Varicose veins myths: the more common misunderstandings
There are many misunderstandings or varicose veins myths about treatments. Here we look at the more common ones we hear about.
Hard surfaces and standing all day
Standing all day might give you sore legs but it is inactivity that causes pooling of venous blood in the legs and may exacerbate problems with varicose veins. If you stand or sit for long periods during the day, wearing compression socks and making sure you build activity into your day will all help to relieve symptoms. You do not want them too tight or too loose. A professional will measure your legs or buy online from a shop where you can supply your measurements.
Varicose veins myths – beige or white compression stockings
While we can order nude-coloured compression socks or thigh-high hose, 90% of our clients prefer to wear black compression socks. Trousers and socks worn over the top and then they’re just like wearing normal socks. If you prefer to wear a dress or skirt, black compression hose look like a dense denier pair of tights.
Varicose veins myths – older people get varicose veins
People of all ages can develop varicose veins. Having said that they do tend to run in whānau/families and have a strong genetic basis. Varicose veins are more common in people over the age of 50 years.
Long recovery time after treatment
We use Venaseal to treat varicose veins. It’s minimally invasive and a day procedure. Because of no anaesthetic, recovery is quick. Previously, varicose veins were stripped in an operation.
Mild discomfort is treated with over-the-counter medications, such as Panadol and Nurofen. Following the post-procedure instructions we give you, including wearing compression stockings and walking often, there is no need to take more than a day or two off work. We can also give you a medical work certificate if needed.
Big varicose veins need surgery
These days, most varicose veins (98%) can be treated with minimally invasive methods such as Venaseal. There are some exceptions to this, for example, very large junction points between the surface and deep veins and varicose veins that emerge from the pelvis in women, also called pelvic varicose veins. Your specialist will discuss these situations with you following your ultrasound scan.
Manual lymphatic drainage and its results with lymphoedema
Taking a holistic view of varicose vein treatment has benefits for better outcomes. Here we look at manual lymphatic drainage, a practice that links to better recovery, especially for those with varicose veins and lymphoedema.
After varicose vein treatment a patient who has manual lymphatic drainage can look forward to: less swelling, better circulation, less pain, faster healing and fewer complications. For patients with lymphoedema this will also help the healing process and make them more comfortable.
What Is Manual Lymphatic Drainage?
Manual lymphatic drainage (MLD) – a specialised type of medical skin massage done by trained therapists. It is gentle and non-invasive, using light pressure to stimulate the lymph vessels that lie just under the skin below the epidermal layer. Stimulating these surface lymphatics increases the flow of lymph fluid, enabling the filling of the deeper lymphatic vessels. The lymphatic fluid in these lymphatics is then transported back to the rest of the body. This touch will be light but powerful.
MLD increases the lymphatic flow. This increase is about twice as effective as walking and a lot more effective than when your legs are at rest. This increase in lymph fluid flow lessens your leg swelling, improves your skin and helps reduce the risk of skin infections, also called cellulitis.
MLD has proven to be effective in reducing oedema (swelling) as well, it soothes and relaxes. It helps reduce pain and improves our defences and immune system health to speed up healing.
How can MLD benefit people with varicose veins?
Manual lymphatic drainage can improve circulation by enhancing the lymphatic flow and helping remove cellular waste and excess fluid from the affected area. This can help reduce pressure on your skin and improve blood flow. Varicose veins may occur when blood pools in the veins due to damaged valves that prevent blood flow. MLD used before your varicose vein treatment can get the body ready for treatment. And, therefore, promote a better result, with faster recovery.
Other benefits of MLD after varicose vein treatment include:
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- Reduced swelling - varicose veins may contribute to swelling in the legs, ankles and feet. Oedema caused by varicose veins is called venolymphoedema. After varicose vein treatment, many patients will continue to have some leg swelling. MLD can help reduce the swelling by getting rid of excess fluid.
