Varicose Veins Survival Guide – Eliminate Vein Pain

Veins Charlotte Blog

Do you have painful leg veins? Do you have tender swollen veins in your legs? How do you make vein pain in your leg go away?

Varicose veins are a common condition that affects millions of people. Occasionally people can start developing varicose veins as early as their teenage years, but it’s much more common for veins to start appearing after age 20. Various factors such as pregnancy, being overweight, being sedentary, prolonged standing, and family history can increase the risk of developing varicose veins.

Above: Varicose Veins - Thigh

Varicose veins are abnormally enlarged, bulging veins located close to the skin surface. Quite often varicose veins can be seen or felt through the skin, especially in situations where the veins are bulging out through the skin. Varicose veins often twist, bend and turn, reflecting the fact that the veins are continuing to dilate and elongate in an area where there’s not a lot of space.

Some people with varicose veins may experience no pain or discomfort. In other people, varicose veins can result in pain and tenderness. Some people with varicose veins will develop a condition called phlebitis, where the veins have become inflamed and tender.

The treatment of vein pain is broadly divided into the following categories:

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Leg compression:

Above: Medi Compression hose

 Compression hose – Circumferential compression garments resist the tendency of the leg to swell, and simultaneously resist the bulging and protrusion of varicose veins. Compression hose come in different strengths and different lengths.

Compression hose are considered medical-strength when the amount of compression applied is 20-30mmHg at the level of the ankle. Over-the-counter hose commonly start at 15-20mmHg. Some people with vein problems require 30-40mmHg strength to get symptom relief.

      Above: Medi Butler Device

 

 Above:  Sigvaris Don N' Doffer

Many people find putting on and removing compression hose challenging. For some people with bad arthritis, back issues, or severe obesity it can be nearly impossible. Several “donning” devices like the Medi Butler donning system and the Sigvaris Doff N’ Doffer can make applying compression hose much easier.

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 Velcro-mediated compression garments – If you have trouble putting compression hose on, then an alternative is using a Velcro-mediated compression garment. Velcro-mediated compression garments, such as the Medi Circ-Aid Juxta Lite, allow compression to be applied to the leg but are much easier to put on. These garments consist of a sturdy, slightly stretchy, fabric that secures in place using adjustable velcro straps. These garments are more expensive than regular compression hose, but they allow leg compression to be achieved without having to fight to get them on.

Above - Circ-Aid Juxta Lite

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 Compression bandages – Another alternative to compression hose is to use compression bandages. There are a variety of compression bandage systems available. “Short-stretch” bandages are engineered to stretch a little, but not too much. The amount of stretch in these bandages has been specifically engineered to provide optimal levels of leg compression, which helps prevent reduce symptoms and control leg swelling.

Above - Multi-layer leg bandage

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 Unna boot therapy – Unna “boots” are a multi-layer compression bandaging system used when people have advanced stages of venous disease and are most commonly used in the setting of a venous ulcer. The term “boot” is a bit of a misnomer, as this multi-layer material bandaging system is relatively soft and flexible.

Unna boot compression bandages are commonly used when vein problems have progressed to the level of skin breakdown. Skin wounds that develop around the ankle because of underlying vein problems are known as venous ulcers.

Above: Unna boot

The internal layer of an Unna boot bandage is impregnated with zinc-oxide, the active ingredient in many diaper rash creams. Most venous ulcers will start to heal rapidly once the leg is placed in an Unna boot bandage. It sometimes takes several weeks of Unna boot treatment for venous ulcers to heal.

The Unna boot is commonly left on for up to 7 days at a time. Showering and bathing can be challenging, as the Unna boot needs to be kept dry. Many patients report success placing a water-resistant plastic boot bag over the Unna boot while showering.

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Non-invasive therapies that reduce pressure in leg veins:

Leg elevation – Elevating your legs eliminates gravitational pressure that can exacerbate varicose vein pain. The most effective form of leg elevation involves elevating the legs above the level of the heart. Effective leg elevation is not always easy to achieve and typically involves lying flat and resting your legs on 1-2 pillows. Most people are disappointed to hear that leaning back on their favorite recliner does not get their legs high enough to provide a meaningful reduction of gravitational pressure.

