Running? Team sport? Find out how to manage varicose veins
Varicose veins can affect your running and team sports. Though the extent varies depending on the severity of them and the type of sport you play.
Varicose veins occur when the valves in the veins, usually in the legs, become weakened or damaged, causing blood to pool and the veins to enlarge.
Are any of these symptoms affecting your enjoyment or taking part?
Some people with varicose veins have aching, heaviness or cramping in their legs, which can be worse when running and playing sport. Your legs may feel more tired. Running may increase blood flow to the legs, and in severe cases of varicose veins, this may cause swelling, which could make running in general uncomfortable. High-impact sports may increase swelling in the legs, too making them feel heavy or tired more quickly. You may find you have less endurance than you used to have and less agility. This can be distracting or limit performance in sports that need a lot of stamina, like squash or basketball.
Varicose veins can make it harder for the body to pump blood efficiently back to the heart, which may mean you fatigue more quickly during sport. Especially when playing sports with long bursts of activity like rugby or hockey.
Some people might feel weakness or instability in their legs. This may increase the risk of falling or injury in sports that require quick direction changes, jumps or sprints.
In some cases, varicose veins can lead to more serious complications like blood clots (thrombophlebitis), which can make running and playing sport more painful or unsafe.
Prolonged venous insufficiency can lead to skin discoloration or ulcers around the veins, which could become irritated by your sports shoes or clothing. Especially if you’re running long distances or playing sport for long periods and sweating a lot.
Varicose veins in the legs may also be unsightly. You may be self-conscious when playing sports.
Tips for playing sport if you have varicose veins:
- Wearing compression stockings can help improve blood flow and reduce swelling and discomfort while running.
- Make sure you have supportive shoes with good arch support to help reduce leg strain.
- Stretching, warm ups and warm downs can help improve blood flow and reduce strain on the veins. This is good advice for all athletes.
- Staying well hydrated and elevating your legs after a run or sport can help reduce swelling.
- You may need to consider reducing or changing your sport – running shorter distances, spending time on the sidelines. Lower-impact activities like cycling or swimming can help reduce the stress on your legs. Remember to rest up after activity.
If your varicose veins are causing a lot of discomfort, it’s a good idea to consult with your GP or vascular specialist. They will recommend treatment options for you.
Focus: find out all about Ehlers-Danlos Syndrome (EDS)
What is Ehlers-Danlos Syndrome (EDS)?
Ehlers-Danlos Syndrome is a group of inheritable disorders that affect the quality of connective tissues supporting the skin, bones, blood vessels and organs. Genetic changes affect connective tissues by altering collagen in the body.
What's more, depending on the type of EDS, the gene causing EDS may have been inherited from one parent or both parents.
What is connective tissue and collagen?
Collagen is a protein found throughout the body, where it supports, protects and provides structure to other parts of the body. And is the main building block of the body.
EDS is caused by changes in the genes that affect the structure and function of collagen. It causes changes in the amount, size, shape and organisation of collagen.
Hypermobility is the most common form of EDS
Hypermobility syndrome is the most common form of EDS (hEDS). Making up 90% of EDS cases. Joint hypermobility, or 'double-jointedness', is typical. But other body systems may also be affected, such as the heart and arteries, nerves, skin, muscle and spine.
Other conditions include generalised Hypermobility Spectrum Disorder (G-HSD), Loeys–Dietz and Marfan syndromes and Osteogenesis Imperfecta, with EDS and G-HSD the most common.
Symptoms can range from mild to severe. For example, chronic and widespread pain, fatigue, nerve and gut problems are common. Affected people will often be treated for other illnesses, such as irritable bowel syndrome and indigestion.
Just how EDS and the other disorders are linked to vascular compression syndromes is not currently known. With more research needed. In fact, vascular compression is mostly picked up when people are scanned for another reason. And, therefore, show no signs of vascular compression at all.
How to diagnose EDS
The genetic cause of the most common EDS subtype – hEDS – has not yet been found. Therefore, there is no genetic test currently available. As a result, diagnosis relies on certain diagnostic criteria. This includes the Beighton Score to assess for hypermobility. Formal diagnosis is by a rheumatologist.