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- Pain relief - varicose veins may cause aching and discomfort, especially after standing or sitting for long times. Varicose vein treatment often will not resolve all of these leg symptoms, especially if lymphoedema is present. MLD can help reduce any remaining swelling to help reduce this pain and discomfort.
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- Prevention of complications - untreated varicose veins can lead to ulcers, phlebitis, blood clots and skin discolourations. MLD can help reduce the risk by improving circulation, reducing pressure on the veins and promoting healing.
"MLD is an effective treatment for managing varicose veins and lymphoedema. As these are long-term conditions, we encourage affected people to learn how to use this massage-like technique themselves daily. MLD moves lymphatic fluid via a special sequence throughout the body or out of an area that is congested," says Lymphoedema and MLD therapist Maria Mudford. "However, MLD should also be used in conjunction with compression garments, careful skin care and exercise and nutrition for the lymphatic system. MLD as a stand-alone treatment helps with immune health as part of a pre and post surgery prehab and recovery tool."
How can manual lymphatic drainage benefit those with lymphoedema?
MLD can help reduce the symptoms and also help prevent certain complications for those with lymphoedema. It is especially helpful for patients with lymphoedema because it allows fluid to drain away from the areas where it collects.
Movement and doing strength exercises can also help with lymphatic drainage. Because waste products, toxins and fluids are removed from the body, reducing the risk of swelling and inflammation post treatment. Richard Evans Vascular refers patients for MLD to approved therapists.
For more information: Lymphoedema Therapists is a group specialising in treating patients with lymphoedema. Search here for a therapist.
Pelvic congestion syndrome in men – rare but worth considering
Pelvic congestion syndrome in men refers to symptomatic dilated veins in the male pelvis causing discomfort and pain. Compared with women it is uncommon but is worth considering as a cause of chronic pelvic pain or atypical varicose veins in the legs.
What other symptoms of pelvic congestion syndrome (PCS) should I look for?
Other conditions linked to pelvic congestion syndrome in men include:
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- Varicocele: or varicose veins around the testicles, usually affecting one side only. Testicular pain is a common symptom, and there may be an association with low sperm count and male infertility.
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- Varicose Veins: most varicose veins start in the legs but PCS can be a cause of atypical varicose veins that start in the pelvis and spread down into the legs .
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- Scrotal veins: these are varicose veins in the skin of the scrotum.
- DVT: or deep vein thrombosis, when DVT has caused blockage or damage to the main veins in the pelvis, varicose veins or increased pressure within the pelvic veins may occur, causing symptoms.
- Venous compression syndromes: examples are May-Turner Syndrome (MTS) and Nutcracker Syndrome (NS). With these the normal large veins are compressed by surrounding structures, causing a restriction in flow through the vein and increased pressure. Some inherited genetic syndromes such as Ehlers-Danlos Syndrome (EDS), make MTS and NS more likely.
What are the symptoms of pelvic congestion syndrome in men?
Pelvic congestion syndrome linked to chronic pelvic pain, may worsen if standing for too long or over exercising. A dull ache in the testicals, more often on the left side, and usually worse when upright, standing or straining. There may be a lump or you can see varicose veins. If you notice a lump please see your general practitioner (GP) as soon as you can.
Varicose veins or smaller spider veins may be visible on the scrotum. The scrotum may be swollen as a result. – pain is always linked with the swelling. Pain during or after ejaculation. You may also feel pain in the legs from varicose veins that began in the pelvis and then spread to the legs. Coupled with these symptoms, men may be stressed, anxious and suffer depression.
How does pelvic congestion syndrome affect trans men?
Pelvic congestion syndrome is more commonly associated with people assigned female at birth. However, it can occur in trans men who have had hormone therapy but retain their reproductive organs. The symptoms of pelvic congestion syndrome in trans men are similar to those of females, including:
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- Chronic pelvic pain, often said to be persistent, dull and achy that gets worse during the day
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- Pain during or following intercourse
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- Irregular menstrual bleeding or worsening of menstrual symptoms in trans men who have not had a hysterectomy
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- Lower back pain that may move to the hips or thighs
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- Urinary issues like pressure or the need to go more often and sometimes with urgency.
