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International Journal of Advances in Nursing Management 2(1): January-March 2014
40
www.anvpublication.org ISSN-2347–8632
ARTICLE
Prevention of Varicose Veins
Mrs. Akoijam Sangita Devi1, Mrs. Malar Kodi Aathi2
1Assistant Professor, Dept. of Medical Surgical Nursing,
M.M Institute of Nursing, M.M University Mullana, Ambala Haryana.133207
2Assistant Professor, Dept. of Child Health Nursing,
M.M Institute of Nursing, M.M University Mullana, Ambala Haryana.133207
*Corresponding Author Email: akdevi81@gmail.com, malargeethu@gmail.com
ABSTRACT:
Varicose veins are abnormal, dilated blood vessels caused by weakening in the vessel wall. Such conditions that
increase pressure on the leg veins such as overweight, lack of exercises, hormonal fluctuations during pregnancy and
menopause, smoking; constipation or people who are prolong standing or sedentary position or repeated heavy lifting
make veins of legs very weak and develop into varicose veins. Researchers reports that “A mild care of varicose veins
does not usually require a doctor’s care, it can relief from the discomfort with at-home treatment and various
alternative remedies, such as acupuncture and acupressure, aromatherapy, colour therapy, diet and supplements, herbal
therapy, exercise, Yoga, homoeopathy, hydrotherapy etc”. Other preventive measures are maintaining ideal weight and
to avoid prolong standing and tight clothing that constricts waist, groin or legs; avoid crossing legs when sitting, avoid
wearing high heels and eat low salt diet that is rich in high fibre food to reduce retention of water or swell. Superficial
varicose veins normally do not require medical attention but to relieve the discomfort; the doctor may recommend
elastic support stockings.
KEY WORDS: Varicose veins, hormonal fluctuations, acupuncture, acupressure, aromatherapy, Colour therapy,
herbal therapy, homoeopathy, hydrotherapy, elastic support stockings.
INTRODUCTION:
Many research articles in vascular disease showed, 15-20%
of the population in India is suffering from varicose veins.
Women suffer this disease four times more than men(4). A
lot of occupations have sprung up where people are
required to either prolong standing or sitting for a
considerable time are more prone to get varicose veins. The
higher prevalence is due to the lack of preventive practice
(5). Varicose veins are often primary (affecting only the
superficial veins), often result from a congenital or familial
predisposition that leads to the loss of elasticity of the vein
wall. Secondary varicosities occur when trauma,
obstruction, or inflammation that causes damage to the
valves (which affect the deep veins). Varicose veins can
appear anywhere in the body, but most often affect the legs
and feet.
Received on 17.12.2013 Modified on 06.01.2014
Accepted on 22.02.2014 © A&V Publication all right reserved
Int. J. Adv. Nur. Management 2(1):Jan. - Mar., 2014; Page 40-45
Although they can be painful and disfiguring, they are
usually harmless. If varicose veins are not treated early,
there can be complications such as chronic venous
insufficiency. Patients with varicose veins are at increased
risk of deep vein thrombosis because venous stasis and
injury often cause superficial phlebitis that can pass through
perforating vessels to involve the deep venous system(6).
Definition:
Varicose veins are twisted, enlarged veins near the surface
of the skin and they mostly develop in the legs and ankles.
When sitting or standing for a long time, the blood in the
veins of the legs can pool and the pressure in the veins can
increase and cause stretching. Stretching of veins can
sometimes weaken the walls of the veins and damage the
vein valves resulting in varicose vein (1-2). (Figure: 1)
International Journal of Advances in Nursing Management 2(1): January-March 2014
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Figure 1: Varicose veins
Causes:
o In 40 percent of the persons, varicose veins are due to
hereditary factors, which run into families and generations
in determining the susceptibility to primary valvular failure.
o Prolonged standing and prolonged sitting with legs
down leads to increased hydrostatic pressure that can cause
chronic venous distension and secondary valvular
incompetence anywhere within the superficial venous
system.
o Pregnancy is common cause of varicosities. During
pregnancy, circulating hormonal factors increase the
distensitiblity of vein walls and soften valve leaflets. Late in
pregnancy, the enlarged uterus compresses the inferior vena
cava, causing further venous hypertension and secondary
distension of leg veins.
o Varicose veins occur both in men and women, but are
more frequent in women because vein walls and valves
periodically become more distensible under the influence of
cyclic increase in progesterone.
o Due to lack of exercise and advanced overweight,
veins become very weak and develop into varicose veins.
