Doctors and medical texts usually define varicose veins as enlarged veins that are swollen and raised above the surface of the skin. Usually, they have a tortuous course and commonly are found on the legs. The complete phrase is “Varicose or Varicosity,” which is from the Latin root word “varix” meaning twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Varicose veins are a common condition in which the veins in your legs become abnormally enlarged and appear swollen, twisted, and bulging, often with a red or skin tone color. They are sometimes bluish-purple in color. Usually, they are not a serious condition, but they can cause aching pain and discomfort and lead to more serious problems. Some people with varicose veins may develop chronic venous insufficiency. This is a more severe condition that may cause leg swelling, skin changes, and sometimes sores (ulcers) on the legs. More seriously, varicose veins can lead to blood clots or deep vein thrombosis. This can be life-threatening if the blood clot travels to the lungs. For this reason, it is important to take into consideration various ways to prevent varicose veins and also to treat them if prevention is not possible.
What are varicose veins?
Valves allow for efficient return of blood to the heart, and legs are often equipped with high-tech valves. Next, as leg muscles flex and relax, they act as a pump, sending the blood back to the heart. The pumping occurs as blood, on its way back to the heart from the legs, flows through major channels deep within the thigh and calf muscles. She also described how the clear-cut operation of one-way valves can become deteriorated. If vein valves become weak, blood can leak back down the vessel and collect there. This pooled blood enlarges and distorts the vein, resulting in what is called a varicose vein. If that happens, the vein overfills and increases in pressure. Due to pressure from more blood collecting in the vein, the wall of the vein can enlarge and lose its elasticity, causing it to stretch. This is why many elderly people have bulging veins.
Causes and symptoms of varicose veins
When researching information for this essay, I could not find any solid information on the actual cause of varicose veins. This is most likely because it is not clear why some people develop varicose veins and others do not, and the wide range of causes. But there are several prominent factors leading to the pooling of blood in the veins, such as congenital or acquired valve abnormalities, deep vein thrombosis, and phlebitis. Congenital valve abnormalities are something a person is born with and it is present in the familial form of varicose veins. Deep vein thrombosis is the presence of a blood clot in a deep vein, which can eventually interfere with the flow of the blood from the legs back to the heart. Phlebitis is an inflammatory condition causing vein swelling, which can greatly damage the valves, unnecessary blood clotting, and vein blockage in the superficial and deep venous systems.
Valves inside your veins keep blood flowing in the right direction, but if the valves are damaged or weakened, blood can flow backwards and pool in the veins, the Heart, Lung and Blood Institute says. This pooled blood causes the veins to enlarge and varicose veins form. Varicose veins are ropy, swollen veins that are close to the surface of the skin. A dull ache in the legs and feet can be a sign of a more severe form of varicose veins. Once varicose veins form, they will not go away, and usually they get worse over time. About half of all middle-aged people have some form of varicose veins, with women developing them more than men, usually because of pregnancy and menopause. The good news is that the effects of varicose veins can be lessened without undergoing painful surgery.
Conventional treatments for varicose veins
Saphenous ligation and stripping is the surgical removal of the great or small saphenous vein, usually because it is the underlying cause for the presentation with varicose veins that the patient has noticed. Surgery is usually reserved for severe varicose veins, when there are skin changes or when there has been an episode of phlebitis or bleeding from a varicosity. Symptoms to be treated with surgery are usually more severe, for example, heaviness and aching after prolonged periods of standing or at the end of the day. Recent minimally invasive techniques using endovenous laser or radiofrequency have been used with good success rates, but their cost-effectiveness with long-term results has yet to be determined. This procedure is usually performed under general anesthesia and involves tying off the vein and then removing it from the leg. It is a very effective treatment for those patients with significant symptoms, skin changes, or repeated episodes of superficial thrombophlebitis. The aim of the surgery is to remove the reflux source from the deep system, which is causing the symptoms and any complications. A small superficial stab avulsion or phlebectomy can be performed to remove the larger surface varicosities; this is usually done at the same time as saphenous surgery.
Compression hose support the affected superficial veins and prevent the blood from refluxing. They are effective for alleviating symptoms such as swelling and tiredness, but they are not able to repair the varicosities. Patients with symptoms and no skin changes do not typically require any active treatment except for the use of compression hosiery. The hosiery is widely available in various sizes and pressures; higher pressures may be required in some patients and these are usually supplied on a made-to-measure basis.