Diagnosing pelvic congestion syndrome in trans men can be hard due to the overlap of symptoms with other pelvic-related disorders. The condition is also rare. Tests such as ultrasound or MRI are needed to see the pelvic veins and assess blood flow. Other treatment options for trans men who have not had hormone therapy may include starting testosterone therapy, as this can induce amenorrhea and help reduce menstrual symptoms.
What are the steps to diagnosis?
For any pelvic pain please see your GP first. They may refer you for an ultrasound scan. An ultrasound uses sound waves to assess tissues and blood flow. Your GP may refer you for a more detailed x-ray. The x-ray will look at your abdomen, pelvis and testicles and scrotum.
What are the treatment options for pelvic congestion syndrome in men?
Your GP may recommend some simple things you can do to relieve discomfort. Including not sitting or standing for long times, keeping a healthy weight and exercising regularly. Wearing supportive underwear may also help with symptoms.
Treatment depends on the cause and how bad the symptoms are. Some over-the-counter pain relief like paracetemol or ibuprofen may help. Minimally invasive treatments, like stents that open up narrowed or blocked veins and embolisation that close down leaking veins, can relieve pain. Finally, surgery may be suitable for people with worsening symptoms and for whom quality of life is being impacted.
Relief for chronic pelvic pain might just be here
There are many conditions that may cause chronic pelvic pain. And patients may see many different specialists before pelvic varicose veins are diagnosed.
Pelvic varicose veins are varicose veins around the uterus and ovaries. These abnormal pelvic veins allow blood to pool in the pelvis, rather than being returned to the heart.
Risk factors include multiple pregnancies, previous pelvic surgery and family history.
Do you have any of these pelvic varicose veins symptoms?
Typical symptoms of pelvic varicose veins include a feeling of heaviness and pain in the pelvis. Many have an urge to pass urine frequently and suffer pain during intercourse. Symptoms may have been going on for months or years. Varicose veins may be also be visible in some women around their vulva or on their legs, particularly on the inner thigh or the back of the thigh.
Many women have been to their family doctor for chronic pelvic pain and been referred to gynaecologists, urologists and gastroenterologists in their search for a diagnosis. Fibroids, endometriosis, chronic pelvic and urinary infections are also common causes of pelvic pain. But pelvic varicose veins is the cause in up to 30%.
Diagnosis for chronic pelvic pain
First, we offer an indepth chat with our specialist nurse. They will consider whether an abdominal ultrasound, a transvaginal ultrasound, a CT or an MR scan are needed. After which they will refer you to our vascular surgeon for a consultation.
What treatment options we offer
Minimally invasive X-ray techniques, such as coiling (embolisation), are an effective way of reducing the symptoms of pelvic varicose veins. Our team of vascular surgeons and interventionist radiologists perform these procedures, supported by out team of specialist nurses.
Coiling seals the abnormal pelvic veins. Common veins sealed by coils include the ovarian veins and branches of the internal iliac veins. The ultrasound, CT or MR scans identify these abnormal veins for the team. Sealing by coils is under X-ray guidance. Typically done under local anaesthetic with a small amount of sedation. Coil sealing is a day procedure. Often performed at the same time as coil sealing, sclerotherapy, which involves introducing a small amount of varicose vein irritant in the varicose veins in the pelvis.
Overall, treatment of pelvic varicose veins with coil sealing and sclerotherapy can reduce a woman’s pelvic pain symptoms. Vulval varicose veins also respond well to this treatment 1.
Other treatment options, usually by a gynaecologist, in conjunction with a person’s GP, may include hormonal treatments. Hormonal treatments aim to reduce the amount of blood flow within the pelvis by suppressing oestrogen levels.