Due to obesity a lot of fat gets deposited. This weakens the
support system of the veins, resulting in the veins dilating
and becoming tortuous.
o Dietary deficiencies or the loss of skin elasticity due to
ageing are the contributing factors.
o High-heeled sandals and tight clothing are significant
contributors to the development of varicose veins; they
obstruct the normal flow of blood in the veins.
o Constipation, which can contribute to varicose veins.
o Repeated heavy lifting can interfere with normal
circulation (to increase the likelihood that varicose veins
will develop and can worsen existing varicosities).
Today a lot of occupations and professions have sprung up
where people are required to either continuously stand for a
long time or made to sit hanging down for a considerable
time computer professionals, security guards, traffic
police, salesmen working at counters in departmental stores,
teachers, nurses, paramedical workers working in various
hospital set ups and persons doing desk jobs day in and day
out are the sufferers of varicose veins (7).
Why do varicose veins usually appear in the legs?
The force of gravity, the pressure of body weight, and the
task of carrying the blood from the bottom of the body to
the heart make legs the primary location for varicose veins.
Compared to other veins of the body, leg veins have the
toughest job of carrying blood back to the heart. They
endure the most pressure. This pressure can be stronger
than the veins out way valves (7).
Signs and symptoms of varicose veins
Prominent dark blue blood vessels, especially in the
legs and feet.
Aching pain or tenderness along the course of a vein.
Easily tired legs.
Leg heaviness.
Swelling in the legs.
Darkening of the skin (in severe cases).
Numbness in the legs.
Itching or irritating rash in the legs.
Burning sensations.
Night cramps.
Pigmentation.
Exercise intolerance.
Bulging, rope-like, bluish veins indicate superficial
varicose veins.
Aching and heaviness in a limb, sometimes with
swelling, but without any prominent or visible blue veins,
may signal a deep varicose vein.
Discoloured, peeling skin, skin ulcers, and constant
rather than intermittent pain are signs of severe varicose
veins.
Subjective symptoms usually are more severe early in
the progression of the disease, less severe in the middle
phases, and worse again with advancing age.
Common symptoms of telangiectasia include burning,
swelling, throbbing, cramping, and leg fatigue. Pain
associated with larger varicose veins usually is a dull ache
that is worse after prolonged standing.
Pain and other symptoms may worsen with the
menstrual cycle, with pregnancy and in response to
exogenous hormonal therapy (e.g., oral contraceptives) (5-
7)
Diagnosis:
Varicose veins are usually diagnosed by inspection, but
their extent can be determined only by palpation with the
patient standing.
Inspection
Visible varicosity, skin changes, telangiectasis, swelling
around ankles, ulceration, prominent varicose veins,
eczematous lesions, scars form a previous surgical
operation, stasis dermatitis (5).
Palpation
Palpable veins, hardness (thrombosis), tenderness.
International Journal of Advances in Nursing Management 2(1): January-March 2014
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Techniques of test
i. Trendelenberg test.
ii. Perthes test.
iii. Doppler auscultation.
1. Trendelenberg test: The Trendelenberg test can often
be used to distinguish patients with superficial venous
reflux from those with incompetent deep venous valves.
(Figure 2)
a. The leg is elevated until the congested superficial veins
have all collapsed. An examining hand or tourniquet is used
to occlude a varicose vein just below the sapheno-femoral
junction (5 cm below and medial to the femoral pulse). The
patient stands with the occlusion still in place (11).
b. If the distal varicosity remains empty or fills very
slowly, the principal entry point of high pressure into the
superficial system has been identified. Rapid filling despite
manual occlusion of the suspected high point of reflux that
some other reflux is involved.