Above:  Leg elevation

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 Weight reduction – Excess body weight, and more specifically an enlarged belly, can cause compression of veins in the pelvis. When veins in the lower abdomen and pelvis are compressed it becomes harder for blood to exit the legs. Resistance to blood flow increases pressure and exacerbates varicose vein pain. Although weight reduction does not resolve venous reflux or eliminate varicose veins, it’s generally accepted that eliminating excess body weight reduces the severity of varicose vein pain.

Above: Excess body weight can cause vein issues!

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Aerobic exercise/calf muscle contraction – When the muscles of the lower leg contract blood in the calf veins gets shunted upstream. This helps clear out pooled blood It takes several calf muscle contractions to meaningfully clear out stagnant blood in the calf veins.  

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Topical therapies that reduce pain, sensitivity, and inflammation:

 Topical ice/cold packs – Temporary or transient application of ice or cold packs reduces pain and inflammation.

Above: Topical cold pack

 

✅  Topical heat / warm compresses - Temporary or transient applications of warm compresses or hot packs can reduce pain and inflammation.

Above: Topical hot pack

 

 Topical Anti-Inflammatory Gel – Can be used for acute flare-ups of phlebitis/vein pain. 

Above: Topical anti-inflammatory Gel

 

Topical Steroid Medications – Can be used for short periods for acute flare-ups of dermatitis (dermatitis due to vein problems is known as “stasis dermatitis”).

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Topical therapies - Non-traditional / “natural” options:

Various topical products have been espoused for the treatment of varicose veins and various other skin conditions. In the world of natural health, the use of oils is commonly advocated.

It’s important to appreciate that there are different types of natural oils. Natural oils are commonly subdivided into “essential oils” and “edible seed (vegetable) oils”. These products are derived using different techniques, and it’s very important to appreciate the differences between the two types, as most essential oils are NOT safe to ingest.

Essential oils (sometimes referred to as volatile oils) are created using a process called distillation. This distillation process involves extracting and isolating a “volatile component” from part of a plant. The part of the plant that’s used varies significantly, depending on the type of plant being distilled.

Essential oils are generally less greasy than vegetable oils. Essential oils commonly evaporate at or slightly above room temperature, whereas the evaporation point of vegetable oils is much higher.

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✅ Topical Arnica – Derived from the perennial herb Arnica montana, topical arnica has natural anti-inflammatory properties and is also used to alleviate tired muscles and reduce bruising. Other names for arnica include mountain tobacco, mountain daisy, leopard’s bane, and wolfbane. Topical arnica comes in cream (or gel ointment) that can be applied to the skin overlying inflamed or painful varicose veins. Topical Arnica should not be applied to open wounds or sores. Arnica montana should not be taken orally as Arnica montana contains the toxin helenalin, which can be poisonous.

Above: Arnica montana

 

Above: Arnicare Gel

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Witch hazel (derived from Hamamelis virginiana plant) contains gallic acid, which reportedly reduces tissue swelling. Some people report soaking a wash-cloth with witch hazel and letting the cloth sit on the affected area. There is no scientific data that witch hazel is effective in the treatment of Varicose Veins. 

Above: Witch Hazel

 

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Topical Castor Oil:

Castor oil is a vegetable oil derived from pressed castor beans (Ricinus Communis). Castor beans are native to tropical parts of Africa and Asia. Castor oil is translucent with a slight yellow tint. The active component of castor oil is ricinoleic acid, which has been reported to decrease inflammation and has moisturizing properties.

Castor oil is quite sticky and messy to deal with. Topical castor oil is typically applied directly to the skin using a cotton ball.

There are multiple anecdotal reports of castor oil being used for various skin conditions including psoriasis, eczema, and acne. Potential side-effects of topical castor oil include allergic reactions such as skin rash, swelling, and itching. There’s no compelling scientific data to support the use of castor oil for the treatment of varicose veins.

Above: Castor beans

 

Above: Castor Oil

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Other essential oils (reported to help spider/varicose veins – no scientific evidence):

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Topical vegetable oils: 

⛔️  Topical Olive Oil – No scientific data to support use.

Olive oil is a vegetable oil derived from pressed or ground olives, the fruit of Olea europaea.

Olive trees are native to the Mediterranean basin but were introduced into the Americas in the 16th Century. Olive oil is translucent with a slight yellow tint. The composition of olive oil varies, but is predominantly oleic acid, with smaller amounts of other fatty acids including linoleic acid, and palmitic acid.