Surgical treatments include hysterectomy, which may be appropriate in some cases.
Prehabilitation – is a thing – you may love the results
Prehabilitation – or prehab may help prepare your body before a treatment or surgery.
It can help reduce the impact and improve the tolerance of surgical treatments. Enhancing a patient's physical condition may lead to better post-operation recovery, less pain and better outcomes.
By improving muscle strength, flexibility and cardiovascular fitness, recovery after surgery or treatment is often faster. Stretches and mobility exercise also mean less stiffness and soreness after a treatment.
Doing prehab may help show up other health issues
Prehab may help show up any other health issues, such as high blood pressure, diabetes or obesity. All can increase the risk of complications during arterial surgery. As well, patients having arterial treatments may have other conditions such as peripheral artery disease (PAD), diabetes or obesity. Prehab may help manage these conditions through lifestyle changes, which may improve outcomes.
What will help a patient with lymphoedema?
For a patient at risk of lymphoedema, or who already has lymphoedema, lymphatic drainage by gentle exercise, movement techniques or manual massage can help reduce the severity of symptoms and help prevent certain complications.
Exercises of movement and using strength can help with lymphatic drainage. This helps to remove waste products, toxins and fluids from the body, reducing the risk of swelling and inflammation post treatment.
What is Manual Lymphatic Drainage (MLD) for prehabilitation?
Manual Lymphatic Drainage (MLD) is a specialised massage to stimulate the flow of lymphatic fluid throughout the body and is used for prehab. It is especially helpful for patients with lymphoedema as it promotes fluid to drain away from areas where it collects.
Therapists use gentle, strokes and light pressure to stimulate the lymphatic vessels and promote the drainage of lymph fluid. The massage is usually directed towards lymph nodes, which act as filtration stations where lymphocytes (a type of white blood cell) can remove toxins and foreign bodies from the lymph fluid.
Doing exercise before a treatment or surgery will give patients some control over their results and recovery. Longer term the patient may be more likely to add exercise to their daily life and so get the benefits of a healthier lifestyle into the future.
Is it sclerotherapy you need to fix your veins?
Using sclerotherapy the surgeon treats small varicose veins and spider veins. It means injecting a solution, known as a sclerosant, right into the affected veins. The sclerosant irritates the lining of the blood vessel and it swells and sticks together. Over time, these veins will fade.
When does the surgeon use sclerotherapy over other methods?
Most often our surgeon will give these injections straight after varicose vein treatment with Venaseal®. Treating the smaller visible veins. Sometimes you will need another lot of these injections.
The choice between sclerotherapy and Venaseal (a medical adhesive that shuts down the varicose vein by glueing the walls together) depends on the size and where the varicose veins are. Ultimately, our vascular surgeon will decide the best option for patients. The first step is to book the patient in for an ultrasound scan. This will give the surgeon a map of the patient's veins. Because varicose veins are not always able to be seen.
Sclerotherapy will be used to treat smaller veins, while Venaseal will be used to treat the ropey varicose veins you see on the surface. Usually on the legs.
Recovery time for both treatments is much the same, with little down time. Some side effects may be bruising, redness and a little pain where the injections went in. Sclerotherapy are injections into the veins. Venaseal will start with a local one but there are no others.
How can it improve the appearance of small veins?
Sclerotherapy can improve the look of varicose veins and spider veins and help reduce aches and pains. As well as other symptoms like puffy legs. Also, when other things such as wearing compression stockings and making healthy lifestyle changes (like doing more exercise and keeping to a healthy weight) don't help. However, it's vital to talk with a vascular surgeon to find out if sclerotherapy is what you need.
Tired of your leaking veins, sick of puffy legs?
Leaking veins usually refer to a condition known as venous insufficiency. When the valves inside the veins are not working properly, blood can leak backward and pool in the veins. This can lead to symptoms such as swelling, varicose veins, pain and ulcers.