Fig.2: Trendelenberg test
2. Perthes test: The Perthes test is a traditional technique
intended to distinguish antegrade flow from retrograde flow
in superficial varices. To perform the test, a tourniquet is
placed over the proximal part of the varicose leg in such a
way as to compress superficial varicose veins, but not the
deep veins. The patient walks or performs toe-stands to
activate the calf muscle pump. The calf muscle pump
normally causes varicose veins to be emptied, but if deep
system obstruction exists, then the varicose veins
paradoxically become more congested (12).
3. Doppler auscultation: Doppler examination is an
adjunct to the physical examination that can directly show
whether flow in a suspect vein is antegrade, retrograde or
to-and-fro. (Figure 3)
Fig. 3: Doppler auscultation
Treatment
A mild case of varicose veins does not usually require a
doctor’s care. You can find relief from the discomfort of
varicose veins with basic at-home treatment and various
alternative remedies (7).
Prevention of varicose veins
Varicose veins may be prevented to some extent by:
1. Exercise regularly
Try to walk 10 to 20 minutes every day or participate in
other exercise, such as bicycling or jogging, swimming to
strengthen leg muscles and improve blood circulation.
Before beginning an exercise programme, check with your
doctor, especially if you have health conditions such as
heart disease, high blood pressure, arthritis, or breathing
difficulties (10).
2. Exercise your legs. When you are sitting down, rotate
your feet at the ankles in both directions, making small
circles. Extend your legs, and point and flex your feet.
Repeat for a minute or two once an hour.
3. High-impact exercises such as running may be
uncomfortable for people with varicose veins.
4. Avoid long periods of standing or sitting: If you must
stand for a long time, shift your weight from one leg to
another every few minutes. Sit down frequently and elevate
your legs. Bounce up and down on the tips of the toes
several times an hour. Take a walk if you can. Some people
use a small stool to prop up first one foot, then the other
when standing at work (11).
If you must sit for long periods of time, stand up and move
around or take a short walk
Every 30 minutes to let the legs pump blood back to the
heart. Stop for a brief walk every 30-45 minutes during long
car trips.
International Journal of Advances in Nursing Management 2(1): January-March 2014
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5. Regularly elevating legs
Elevating the legs helps keep the blood from pooling in
the lower legs and improves blood flow to the rest of the
body.
Keep the legs elevated when you sit or lie down, use a
foot rest at work and a foot stool at home to elevate the
feet.(Figure 4)
Fig. 4: Elevating legs
Lie down and raise the legs above the heart level at the end
of the day. Try lying on the back on a bed with feet propped
on the wall or on pillows to improve blood flow back to the
heart.
6. Avoid crossing legs:
Try not crossing the legs at the knees when sitting. If you
can’t prop up the feet, set them flat on the floor or cross
them at the ankles. Crossing legs at the knees squeezes
veins and blocks blood flow. (Figure 5)
Fig.5: legs crossing
7. Wearing compression stockings:
Compression stockings help relieve symptoms and slow the
progress of varicose veins. Compression stockings are
elastic stockings that squeeze veins and prevent blood from
flowing backwards. Put the stockings on before getting out
of the bed every morning and wear all the day. (Figure 6)
Fig. 6: compression stocking
For many patients, compression stockings effectively treat
varicose veins and may be all that are needed to relieve pain
and swelling, and prevent future problems. Compression
stockings also can help heal skin sores and prevent them
from returning. Usage of compression stockings will not be
beneficial if the person is lying down. For very mild
symptoms, start with using regular support panty hose, knee
socks (which end just above the calf, below the knee).For
more serious symptoms, use special compression stockings
from a medical supply store (with a doctor’s prescription).
These stockings are tighter at the feet and get looser as they
go up Replace the compression stockings when they lose
elasticity. For serious varicose veins symptoms, be sure not
to buy stockings that are too tight and uncomfortable to
wear. Compression stockings may help the problem from
getting worse and may help avoid surgery (11).
8. Maintaining ideal weight:
Too much body fat, particularly in the mid section, can put
pressure on the thighs and groin, weakening the walls and
valves of the veins in the legs and groin.
9. Avoid tight clothing:
Clothing that restricts blood flow in the waist, groin or legs
increases the risk of developing varicose veins.