Herbal Remedies for Varicose Veins
At the European Academy of Phlebology, it was mentioned that horse chestnut seed extract is the most successful in treating varicose veins. Aescin, a phytochemical in horse chestnut seed, is credited for this effect. It appears to have an anti-inflammatory effect. A study compared horse chestnut seed extract and compression therapy to the same dose of synthetic aescin and placebo. After 12 weeks, swelling in the leg decreased significantly more with the seed extract, and the subjective feeling of pressure and tension in the leg decreased in the same group as well, but there was no difference between the two groups in improvement in venous tone. A review of randomized controlled trials using horse chestnut extract that were compared to placebos or reference treatments and on patients that had chronic venous insufficiency due to varicose veins. The extract was given orally or by injection just under the skin, and the length of treatment varied anywhere from 3 to 12 weeks. Venous function and chronic swelling were significantly improved, with the only major side effect being mild gastrointestinal intolerance. There were some mild allergies to the seed coat. Since horse chestnut extract is an effective remedy for varicose veins without side effects due to medication that also improves skin, it is useful for all classes of varicose veins. Another study was conducted to evaluate the short-term efficacy of an oral, total triterpenic fraction of Centella asiatica (TTFCA) on symptoms and signs of chronic venous insufficiency (CVI). The trial was a double-blind, placebo-controlled, randomized, multi-center study carried out in 6 phlebological medical clinics. 86 patients with CVI and ankle edema were selected, free from deep vein thrombosis and/or saphenous reflux. They were randomized to receive placebo or TTFCA in fixed doses for 6 weeks after a 2-week run-in period with 40mg daily increasing by 20mg each day for the first two weeks. Overall, the goal of this study was achieved, and the use of Centella asiatica resulted in an obvious reduction in ankle edema compared to the control cases. In a combined therapy with Rutosides and Coumarins compared to Rutosides alone in chronic venous diseases: a double-blind multi-center trial, various chronic venous diseases were treated with either rutosides (Venoruton) alone or in combination with the coumarin agent sodium warfarin. The patients were under surveillance for a period of 12 weeks. The variations in symptoms or signs were evaluated largely by the change in leg swelling by water displacement and calf circumference. The Rutosides are a good treatment for patients in classes C2 and C3, who have skin changes but no ulceration, or classes C4 and C5 with associated mild varicose episodes, but they were more effective when combined with the coumarin agent in reducing edema and edema in all causes of chronic venous disease.
Horse chestnut extract
Gotu kola is widely used in traditional systems of medicine for varicose veins. It is thought to improve connective tissue, increase vein strength, and reduce vascular inflammation and has an edema-reducing and anticoagulant effect. Gotu kola has been shown to improve symptoms of venous insufficiency in one double-blind study but further research is needed to confirm its efficacy and safety. The common recommendation is for 60mg of standardized triterpenoid extract (total triterpenoids 40%) to be taken three times per day with meals, using either capsules or tablets. Measures should be taken to ensure that gotu kola is not used concurrently with drugs that affect the liver as it has been shown to be hepatotoxic in high doses in animal studies. No data are available regarding safety in pregnancy or lactation so it is advisable for women in these groups to avoid using gotu kola until more information is available.
Horse chestnut is now recommended by many herbalists as a treatment for varicose veins. It has anti-inflammatory and anti-edematous effects, mainly attributed to the presence of a saponin fraction known as aescin. Aescin reduces fluid leakage from small blood vessels and has been shown to have a toning and constricting effect on veins, thus promoting normal return of blood to the heart. Double-blind studies have shown that treatment with horse chestnut products significantly improves the symptoms of varicose veins compared to a placebo. One review of the available evidence concluded that horse chestnut seed extract is an efficacious and safe short-term treatment for chronic venous insufficiency. Horse chestnut is available for internal use in the form of aescin tablets and for topical use in creams and lotions. It is also commonly taken internally in the form of a tincture. Residents of the UK should be aware that only licensed aescin products should be used medicinally, due to the fact that immature horse chestnut seeds and the bark of the tree contain esculin, which is toxic to the kidneys.
