dressings, washing, walking, exercise, lifting and any compression they prescribe. Ask what symptoms are expected and how to contact the team if you are worried.

Return to work depends on your job, pain, mobility and procedure. Ask about transport home, driving, long journeys and follow-up before treatment. Do not drive until you can control the vehicle safely and meet your team's advice and insurer's requirements.

Get urgent advice for new one-sided pain and swelling or concerning wound changes. Use 999 for leg symptoms with chest pain or shortness of breath, or severe uncontrolled bleeding. NHS — deep vein thrombosis · NHS England — treatment decision aid (PDF)

• Bring your medicine and allergy list, including blood thinners; do not stop medicines yourself.
• Describe when pain, swelling or itching happens, any bleeding and any past DVT, ulcers or vein treatment.
• Tell the team about pregnancy, mobility, work duties and communication or access needs.
• Ask: what did the ultrasound show, and which options are suitable for me?
• Ask about likely symptom improvement, risks, repeat sessions and the choice not to have a procedure.
• Ask about stockings, wound care, recovery, work, transport home and follow-up.
• Ask which warning signs need a clinic call, urgent care or 999, and keep the contact number.

You can use the NHS England decision aid to prepare questions with a trusted helper. It supports discussion, not a diagnosis or guaranteed outcome. NHS England — treatment decision aid (PDF)