10. Avoid wearing high-heeled shoes:
They can restrict ankle movement and thereby affect the
pumping mechanism of the large veins in the feet and
calves. High-heeled shoes make use of the muscles of
buttocks, rather than calf muscles to walk. Low-heeled or
athletic shoes help strengthen the calf muscles and improve
circulation (6).
11. Eat a low salt, high fibre diet food:
Eating fibre reduces the chance of constipation which can
contribute to varicose veins. Eating too much salt can retain
water or swell.
International Journal of Advances in Nursing Management 2(1): January-March 2014
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Preferred foods: Whole food diet with emphasis on the
following foods: fresh fruits, including berries and cherries,
and citrus fruits, whole grains especially buckwheat, and
millet, garlic, onion, ginger and cayenne pepper. Eat plenty
of fish and cut down on red meat as much as possible.
Moderately restrict fats and refined carbohydrates in the
diet.
Foods to avoid: Sugar, salt, fried foods, processed and
refined foods, animal protein, cheeses and ice cream (8).
12. Alternative remedies:
To cope with varicose veins, try a two-pronged strategy of
natural remedies to ease the discomfort and preventive
maintenance to keep your body fit and strong.
13. Acupuncture and acupressure:
Legs may be pressed for ten minutes daily. Cannot help
aesthetically; only prevent the situation from worsening.
(Figure 7)
Fig. 7: Acupuncture and acupressure
11. Colour therapy: Use red and yellow colour all over the
affected area for thirty minutes once per day. In cases of
ulcers in the legs use blue light radiation for thirty minutes
followed by ultraviolet for forty-five minutes, everyday for
ten to sixty days.
Aromatherapy:
Diet of rosemary (Rosmarinus officinalis) massaged gently
into the affected area may help stimulate circulation by
causing capillaries to dilate. Oils of cypress and chamomile
(Matticaria recutita) may soothe swelling and inflammation
and help relieve pain.
12. Herbal therapies
Witch hazel: Application of this ointment three or
more times is necessary for 2 or more weeks before
results can be expected (may cause minor skin
irritation in some people and is not recommended for
internal use).
Horse chestnut: Used both internally and external
application for problems of venous circulation,
including varicose veins (should be avoided by anyone
with liver or kidney disease and internal use is
contraindicated during pregnancy and lactation).
Gotu kola, Ginkgo and hawthorn: Strengthen blood
vessels and improves peripheral circulation.
Bilberries: Supports normal formation of connective
tissue and strengthens capillaries in the body and in
this way help prevent varicose veins (9).
13. Homoeopathy
Hamamelis: Tincture or lotion may be applied locally
at night. Hamamelis 3X every three hours when veins
are affected.
Carbo vegetabilis: When constipation and with poor
circulation. In cases of ulcers of varicose veins.
Ferrum metallicum: If legs look pale, but redden
easily and walking slowly relieves the weak, achy
feeling.
14. Hydrotherapy:
It is beneficial to alternate between hot and cold baths to
stimulate circulation in the legs. Take 2 buckets or plastic
waste buckets tall enough to submerge the legs up to the
knees. Fill one container with hot water to cover the lower
legs and the other container with the same amount of cold
water. Add 2 tablespoons of Epsom salts per quart of water
or can add aromatherapy oil to the water. Soak feet and legs
in the hot water for about 3 minutes. Then immerse them in
the cold water for about 30 seconds. Repeat three times,
finishing with cold soak. Perform this treatment once a day
for at least one month to see the results (for diabetes use
warm water). Sponging or spraying legs with cold water
can relieve aches and pain from superficial varicose veins.
15. Juice therapies:
Fresh fruit juices can be very helpful for those with varicose
veins. Dark coloured berries such as cherries, blackberries
and blueberries contain anthocyanins and
proanthocyanidins, pigments that tone and strengthen the
walls of veins. Pineapples are rich in the enzyme bromelain,
which helps prevent blood clots (uncommon but serious
complication of varicose veins). One or two glasses of fresh
fruit or vegetable juices – especially any combination of
apple, beet, carrot, celery, citrus, parsley or pineapple – and
dietary may be helpful in preventing and treating
varicosities (5).