Butcher’s broom
Butcher’s broom (Ruscus aculeatus) is an evergreen plant that is known to promote a narrowing of the veins. It is an alpha-adrenergic agonist with a vasoconstrictive action. Its traditional uses include alleviating symptoms of circulatory disturbances, such as varicose veins. By constricting veins, it prevents blood from pooling in the vessels, makes vessel walls stronger, and less permeable in capillary fragility, reducing swelling by possibly reducing vascular permeability. Butcher’s broom also has an anti-inflammatory and anti-edemic action, which would help in decreasing symptoms such as swelling, itching, and pain. The drugs available in the market today are available in capsule form or as a direct ruscogenin extract. Some scientific studies have confirmed these traditional uses to be effective. A study conducted by compared the effects of a ruscus aculeatus preparation to the commonly used anti-inflammatory drug, fluocortolone, in patients with confirmed varicose vein symptoms (e.g., swelling, itching, and pain). Patients were allocated to either treatment for 2 weeks. At the end of the trial, a success rate of 65% was observed for the active drug preparation compared to 47% for the fluocortolone treatment. Further studies were able to confirm the effectiveness of ruscus extract in reducing leg volume in patients with chronic venous insufficiency. Due to the vasoactive nature of this herb, it is not recommended during pregnancy or with high blood pressure.
Grape seed extract
All of these studies taken together provide considerable evidence that grape seed extract can be an effective treatment for a variety of symptoms seen in CVI and varicose veins.
A randomized, double-blind, placebo-controlled study evaluated the effects of Vitis vinifera seed extract on symptoms of CVI (stasis level skin changes or venous ulcers). Over 6 months, 40 patients taking 2 capsules of 360 mg of extract daily had significant improvement compared to those taking placebo in pain, itching, edema, and circumference of the ankle and calf. An improvement in capillary filtration rate in the grape seed extract group may suggest that the treatment reduces the severity of microangiopathy associated with CVI.
Procyanidins in grape seed extract can have direct effects on the symptoms of CVI. In a study of 40 patients with CVI, 150 mg of procyanidins per day significantly reduced ankle edema and lymphedema, with 86% of patients experiencing at least good relief of symptoms and 75% seeing improvement in trophic skin changes. In another study, 140 patients with CVI were given 100 mg of grape seed extract twice daily or placebo for 6 weeks followed by the option for an additional 6 weeks of extract or placebo. The group given grape seed extract showed improvement in swelling, pain, and subjective feeling of heaviness in the legs, especially those who stayed on the extract for the full 12 weeks.
Grape seed extract works in fighting against varicose veins and other chronic venous insufficiency (CVI) symptoms in a couple of different ways. Perhaps the most significant way is in its ability to prevent the breakdown of the collagen in the wall of the veins. It does this because it contains compounds called procyanidins, also found in pine bark extract, which also has similar effects. The loss of collagen is thought to be a causative factor in varicose vein formation.
Alternative Therapies for Varicose Veins
Compression therapy is an effective non-invasive treatment for varicose veins. It involves wearing specialized stockings which apply graduated pressure to the leg. The elastic material helps to squeeze the vein walls together, making it easier for the muscles to push blood back to the heart and prevent further valve damage. This also helps prevent swelling and discomfort and aids in preventing other vein disorders. Studies support the effectiveness of compression therapy. They may, however, be unsuitable for frail patients or those with peripheral arterial disease or dermatitis. Always consult your doctor before use.
Acupuncture is a medical treatment that involves the insertion of very thin needles through the patient’s skin at specific points on the body. The needles are then manipulated by the practitioner’s hand or electrical stimulation. It is a key component of traditional Chinese medicine and is most commonly used to treat pain. Research has shown that acupuncture has a significant impact in relieving pain, reducing inflammation, and slowing the progression of varicose veins. Patients are often advised to receive treatment at least 1-2 times per week for a few months to see their condition effectively improve. By treating the cause as well as the symptoms, acupuncturists usually use a combination of Chinese herbs, lifestyle/dietary recommendations, and acupuncture to promote strengthening and repair of the affected area. For thinning vein walls and valves, the aim is to increase circulation and blood flow, then to brighten/varicose veins, then to clear any stagnation and clots, relieving any aches or swollen symptoms during the process. When valve function is restored and the circulation is more efficient, it is possible to reabsorb some of the pooled blood and improve or eliminate the varicose veins. Recommended Chinese herbs would involve blood vitalizing herbs (tao hong si wu tang), clearing damp heat herbs (Yin chen hao tang), tonify Qi, yang, and jing herbs (Zuo gui wan) to keep balance with the rest of the body. One must consult a qualified acupuncturist and Chinese medicine practitioner. They can be found through the Australian Acupuncture and Chinese Medicine Association Ltd (AACMA). Always consult your doctor when considering your condition with any treatment.
