Varicose veins: What they are, causes, and how to treat them

Venous surgeon Professor Mark Whiteley explains all you need to know about varicose veins and how they're affected by exercise

What are varicose veins?

What are varicose veins?

Varicose veins are swollen bulging veins that usually occur on the legs and around the ankles, though they can be found on the thighs, calves and sometimes in intimate areas around the genitalia and buttocks. They’re a relatively common condition that can affect up to 30% of us in our lifetime.


They appear as enlarged lumps on standing that reduce on lying down. If deep, they’re colourless but if near the surface can appear green, purple, blue or red. The bulging appearance can leave many feeling self-conscious.

What causes varicose veins?

Varicose veins occur when valves in our leg veins fail, letting venous blood fall back down the veins when standing up, rather than flowing upwards towards the heart as it should.

Can exercise cause varicose veins?

No – in fact, it’s almost the opposite. The more you exercise, the bigger your veins get because they must return blood back to heart. However, these are normal veins with working valves. They tend to get smaller in the cool weather and only bulge in warm weather or when you exercise.

However, there’s good evidence that the more you exercise the healthier the veins are. Without getting too scientific, the faster the blood flows up a vein, the more ‘shear stress’ there is on the wall and the more the cells in the vein wall secrete a substance called nitric oxide.

This chemical keeps the vein wall very healthy. So, exercise doesn’t cause varicose veins and indeed is highly recommended in patients with or without venous problems.

Does exercise prevent varicose veins, improve them or make them worse?

Whether you get varicose veins or not depends upon your genetic makeup. However, the speed at which your veins deteriorate depends very much upon exercise.

People who exercise regularly tend to get fewer complications from varicose veins. Those that exercise infrequently are more likely to deteriorate to swollen ankles, skin damage, clots in the veins, venous eczema, and leg ulcers.

Therefore, anyone with varicose veins should keep exercising to reduce the risk of deterioration, although they’ll not get a permanent cure until they have proper endovenous treatment.

Do varicose veins affect you when you swim, bike, and run and your athletic performance?  

Until recently the answer to this would be ‘no’. However, I’ve seen some unpublished research where a new research stocking has been shown to improve blood supply to the legs by helping venous blood out of the varicose veins.

The research study looked at some of the available ‘sport stockings’ and didn’t find any improvement. However, using a new stocking that has been designed specifically for sports, an improvement in blood supply to the muscles during exercise was found.

Therefore, although this isn’t available at the moment, I think there are exciting developments coming in this area.

Probably the biggest tip for athletes at the moment is that, if you have got varicose veins, you do need to get them treated if they cause any aching, tired legs, discomfort at all or if you get any swollen ankles, red or brown patches around ankles, eczema over the ankles or veins themselves, or if you have ever had phlebitis in the varicose veins (hard red lumps that get painful) or a bleed from the veins.

All of these are medical indications outlined in NICE Clinical Guidelines 168 that have been shown by research to require veins to be treated. Nowadays, it’s been shown that no one should have the vein stripped and all the new effective techniques are done under local anaesthetic as walk-in/walk-out endovenous procedures.

How are varicose veins treated?

There are several different techniques available for treating varicose veins effectively. Some of the cutting-edge techniques we use today at The Whiteley Clinic include:


Sonovein (also called HIFU Echotherapy) is the latest innovation in treatment for varicose veins and uses high precision echotherapy to treat patients 100% non-invasively.

Unlike traditional varicose vein treatments, no catheters, chemical injections, or incisions are required with Sonovein, meaning patients are left with no scars or risk of infection, and can return immediately to their normal daily activities.

During the echotherapy treatment, a high-intensity ultrasound beam is focused step-by-step on the troublesome vein. As the thermal energy is delivered, the affected vein shrinks and is sealed closed. A small local anaesthetic injection might be needed around sensitive veins.

EVLA (endovenous laser ablation)

This technique destroys the veins at the root of the problem as a walk-in/walk-out procedure. Under ultrasound control, a needle is placed in the vein near the knee or ankle. A wire is then passed into the vein and a long ‘sheath’ is passed up the vein to the top. The ultrasound is used to position the end of the sheath exactly.

Local anaesthetic is injected around the vein – again using ultrasound to make sure the fluid is in the right place. Once the anaesthetic is in place, the laser fibre is passed up inside the sheath until it comes out of the top. The fibre is fixed to the sheath and the laser is switched on.

The sheath and laser are then pulled back at an exact rate, making sure the vein is destroyed – but without damaging the surrounding tissues.

Microwave ablation 

Microwave ablation technology has traditionally been used for the treatment of cancer, particularly of the lung and liver. It uses electromagnetic waves in the microwave energy spectrum to produce tissue-heating effects, which destroy cancer cells.

The advantage of the new microwave ablation technique is that it produces reliable heat at exactly the point needed to destroy the varicose vein permanently. This is because it targets water, and so does not require contact with the vein wall – offering the same advantages as laser ablation.

However, because there is no laser light involved, surgeons do not require special rooms, regulations or eye protection to carry it out.


This precise technique is used for patients with perforating vein problems. Most doctors do not treat perforating veins and research has shown this is one of the major reasons why patients get varicose veins back again after treatment. Successful treatment of varicose veins and venous leg ulcers often requires perforating vein treatments.

Foam sclerotherapy 

Injection of foam sclerotherapy followed by three weeks of bandaging can give very good results for the treatment of small varicose veins. However, it is very ineffective for large veins.

Therefore, the best results come from using combinations of the treatments above along with foam sclerotherapy later. Some doctors try to treat patients with foam sclerotherapy alone. Unless veins are very small, and do not have an underlying cause, this usually leads to a high chance of veins coming back again.

If you’re at all concerned about your venous health or any other health issue, always consult a doctor.


Top image: Getty Images