16. Yoga:
Yoga’s stretching and relaxation techniques can be
particularly beneficial for varicose veins. The deep
breathing exercise in yoga may further alleviate discomfort
International Journal of Advances in Nursing Management 2(1): January-March 2014
45
by getting more oxygen into the bloodstream (start by lying
on the back on the flow, arms at sides with your feet resting
above you on a chair. Breathe deeply through nose and
gravity helps pull blood form legs. The deep breathing
creates a pull in chest cavity that also draws blood from the
legs. Fresh blood then enters the legs, easing the pain. The
exercise should be done once a day for about ten minutes
(9- 11)
Surgical or minimally invasive treatment
These treatments include sclerotherapy, ablation, and vein
stripping and laser treatment.
1. Sclerotherapy:
Sclerosant is injected directly into the veins using a very
fine needle. The solution irritates the veins, causing the
veins to swell, stick together and seal shut, thus closing it
off and preventing any blood flow and the vein turns into
scar tissue. In a few weeks, the vein should fade, by the
body’s natural healing process. It may need to be treated
more than once. (Figure. 8)
Fig. 8: Sclerotherapy
2. Ablation:
Use a thin, flexible tube (catheter) inserted into a varicose
vein. Tiny electrode at the tip of the catheter heats the walls
of varicose vein and destroys the vein tissue. As with
chemical sclerotherapy, vein is then no longer able to carry
blood, breaks up naturally, and is absorbed by the body.
3. Laser treatment:
Inserts a tiny fibre into a varicose vein through a catheter.
The fibre sends out laser energy that kills the diseased
portion of the varicose vein. The vein closes and the body
eventually absorbs it.
4. Vein stripping:
With this treatment, problematic veins are tied shut and
completely removed from the leg. Removing the veins does
not affect the circulation of the blood in the leg. Veins
deeper in the leg take care of the larger volumes of blood.
Most varicose veins removed by surgery are surface veins
and collect blood only from the skin (12).
Complications of untreated varicose veins
1. Phlebitis (inflammation)
2. Blood clots (actually in very rare complications)
3. Varicose eczema
4. Bleeding and venous ulcers
5. Deep vein thrombosis
CONCLUSION:
The prevention of varicose veins begins by knowing the
risk factors and working on ones that can be controlled
(such as obesity and prolonged standing). Improving
circulation and muscle tone, especially in the lower legs,
will also help in preventing varicose veins.
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Article
Objectives The homoeopathic remedy, Hamamelis , has been extensively used to treat varicose veins. However, scientific research conclusively proving its utility is lacking. This study was performed to ascertain the remedy’s therapeutic utility and efficacy in treating varicose veins and its complications using the revised venous clinical severity score (VCSS) tool and Doppler studies. Materials and Methods A prospective uncontrolled experimental study with purposive sampling was performed; the subjects were selected from the outpatient department. A total of 32 cases, fulfilling the inclusion and exclusion criteria were clinically examined. The VCSS and Doppler test before and after treatment with Hamamelis 30 were performed. Results The Wilcoxon signed-rank test was applied and the change in the median VCSS was found to be statistically significant. P -value of the pre score was 5.53 ± 4.15 and that of the post score was 3.45 ± 2.36 with a mean change of 2.09 ± 2.87 and 37.69% improvement with P -value of 0.000 < 0.01. The Doppler study showed no significant change or improvement. Conclusion This study revealed that the homoeopathic remedy Hamamelis 30 is effective in the management of varicose veins and its complications by ameliorating symptoms and improving the VCSS. However, the Doppler study reports showed no changes or improvement perhaps due to the short period of treatment.
Available from:URL:http://www
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Society for vascular surgery, vascular Web:varicose veins [online]. [cited on 2006 Feb 7]. Available from:URL:http://www. Vascular web.org.
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Acharya Shivanad Das. Varicose veins:Art of hypnotism. Mumbai and Delhi.2007 Jul 3.
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Craig Feied, MD, FACEP, FAAEM, FACPH, emedicine:varicose veins and spider veins. 2004 Oct 1.
Medical surgical nursing 6 th ed. Philadelphia: Mosby Publication
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Phipps, Sands, Marek. Medical surgical nursing 6 th ed. Philadelphia: Mosby Publication; 1999
varicose veins and spider veins
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Health J. varicose veins and spider veins. [online] Available from:http;