Overview
Varicose veins are enlarged, twisted veins that most commonly appear in the legs. They develop when the one-way valves inside veins fail, allowing blood to pool and veins to bulge. Most varicose veins are primarily a cosmetic concern, but they can cause aching, heaviness, and skin complications. A small proportion lead to serious venous disease.
How common is it?
Varicose veins affect approximately 20 to 25% of adults, with prevalence increasing with age. Women are more commonly affected, though the gender gap narrows with age.
Causes and risk factors
Faulty vein valves allow backflow of blood under gravity, increasing venous pressure and causing vein wall dilatation and elongation.
Common risk factors
- Family history (inherited valve weakness)
- Female sex and hormonal changes
- Prolonged standing occupations (hairdressers, teachers, surgeons)
- Obesity
- Pregnancy (increased pelvic venous pressure)
- Age (valves weaken over time)
- Previous DVT (post-thrombotic syndrome)
- Sedentary lifestyle
Symptoms
- Visible, bulging, twisted blue or purple veins on the legs
- Aching or heaviness in the legs, especially after prolonged standing
- Swollen ankles, particularly at the end of the day
- Itching around the veins
- Restless legs at night
- Skin changes in advanced disease: discolouration (haemosiderin staining), lipodermatosclerosis, varicose eczema
- Venous leg ulcers in severe longstanding disease
When to see a doctor
Arrange assessment for troublesome pain, swelling, skin changes or a leg sore that has not healed. Bleeding from a varicose vein needs urgent advice; heavy or uncontrolled bleeding needs emergency help. A newly hot, painful or swollen leg, or a hard painful vein with red or darkened skin, needs urgent assessment.
Diagnosis
Clinical examination with Trendelenburg test to identify the site of valve failure. Duplex ultrasound maps the venous anatomy and confirms incompetent valves (essential before treatment).
Treatments
Conservative management
Walking, leg elevation and weight management may help symptoms. Compression stockings may help selected people, but their type and fit need advice and arterial circulation must be checked. They do not cure varicose veins and are not the preferred long-term option when suitable procedures are available.
Endovenous thermal ablation
Laser or radiofrequency energy is delivered via catheter into the great saphenous vein, causing it to close. Less invasive than surgery, done under local anaesthetic, with rapid return to normal activity. NICE-recommended first-line interventional treatment.
Foam sclerotherapy
A foam agent is injected into varicose veins, causing scarring and closure. Used for smaller and recurrent varicosities or after ablation to treat residual tributaries.
Surgical stripping
Traditional surgery under general anaesthetic to physically remove the saphenous vein. Now reserved for cases not suitable for endovenous techniques. Higher complication and recurrence rate than thermal ablation.
Self-care and lifestyle
- Regular walking helps the calf muscles support blood flow back from the legs.
- Avoid prolonged standing without moving — shift weight and take walking breaks
- Elevate legs above heart level when resting (for 30 minutes 3 times daily)
- Maintain a healthy weight. Use compression stockings only after advice about suitability, circulation and fit.
Prevention
Varicose veins cannot always be prevented. Regular movement and weight management support general health and may help symptoms. Compression is not a proven way to prevent varicose veins in everyone.
Sources for targeted updates
Updated: 24 October 2026. Urgent-care guidance and the specific treatment or self-care statements corrected in this update. This update covers the named sections; a full review of the remaining guide is pending.