There are many treatments for leaking veins, including:
Wearing compression stockings. We usually say to the knee are fine. Medical-grade compression stockings can help improve circulation in the legs and reduce swelling. This is because they help to keep the blood flowing rather than it pooling.
For most conditions keeping to a healthy weight and exercising often is important in self-managing these conditions. It's no different for leaking veins, as this condition also benefits from having a healthy lifestyle. Raising your legs at the end of the day can help improve circulation and reduce symptoms. Propping your legs will help after a day spent standing. And when your legs are swollen and puffy at the end of the day.
When leaking veins - varicose veins – run in your family
If varicose veins run in your family, most likely you will have them, too.
Varicose veins are most commonly visible on the legs and behind the knees. They look ropey and twisty and protrude above the surface.
We treat varicose veins using a medical adhesive to shut off the leaking veins that are no longer working. It is a minimally invasive procedure under local anaesthetic, where you walk in and walk out.
Smaller veins treated with sclerotherapy
Sclerotherapy will mostly be used for treating smaller veins. Just after varicose vein treatment or when a patient returns for a follow-up appointment after varicose vein treatment. A solution injected into the smaller affected veins closes them off and redirects blood flow to healthier veins.
See a vascular specialist for leaking veins, even if you’ve been putting up with them for years. As well, your GP can provide advice on your treatment options.
So, which doctors treat varicose veins in New Zealand?
Many doctors treat varicose veins in New Zealand. These include:
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- Vascular surgeons
- General surgeons
- Interventional radiologists.
- Cosmetic doctors who have an interest in varicose veins. And often in other cosmetic treatments, too. Often called a ‘Phlebologist’ or Vein Specialist
- Other doctors, like emergency doctors, will also treat varicose veins when they have an interest in this area.
All of these doctors can be called vein specialists but there are some differences between them.
Differences in which doctors treat varicose veins
The main difference is in the training and the range of the medical practice they offer.
Vascular Surgeons
General Surgeons
General surgeons are registered specialists in general surgery with the New Zealand Medical Council. They will mostly do surgery such as gastrointestinal, colorectal, hernia and breast surgery. Some general surgeons will also do vascular surgery in hospitals where vascular surgeons may not be available.
Interventional Radiologists
Interventional radiologists are registered specialists with the New Zealand Medical Council. They are specialists in radiology and in a range of image-guided treatments.
Phlebologists or Vein Specialists
These are doctors who have often trained as general practitioners and then branched out to work in the areas of cosmetic and vein treatments. This group of doctors are not registered specialists with the New Zealand Medical Council. Their are appropriately trained in varicose vein treatments but do not offer the full range of vein and artery care.
Other doctors treat varicose veins
There are also some other doctors offering varicose vein treatments in New Zealand. This group may include doctors such as emergency physicians, who might also have an interest in varicose vein treatments. These doctors may work under the guidance of a vascular surgeon. Or they may work independently in a similar capacity to phlebologists, if they have completed appropriate training.
So, which doctor will be best to treat my veins?
Often, the main thing to think about when choosing your varicose vein doctor is their expertise and experience. As well as a low number of complications from their work. And, following on from this, how they manage any complications if they do arise. A registered specialist is more likely to be able to handle these situations. Because they have more training, as well as more experience.
Ask your GP which doctors treat varicose veins
Ask your own GP for advice on who could treat your varicose veins. You might want to think about those doctors who are close to where you live or work. There is a wide range of choice. Making a good choice can be confusing for you.
At the same time, your doctor will talk with you about your symptoms. And may suggest some things you can do, too to help. Like wearing compression stockings. Or raising your legs at the end of the day to help reduce any swelling. Eating a healthy diet, giving up smoking and doing more exercise may also help you, like going on walks. If doing these things doesn’t help with your veins, your doctor may refer you. Or, if you have done your own research, you can refer yourself.
