Varicose Veins: Causes, Treatment and What Actually Helps

Varicose veins are usually treated as a cosmetic complaint, which is fine until they start aching by late afternoon, swelling the ankles or itching along the shin. At that point they are a circulation problem rather than an appearance problem, and the treatment options are better and less invasive than most people expect. Here is what causes them, what helps, and when they need medical attention.

What varicose veins are, and the short answer on treatment

Veins in the legs carry blood upward against gravity, helped by one-way valves and the squeezing action of calf muscles. When those valves weaken and leak, blood pools and the vein stretches, becoming enlarged and twisted near the surface. That is a varicose vein, and it is the visible end of a process called venous insufficiency.

Compression stockings ease aching and swelling, and they are genuinely useful, but they do not remove varicose veins. The treatments that actually eliminate them are procedures, and the usual first choice is endovenous ablation, where a catheter delivers heat inside the vein to seal it shut, performed under local anaesthetic through a small puncture. Lifestyle measures help symptoms and may slow progression, but no exercise, cream or supplement makes an existing varicose vein disappear.

Why they develop

Risk comes down to pressure and vein wall strength. Family history is one of the strongest factors, since valve and vein wall structure is partly inherited. Pregnancy is another, driven by hormonal changes, increased blood volume and pressure from the growing uterus, and veins that appear during pregnancy often improve in the months afterwards.

Other contributors include standing or sitting for long periods, which is why it is common in teaching, retail, hospitality and healthcare work, along with excess weight, older age, previous deep vein thrombosis and leg injury. Women are affected more often than men. Crossing your legs and wearing tight clothing are frequently blamed, with little evidence behind either. The common thread is sustained pressure in the leg veins combined with less help from the calf muscle pump.

Symptoms and when they matter

Many varicose veins cause nothing beyond their appearance. When symptoms do occur, they follow a pattern: aching or heaviness that worsens through the day and in hot weather, swelling around the ankle by evening, throbbing, itching over the vein, muscle cramps at night, and relief when the legs are elevated.

The signs that this has moved beyond cosmetic are worth knowing, because they change the treatment decision and, in some health systems, eligibility for treatment. Brown staining of the skin around the ankle, dry itchy inflamed patches known as venous eczema, hardening of the skin, bleeding from a vein, and ulcers near the ankle all indicate that the raised pressure is damaging the skin. Phlebitis, where a surface vein becomes hard, red and tender, is also an indication for assessment. These stages tend to progress slowly, which is why early treatment is preferable to waiting for skin damage.

What helps day to day

These measures reduce symptoms and support the circulation, even though they do not remove the veins.

• Compression stockings: graduated class 1 or 2, put on first thing in the morning before swelling builds. The single most useful conservative measure for aching and swelling.
• Walking daily, which activates the calf muscle pump that moves blood upward.
• Calf raises and ankle circles when you have to stand or sit for long periods.
• Elevate the legs above heart level for 15 to 30 minutes in the evening.
• Avoid long static standing where possible, shifting weight and moving regularly.
• Lose excess weight, which reduces pressure in the leg veins.
• Moisturise the skin around the ankles to reduce the risk of venous eczema and breakdown.

Horse chestnut extract has some evidence for reducing leg swelling and discomfort in chronic venous insufficiency, although it does not change the veins themselves. Most other supplements and creams marketed for varicose veins have little support.

Pregnancy is a common and usually temporary situation. Veins that appear during pregnancy often improve in the months after birth, so treatment is generally deferred until at least several months postpartum. Compression stockings are safe and helpful in the meantime, alongside walking, elevation and avoiding long periods standing still.

Procedures that remove them

Modern treatment is largely done under local anaesthetic without a hospital stay. Endovenous thermal ablation, using radiofrequency or laser energy inside the vein, is usually the first-line option, with good long-term closure rates and fast recovery. Ultrasound-guided foam sclerotherapy injects a foam that irritates and seals the vein, useful for certain veins and for recurrence. Mechanochemical and adhesive techniques avoid heat altogether.

Traditional surgery, stripping the vein, is now used less often but remains appropriate in some cases. Smaller surface veins and thread veins are treated with microsclerotherapy or surface laser, usually considered cosmetic. Whichever is used, assessment begins with a duplex ultrasound scan to map which veins are leaking, because treating a visible vein without addressing the leaking one feeding it leads to rapid recurrence.

Recovery from these procedures is quick by surgical standards. Most people walk out the same day, wear compression for a week or two, and return to desk work within a day or so, with heavy activity resumed over a couple of weeks. Bruising and tightness along the treated vein are normal for several weeks. New veins can still appear over the years, since the underlying tendency remains, which is why follow-up scanning is sometimes advised. Public health systems typically fund treatment for symptomatic veins or skin complications rather than for appearance alone.

When to see a doctor

See a doctor if varicose veins ache, swell, itch or cramp, if the skin around your ankle is changing colour or texture, or if you have had phlebitis. Ask for a duplex ultrasound assessment, since that determines which treatment is appropriate. Treating early, before skin damage develops, gives better outcomes.

Seek urgent care for bleeding from a varicose vein, applying firm pressure and elevating the leg while you get help, and for an ulcer near the ankle that is not healing. Also seek same-day assessment for sudden painful swelling of one leg with warmth or redness, which can indicate a deep vein thrombosis and is a different, more urgent problem. This is general information rather than medical advice. The practical summary is that stockings and movement manage symptoms well, while only a procedure removes the vein.

Frequently asked questions

Can varicose veins be cured without surgery?

Procedures such as endovenous ablation and foam sclerotherapy are not traditional surgery and are done under local anaesthetic. Compression and lifestyle measures relieve symptoms but do not remove veins.

Do compression stockings get rid of varicose veins?

No. They reduce aching and swelling and help prevent skin complications, but only a procedure removes the vein itself.

Are varicose veins dangerous?

Usually not, but they can progress to skin staining, venous eczema, bleeding or ankle ulcers. Those complications mean treatment is medically indicated rather than cosmetic.

What makes varicose veins worse?

Prolonged standing or sitting, excess weight, pregnancy, heat and inactivity. Walking, calf exercises, elevation and compression counteract the pressure.

When should I worry about leg swelling?

Sudden painful swelling of one leg with warmth or redness needs same-day assessment for deep vein thrombosis, which is a different and more urgent condition.

Read next

• Walking: The Most Underrated Heart Habit

  Why the calf muscle pump matters for circulation.

• Sitting Too Much: Is It Really the New Smoking?

  The cost of long static hours, examined.

• Warning Signs You Should Never Ignore, and Where to Go With Them

  Telling a clot from an ordinary swollen leg.

This article is for general informational purposes only and is not medical advice. Always consult a qualified healthcare professional about your individual situation, and never start or stop a medication without your doctor. See our Medical Disclaimer.