Acupuncture
In a recent clinical trial at the University of Maryland, 19% of patients reported that their symptoms significantly improved with acupuncture, while only 6% of those receiving a sham treatment felt the same improvement. There are no known scientific studies on how acupuncture may change the appearance of varicose veins, but it is thought that the increase in circulation from acupuncture may reduce some of the swelling and discoloration in the lower legs. Acupuncture may also help alleviate some of the symptoms associated with varicose veins such as restless leg syndrome and night cramps, thus improving the quality of life for the patient. It is recommended that patients sign up for 8-12 sessions of acupuncture to see if it will be helpful for the treatment of their varicose veins.
Acupuncture has been shown to improve the symptoms of varicose veins in some patients. Acupuncture is the ancient Chinese practice of inserting fine needles into pathways or meridians along the body in order to treat a variety of illnesses or conditions. Western practitioners of acupuncture recognize that using this therapy in combination with herbs may be helpful.
Compression therapy
Compression therapy involves utilizing an external compressive force on affected limbs to decrease venous capacity, reduce venous distention, and improve venous valve function. This therapy may be delivered via elastic bandages, stockings, or intermittent pneumatic compression devices. Several randomized controlled trials have shown that compression therapy is the only modality that consistently demonstrates improvement in healing venous ulcers. Meta-analysis of the data has shown that compression increases the healing rate compared to controls such as zinc gel or Unna boot. There is, however, a slight increase in the rate of adverse events (mainly minor skin breaks and ulceration) in patients treated with high compression bandages. The events were usually resolved by simple management of the affected limb and discontinuation of the bandages. This increased rate of ulceration with high compression bandages was the rationale for the development of lower dose, four-layer bandage system, the LITE system, and single-layer high compression bandages. The four-layer bandage system has been shown to have a lower adverse event rate and is more effective in ulcer healing than the original high compression bandages, and is more expensive. The new LITE system has only been shown to increase the healing rate of ulcers compared to controls at a higher cost. ILC devices have been shown to be more effective than the standard therapies at healing and prevention of ulcers in randomized controlled trials but are too costly to be routinely used in most developed countries at present. Compression has also been shown to improve many of the symptoms of venous insufficiency and prevent the worsening of skin changes seen in chronic venous disease.
Exercise and lifestyle changes
A sedentary lifestyle contributes to the formation of varicose veins. Sitting or standing for extended periods puts stress on your veins, weakening the walls and leading to swelling. Exercise is a great way to improve your vein health. Even for people who already have varicose veins, exercise can prevent any further progression of the disease. The standard recommendation of exercising 30 minutes, five times a week is all that is needed. Ironically, walking, the best exercise for your veins, is often the one activity avoided by those with varicose veins. Although walking increases the pressure in the veins of the calf, it also strengthens the calf muscles. Stronger muscles help the veins push the blood back to the heart, lifting stress off of the vessel walls. Swimming and cycling are also excellent exercises as they work calf muscles while minimizing stress and impact on the legs. Muscle strengthening is another important aspect of an exercise program. With stronger leg muscles, comes better circulation in the legs. Exercise is a great way to start losing any excess weight. Being overweight puts extra pressure on your veins, especially in the legs. Combine exercise with a low sodium, high fiber diet to reduce constipation and decrease any swelling in the lower extremities. However, overexercising should be avoided, as excessively high impact or intense activity can cause more damage to the veins. Inactivity may be the easiest way to exacerbate vein disease, but overstraining your legs can do just as much damage.