Diabetes and its big risk factor for vascular problems
Diabetes and vascular conditions are closely related. People with diabetes have more risk of developing some vascular problems. This is because high blood sugar levels can damage blood vessels over time.
There are vascular conditions linked to diabetes
Diabetes can lead to narrowing and hardening of the arteries in the legs, known as Peripheral Artery Disease or PAD. This can mean less blood flow to the legs and feet, causing pain, cramping and wounds to not heal well. Worse cases can lead to gangrene and having limbs removed.
Atherosclerosis, is a build up of fat spots (plaque) in the blood. People with diabetes are at a higher risk of developing these, which can affect many blood vessels, including those in the heart (coronary artery disease, see below), brain (stroke) and legs (PAD, see above).
There is also more risk of blood clots and plaque in the blood vessels in the brain, bringing with it more risk of stroke.
Diabetes is a big risk factor for Coronary Artery Disease (CAD) or narrowing of the coronary arteries. This can lead to angina (chest pain) or heart attacks.
High blood pressure also poses a risk, because high blood pressure can mean more risk of vascular issues. As well, diabetes may damage the blood vessels in the retina, called Diabetic retinopathy. Following, this can lead to eye problems and blindness if left.
Blood vessels in the kidneys may also be at risk of damage or kidney failure. Nerve damage may also be caused by diabetes. Meaning poor blood flow, especially in the feet and lower legs.
Management is key
Managing diabetes and vascular conditions means keeping blood glucose within target ranges.
Eating healthy food and keeping blood pressure and cholesterol under control are all key for managing vascular risks. So, too, is doing regular exercise and not smoking or vaping.
Your vascular specialist or doctor may advise on medicine to control blood pressure or lower cholesterol, as well as medicine to help stop blood clots. People with diabetes need lots of checkins with their healthcare team to help reduce the risk of vascular problems.
More on carotid artery disease, is there a concern?
The carotid arteries are two major blood vessels either side of the neck that supply blood to the brain, head and neck. The right carotid artery and the left carotid artery. These arteries are vital for delivering oxygen-rich blood to the brain, allowing it to function properly. Strokes happen when there is a reduced blood flow to a part of the brain. Strokes can be caused by many factors. One common cause is the narrowing or blockage of the carotid arteries. This condition is known as carotid artery stenosis or carotid artery disease.
How carotid artery disease leads to strokes
The most common cause of carotid artery disease is the build up of fatty deposits (plaque) on the inner walls of the arteries. Over time, this plaque can narrow these arteries and therefore reduce blood flow to the brain.
Sometimes, the plaque in the carotid arteries can break apart. When this happens, it can cause blood clots. These blood clots can then travel through the bloodstream until they get stuck in smaller blood vessels within the brain. This will block blood flow and may cause a stroke. This type of stroke is called an embolic stroke.
Even if there aren't blood clots, narrowing of the carotid arteries can lead to reduced blood flow to the brain. If this blood flow is restricted, it can mean oxygen and nutrients may struggle to get to the brain cells. This may cause cell damage or death. This type of stroke is called an ischemic stroke.
Stroke symptoms and carotid arteries
When a stroke occurs due to carotid artery stenosis, the symptoms can vary. Symptoms may include sudden weakness or numbness on one side of the body, the person may have trouble with their speech or vision. Severe headaches and a loss of coordination may happen too. Following on from this, urgent medical help is vital if stroke symptoms are present.
Your vascular surgeon is an expert on carotid artery stenosis. To help prevent strokes caused by carotid artery stenosis, they may recommend lifestyle changes and medicines to manage risk factors. Risk factors include high blood pressure and high cholesterol. In some cases, surgery such as carotid endarterectomy to remove plaque or widen the narrowed artery or arteries will be needed.
Regular check-ups and monitoring by your vascular surgeon can help manage carotid artery disease and the risk of stroke. This may also include having regular ultrasound scans.
Seek medical help straight away if you suspect you or someone else is having a stroke, because quick intervention can help reduce brain damage for better outcomes.