Suffering from this unsightly condition doesn't mean having to live with it. Siobhan Mason investigates the latest and greatest possible treatments and procedures

One of the many things most of us dread about ageing is the cluster of blue, lumpy snake-like veins that grace our once smooth, youthful legs. One in 10 men and one in five women suffers from varicose veins, which are most likely to appear on the backs of the calves or anywhere along the insides of the legs. Although the main problem with these veins is that they're unsightly, sometimes they can actually cause legs to become swollen and painful as the condition progresses.

Why have I got them?
'Relatively little is known about varicose veins,' says Tony Chant, director of the British Vascular Foundation. 'We don't really know what causes them, despite the fact that varicose veins are such a common condition. We do know that there's a genetic component, though it can hop the odd generation,' he adds.

Varicose veins occur when there is a fault in the special one-way valves of the leg that help blood flow back up to the heart. If these valves leak or become defective, the blood flows back down the wrong way so that it pools in the bottom parts of the leg instead of moving up towards the heart. When you stand, the natural force of gravity causes pressure to increase inside the vein, making it stretch and swell.

This doesn't mean that varicose veins are actually caused by standing for long periods of time. 'You're born with a tendency to varicose veins and, as time goes on, the more you're in an upright position, the more pressure builds up in the lower leg, leading to bigger bulging veins,' says Chant.

Vascular surgeon Mark Whitely from Nuffield Hospital in Guildford, Surrey, agrees. 'Most leg vein valves fail in the teenage years, and if you then spend a few years in a job where you stand up a lot, the writing is on the wall,' he says. He adds that standing still for long periods of time probably does not cause the condition in itself. However, if the valves are already defective, then standing is most likely to make both the symptoms and the speed of the deterioration of the veins worse.

If you have a tendency to get varicose veins, they may worsen if you're overweight, on the Pill or pregnant. If you're overweight, the tissue around your veins may be less supportive, causing them to become more visible. During pregnancy there is an increase in hormone levels that relax the muscles and make veins larger.

Treatment
If your symptoms are mild, a few self-help remedies - such as wearing support stockings or elevating your feet several times during the day - may be all you need. However, varicose veins can get worse over time and if left untreated they can lead to eczema (patchy, dry skin) or phlebitis (an inflammation of the vein that makes it tender and painful). According to the British Vascular Foundation, surgery is rarely essential, and the decision about treatment depends on how much the veins bother you or whether you have any of the above complications.

Non-surgical options

• Wearing support stockings, although not the most attractive addition to your wardrobe, may help stop veins from swelling, particularly if you stand up a lot. Properly fitted medium-strength support stockings usually work best. 'Make sure they fit properly, otherwise, if they're too tight, they may restrict circulation,' says Chant. He advises people to go for a below-the-knee support stocking, which is easy to fit. 'If you've got a serious problem and need a stocking above the knee, it's best to go to a surgical appliance office. Look at www.yell.com under Surgical Instruments, and you'll find someone who can measure you properly,' he says.
• Also, make a conscious effort to elevate your legs from time to time during the day. Sitting on a sofa with your legs elevated higher than your head can ease aching, swollen legs by allowing blood to flow easily back to your heart.
• Muscles in the legs help pump blood back to the heart, so by exercising regularly, you'll help the blood flow more freely. Try to exercise two or three times a week or at least build more activity into your day.
• For obvious reasons, it's a good idea to avoid long periods of standing if you can.
• If you do have to stand for long periods, try 'rocking' movements, transferring weight forwards onto the balls of the feet and lifting the heels, and then rocking backwards to take the weight on your heels and lifting the front of your foot. These movements contract the calf muscles and pump blood back to the heart. The same sort of foot movement can be done if you have to sit for long periods of time. You can also do ankle rotations of the type recommended on aircraft to pump blood out of the legs and stop it pooling in the veins

Surgical options
The aim of surgery is to remove or close the faulty vein so that blood diverts away from this vein and flows along the healthier ones. 'There's a complete spectrum of people who have surgery on their veins - from models who get it done for cosmetic reasons to those who need it because they're in a lot of pain,' says Chant.

These are the main types of surgical treatments:

Sclerotherapy
Cost: Around £350-£400 a leg
This procedure is most commonly used for early varicose veins or thread veins and it involves chemicals, called sclerosants, being injected into the veins to destroy their lining. As a result, the vein shrivels up and closes permanently so no blood will flow through it. 'The procedure takes about half an hour, then you have to wear pads and bandages for about four-six weeks,' says Chant. He also remarks that 'the injections can sometimes cause staining of the skin,' which can cause skin to go slightly brown and looked bruised. However, discolouration usually disappears in a few weeks and is rarely permanent.

Vein removal
Cost: Around £1,500 a leg
This is the treatment most people opt for. If you have leaky valves in the groin area and behind the knee, or if you have large veins in the thigh and back of the leg, you can have surgery to completely remove the vein from ankle to groin, which will be done under a general anaesthetic. According to Consultant Vascular Surgeon John Scurr from University College and Middlesex hospitals, 'only small incisions are made and they often heal without scarring. There can be some discomfort after surgery, but most people are back at work in a week, while some return to work after two days.'

Closure

Cost: Around £2,500 a leg
This is a new, controversial treatment for varicose veins and is practised privately by Mark Whiteley at the Nuffield Hospital in Guildford, Surrey. Although this treatment was developed in the United States, Whiteley is one of the few doctors practising it in the UK. This procedure involves making an incision at the knee or ankle, rather than at the groin, and then effectively dissolving the veins rather than removing them.

The surgeon will first perform an ultrasound scan to see what's going on inside the leg. A catheter is then inserted into the troublesome vein, which heats the vein wall, destroying the vein and leaving an internal scar that gets slowly reabsorbed by the body. Whiteley argues that 'recovery is less painful and speedier than standard surgery.' However, critics say it's an unproven technique, and this treatment is not available on the NHS. For more details, see Whiteley's website at www.veins.co.uk or check out www.vnus.com.

For general information on varicose veins, have a look at www.jscurr.com.