There are anecdotal reports of olive oil being used for various skin conditions. The topical application of olive oil has been studied. Researchers concluded that there’s no compelling scientific data to support the use of topical olive oil for skin conditions, and the product may exacerbate dermatitis. There’s currently no accepted role for topical olive oil for the treatment of varicose veins.

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⛔️  Apple-Cider Vinegar:

Apple cider vinegar is derived from fermented apple juice. The fermentation process involves adding bacteria and yeast to the juice obtained from crushed apples. The fermentation process generates alcohol, which is subsequently fermented into vinegar (acetic acid) using a specific type of bacteria (Acetobacter).

Topical apple cider vinegar is potentially hazardous and may cause chemical injury (chemical burn) to the skin. There’s no scientific evidence (or clinical data) to support topical apple-cider vinegar in the treatment of varicose veins.

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 Oral Anti-inflammatory drugs:

These types of medication are sometimes used on a short-term basis (eg. 7-14 days) to treat acute flare-ups of vein pain. Long term use increases the risk of side-effects and should be avoided.

 

Oral Diuretics:

Sometimes used to reduce generalized leg swelling / fluid retention – Diuretics do NOT fix underlying vein problems.

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Veno-active Drugs ("VADs") & Herbal Supplements

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Procedures that reduce leg vein pressure:

✅  CLOSUREFAST PROCEDURE:

Closurefast, also known as radiofrequency ablation (or venous closure) is a minimally-invasive procedure that reduces pressure in varicose veins. Closurefast uses radiofrequency energy to deliver controlled heat energy to seal and close the target vein. After the target vein is closed, blood naturally reroutes to healthy veins. The treated vein slowly heals and contracts over a few weeks. The net result is less pressure and fewer symptoms in downstream varicose veins.

Above: Closurefast Procedure

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✅  VENASEAL PROCEDURE:

The VenaSeal adhesive closure system involves injecting a proprietary medical adhesive into the target vein. This powerful adhesive immediately seals and closes the vein, which reduces pressure in varicose veins in the lower portion of the leg. This procedure is painless and offers an immediate return to work and sporting activities.

Above: VenaSeal Closure System

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✅  VARITHENA® MICROFOAM PROCEDURE:

Varithena is a specially formulated microfoam (a combination of polidocanol and oxygen) that gets injected into the problem vein(s). After injection into the veins, the foam expands to reach the surrounding vein walls. The medication is designed to make the veins collapse, contract, and gradually get reabsorbed into the surrounding tissues. Varithena is extremely versatile and can be used to treat saphenous veins, saphenous vein branches, and varicose veins. Because the product is a viscous foam, it can easily track through bends in the vein, and can safely treat veins close to the skin surface.

Above: Varithena Microfoam Procedure

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Procedures that occlude or remove symptomatic varicose veins:

✅  PHLEBECTOMY:

Phlebectomy is a procedure where varicose veins are directly removed through tiny pinhole skin incisions that typically measure <2mm in diameter. The hook is tiny and narrow, and the procedure is routinely performed using local anesthesia. Not everyone needs phlebectomy, and if the visible skin surface veins can be decompressed using one of the “indirect” techniques described above and followed up with some of the other sclerotherapy options (listed below) then quite often phlebectomy can be avoided (or at least minimized).

Above: Phlebectomy

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✅  Sclerotherapy

Sclerotherapy involves injecting medicine into the veins which causes the veins to shrivel, regress, and fade. Sclerotherapy can be used to treat small varicose veins, reticular veins, and spider veins.

For most patients, sclerotherapy is rated as mildly uncomfortable as the tiny needle punctures the skin, but the procedure can be made more comfortable by the application of a topical anesthetic (numbing) spray. At Vascular Solutions, we use topical ethyl chloride spray to numb the area when we perform sclerotherapy.

Above: Sclerotherapy

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Dr. Peter Ford, Kristin Hartman PA, and team are the best vein specialists in Charlotte and the Carolinas.  Contact us today if you would like to be evaluated.

 

VEINS CHARLOTTE BLOG – SOLUTION SOLVED

 

Author
Peter Ford MD FACS RPVI Peter Ford, MD, FACS, RPVI, is a board certified vascular surgeon who works at Vascular Solutions in Charlotte, North Carolina. Dr. Ford specializes in the management of varicose veins and venous disease.

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