page_title: Varicose veins
section_title: Causes
hierarchical_section_title: Varicose veins / Causes
context_page_description: Varicose veins are superficial veins that have become enlarged and twisted. Typically they occur just under the skin in the legs. Usually they result in few symptoms but some may experience fullness or pain in the area. Complications may include bleeding or superficial thrombophlebitis. When varices occur in the scrotum it is known as a varicocele while those around the anus are known as hemorrhoids. Varicose veins may negatively affect quality of life due to their physical, social and psychological effects.
  Often there is no specific cause. Risk factors include obesity, not enough exercise, leg trauma, and a family history of the condition. They also occur more commonly in pregnancy. Occasionally they result from chronic venous insufficiency. The underlying mechanism involves weak or damaged valves in the veins. Diagnosis is typically by examination and may be supported by ultrasound. In contrast spider veins involve the capillaries and are smaller.
  Treatment may involve life-style changes or medical procedures with the goal of improving symptoms and appearance. Life-style changes may include compression stockings, exercise, elevating the legs, and weight loss.
context_section_description: Varicose veins are more common in women than in men and are linked with heredity. Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are unlikely to be caused by crossing the legs or ankles. Less commonly, but not exceptionally, varicose veins can be due to other causes, such as post-phlebitic obstruction or incontinence, venous and arteriovenous malformations.
  Venous reflux is a significant cause. Research has also shown the importance of pelvic vein reflux (PVR) in the development of varicose veins. Varicose veins in the legs could be due to ovarian vein reflux. Whiteley and his team reported that both ovarian and internal iliac vein reflux causes leg varicose veins and that this condition affects 14% of women with varicose veins or 20% of women who have had vaginal delivery and have leg varicose veins. In addition, evidence suggests that failing to look for and treat pelvic vein reflux can be a cause of recurrent varicose veins.
  There is increasing evidence for the role of incompetent perforator veins (or "perforators") in the formation of varicose veins. and recurrent varicose veins.
  Varicose veins could also be caused by hyperhomocysteinemia in the body, which can degrade and inhibit the formation of the three main structural components of the artery: collagen, elastin and the proteoglycans. Homocysteine permanently degrades cysteine disulfide bridges and lysine amino acid residues in proteins, gradually affecting function and structure. Simply put, homocysteine is a 'corrosive' of long-living proteins, i.e. collagen or elastin, or lifelong proteins, i.e. fibrillin. These long-term effects are difficult to establish in clinical trials focusing on groups with existing artery decline. Klippel–Trenaunay syndrome and Parkes Weber syndrome are relevant for differential diagnosis.
  Another cause is chronic alcohol consumption due to the vasodilatation side effect in relation to gravity and blood viscosity.
caption: How a varicose vein forms in a leg. Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows where varicose veins might appear in a leg.