Precautions and Considerations
It is important for individuals interested in trying herbs and other remedies to manage their varicose veins to keep in mind that the improper use of herbs has the potential to cause a worsening of the condition or cause other serious health problems. Before embarking on any herbal regimen or using an alternative therapy, it is essential to consult with a healthcare professional. This is especially important because varicose veins are often an indicator for other serious health risks, such as circulatory problems. A healthcare professional can help diagnose the severity of the condition and any underlying health problems and give advice on the most suitable treatment. They can also give advice on the safety and effectiveness of specific herbs and therapies. Consulting with a healthcare professional is important not only for those considering oral herbal supplements but also for those considering using any type of herbal or aromatherapy preparation on their skin. It is important to keep in mind that many alternative treatments for varicose veins have not been well researched, especially in terms of possible drug interactions and side effects. In the case of known side effects or interactions with prescription or over-the-counter medications, it is important to talk to a healthcare professional and herbal practitioner to weigh the risks and benefits and perhaps make an adjustment in medication use. For those who experience a new symptom after starting an herbal treatment, it is crucial to be aware that this may be a side effect and to consult with a healthcare professional to determine if the herb should be continued. If a side effect appears to be a serious health threat, it is important to seek emergency medical care. A well-documented record of the herb used and its symptoms will be helpful for healthcare professionals in the treatment of the problem.
Consultation with a healthcare professional
Health professionals can also provide advice on the optimal dosage for taking supplements, and recommendations for the duration of treatment. Finally, they can assist in the monitoring and evaluation of the supplements’ effectiveness in treating your varicose veins, and any changes in your symptoms. This is particularly useful if you suffer from concurrent chronic venous insufficiency and are considering using horse chestnut seed extract. Some formulations of this extract are available by prescription under specific brand names, and research has shown that these prescription products may be more effective than the commonly available non-prescription forms. Analysis of a person’s symptoms and quality of life can be assessed using specific health assessment questionnaires, and compared at intervals throughout treatment. With professional guidance and monitoring, herbal supplements may be used as a viable and effective option for treating varicose veins and managing its associated symptoms.
Whether you’re contemplating taking supplements to treat your varicose veins or are already doing so, it is always helpful to seek the advice of a healthcare professional. They can provide guidance and suggestions based on your individual circumstances, including the severity of your varicose veins and any other health conditions you may have. Primarily, they can help ensure that any supplements you’re considering won’t be harmful or detrimental to your health. This is particularly important advice for those considering grape seed and pine bark extracts. As mentioned earlier, these have the potential to lower blood pressure and thin the blood, so suitability for those with hypotension or other low blood pressure conditions may be questionable. Taking ginkgo biloba or garlic supplements may also carry a risk of blood thinning and increased bleeding time, possibly affecting those who have an upcoming surgery or who have a bleeding disorder. For this reason, it is of paramount importance that these individuals consult their doctor before taking these supplements.
Potential side effects and interactions
A potential risk when using herbal remedies to treat chronic venous disorders is the delaying of seeking evidence-based medical treatment, such as elastic bandaging, compression stockings, intermittent pneumatic compression, simple analgesia, endovenous or surgical treatments, and sclerotherapy. This is important as delayed treatment of chronic venous disorders can result in skin damage and/or venous ulcers, the outcomes of which there may be no effective alternative treatment using herbal medicine.
Specific studies often do not exist regarding potential side effects and drug interactions associated with various herbal remedies. This is particularly true for venous disorders, such as varicose veins and chronic venous insufficiency, which tend to use alternative medicines a lot. Most of the side effect and drug interaction data provided in this section is theoretical and based on known pharmacology and reported adverse events. Each remedy must be considered on an individual basis in relation to potential adverse events and drug interactions. A suggested approach would be to consider the pharmacology of the herbal remedy in question and its known side effects, followed by a risk-benefit analysis in the context of the severity of the venous disorder in question.
Other lifestyle modifications for managing varicose veins
Compression stockings can be used if exercise and elevating the legs is difficult to fit into your day. They are often advised if you have just had a deep vein clot and when standing for long periods. The pressure exerted by the stockings decreases as they go further up the leg to help push blood back up towards the heart. Though not the most glamorous of garments, they may be a quick and effective way to improve varicose vein symptoms.
The heating during hot baths and strong sun can cause the veins to dilate and blood to pool. Saunas and steam rooms have the same effect. It is best to keep looking for the shade when it is hot and avoid a hot bath, going for a cooler shower instead. When you get feet and ankle edema after a hot day this can be reduced by elevating the legs to the level of the heart for fifteen minutes.
Exercise helps strengthen the veins and reduces the pooling of blood. Walking is the best exercise. It is low impact and does not put too much pressure on the legs. The calf muscle is called the peripheral heart. When you move your calf muscle, it causes the veins to pump blood up towards the heart. Swimming and cycling are also good activities to improve vein strength. Try and exercise more during the day and avoid hour upon hour of sitting or standing. If your job requires this, military strength marches on the spot are useful every half an hour.