Management of symptoms
There is no cure for EDS. Management involves addressing each person’s symptoms. Physiotherapy and pain management, as well as using equipment, such as splints for hypermobile joints, are all helpful therapies. Those that help to improve quality of life are essential. Monitoring of blood vessels by ultrasound scan is beneficial for some sub-categories of EDS.
Hormones, such as progesterone and oestrogen can heavily affect those with EDS. In addition, prolonged menstruation and dysmenorrhea is often reported by women with EDS.
Increasing awareness about EDS is essential for early diagnosis and better support.
Finally, advances in genetic sequencing and understanding of collagen biology offer hope for targeted therapies that could help reduce symptoms and improve outcomes for those with EDS.
Pelvic vein care, chronic pain and finding out about treatment
Symptomatic pelvis veins are relatively common in women who have had children and may be a cause of chronic pelvic pain. This is called pelvic congestion syndrome. Pelvic varicose veins may be the cause of chronic pelvic pain in up to 30% of women.
Pelvic veins are varicose veins around the uterus and ovaries. Abnormal pelvic veins allow blood to pool in the pelvis, rather than being returned to the heart, and cause pressure symptoms. Sometimes they may escape the pelvis and cause varicose veins around the groin and in the legs.
Some of the symptoms of pelvic veins may include:
- A heavy dragging feeling in the pelvis, worse when sitting
- An urge to pass urine frequently
- Pain during intercourse
- Groin/vulval/labial veins first appearing in pregnancy, improving after birth then coming back in the next pregnancy
- Veins that started in the groin and moved to the upper, inner or back of thighs
- Unexplained pelvic pain even though you’ve been seen by other specialists.
Our dedicated pelvic vein care nurse would be happy to discuss pelvic veins with you. She is available on 0800 45 45 88.
If it is likely that you have pelvic veins, our nurse will discuss this with our specialists. Often you will need an ultrasound scan and possibly a CT scan to confirm the diagnosis. We will organise these investigations for you.
Sometimes other causes of the pain are discovered during these scans. If you do not have pelvic veins our nurse will discharge you back to your GP after discussing your details with our specialist. Sometimes a referral to another specialist will be needed, and this will be done in conjunction with our specialist and your GP.
Next, your treatment plan
If you do have pelvic veins that have been confirmed on the scan(s), an appointment will be made with our specialist and a treatment plan will be recommended. Your diagnosis will most probably be pelvic congestion syndrome or atypical leg varicose veins that emerge from your pelvis.
What is ovarian vein embolisation?
Ovarian vein embolisation is the most common form of treatment for pelvic veins. This is a minimally invasive treatment that is performed under X-ray guidance. The leaking ovarian veins are closed off with small coils and by introducing a vein irritant (sclerotherapy) into the branches that arise from them. This closes the veins so they can no longer enlarge with blood, thus relieving symptoms.
Our team will be back in touch to book your treatment day. Your treatment will be at modern Wakefield Hospital in Wellington and is a day-case procedure.
Pelvic vein care – about the procedure
Once admitted, a sedative will relax you. You will still be awake during the procedure. Local anaesthetic will be injected around the access site. A catheter is inserted into the problematic vein(s). Coils are inserted to block off the varicose veins, which stop blood flowing through them. The number of veins needing to be treated will determine the length of the procedure. Sclerotherapy is usually performed at the same time. A small amount of varicose vein irritant is injected in the varicose veins in the pelvis.
After the procedure
After your procedure you will be monitored for several hours. You may experience some pelvic discomfort and this can be relieved with pain medication. You cannot drive yourself home and may need to stay in Wellington for the night if you are from another region.
Will pelvic vein care service help reduce symptoms?
Overall, the treatment of pelvic veins with coil sealing and sclerotherapy can reduce a woman’s pelvic pain symptoms. Groin varicose veins and atypical leg varicose veins also respond well to this treatment.
Finally, for more information in an earlier blog we talk more about chronic pelvic pain.
Varicose veins myths: the more common misunderstandings
Common Varicose Vein Myths: What You Need to Know
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: Symptoms & Treatment
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
Effective Treatments for Chronic Pelvic Pain and Varicose Veins
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.
