When you hear the term “varicose veins”, chances are the first thing that springs to mind is the legs. This is not unexpected, as varicose veins are by far most associated with (and most obvious in) the legs. This condition, however, is not limited to the lower extremities, and some people experience varicose veins elsewhere in the body.
Varicose veins can occur anywhere in the body – as a direct result of damage due to swelling and stretching of the blood vessel, and which occurs due to increased venous blood pressure. When this damage occurs, blood can flow backwards and pool, leading to further damage, weakening of the vein wall, and leakage of blood into the surrounding tissues. The veins become swollen, twisted, and uncomfortable.
While this happens by far the most in the lower legs (thanks to gravity), it can also commonly happen in the upper legs.
More unexpectedly, it can also happen in other body parts…
While an unusual area for varicose veins to arise, it does happen occasionally when damaged veins swell, weaken, and leak blood. It causes a swollen or twisted vein that is visible under the skin, usually in the upper arm. It may be itchy or cause a dull ache. While most are not of concern, if it is uncomfortable it requires a medical assessment – like other varicose veins, they can lead to an increased risk of clotting disorders like DVT.
Esophageal varices occur due to cirrhosis of the liver, which is liver damage caused by hepatitis (viral infection) or heavy alcohol consumption. The liver becomes scarred and this causes blood flow to slow, thereby increasing venous pressure around the stomach and oesophagus. Due to the anatomy of the oesophagus, the veins in the region are close to the surface, making them more vulnerable to rupture and bleeding. If this occurs, it can be a medical emergency.
Moderating alcohol intake is one way to prevent esophageal varices from occurring. Mitigating the risks of hepatitis infection is also important (e.g. vaccination against Hepatitis A and B, not sharing hypodermic needles, and practising safe sex).
When varicose veins occur in the pelvis, it is called PVCS or Pelvic Venous Congestion Syndrome. It is sometimes called ovarian vein reflux. Impacting the pelvic veins of women, especially those around the ovaries, this condition can result in chronic pelvic pain and lower abdominal pain. Some women experience a dragging sensation in the pelvis, fullness in the legs, and any symptoms of irritable bowel syndrome and stress incontinence may worsen. Some women will also develop visible varicosities on the inner thigh or the vulva.
The condition is more common in younger women, especially those who have had two or more children. While the cause is not well understood, it is surmised that compression of the ovarian vein during pregnancy may cause the damage. Polycystic ovaries may also be a risk factor.
Managing PVCS requires keeping blood circulating, especially for women who have sedentary jobs/lifestyles or who are on their feet all day. It includes doing gentle exercises like yoga, walking, swimming, and stretching exercises. Some women benefit from more vigorous activity if their fitness levels allow for cycling or running.
For moderate to severe cases, proper diagnosis through imaging is important and management includes medication, pelvic or ovarian vein embolisation (using interventional radiology), or laparoscopic surgery to tie off the affected vein.
Haemorrhoids (“piles”) are varicose veins of the rectum and anus and are very common in both men and women. They may be internal, external, or prolapsed. Bleeding on the toilet is the most common symptom – and this must always be assessed by a doctor as rectal bleeding can also be a symptom of other conditions, including colorectal cancer.
Both men and women develop haemorrhoids due to constipation, excessive straining on the toilet, genetics, and heavy manual labour.
Many women experience haemorrhoids during pregnancy and after vaginal childbirth due to the increased pressure of carrying and birthing the baby. The increased blood volume due to the hormone progesterone also has a role to play.
Management includes relieving constipation with a fibre-rich diet, plenty of plain drinking water, and minimising salt intake. Treatments include astringent suppositories/ointments, band ligation (carried out by a gastroenterologist), or more invasive surgery.
Men and women can both develop varicose veins in the genital region.
Women are most at risk of vulvar varicosities during pregnancy (they are also more at risk of varicose veins all over the body at this time) due to the weight of the growing baby and hormonal changes that cause greater blood volume and relaxing of many of the body tissues, leading to stretching and swelling of the veins. Vulvar varicosity can cause pain, heaviness, fullness, swelling, itching, and increased urination. Dull lower backache is also common. Most cases will resolve within 8 weeks of childbirth.
Men can experience varicocele, which is a varicose vein in the scrotum or on the outside of a testicle. As many as 15% of men have an (often undiagnosed) varicocele, most developing in adolescence between ages 15 and 25. They may be asymptomatic or cause noticeable swelling, a dull ache, or testicular fullness. The symptoms usually resolve when the man lies down.
Most varicoceles are of no concern, though for some men, the presence of varicoceles can impact sperm count and sperm quality and contribute to infertility. This is thought to be due to warm blood leaking from the varicocele pooling in the region and overheating the testicle.
If treatment is required for more severe cases where there are discomfort or fertility issues, scrotal ultrasound confirms the diagnosis and a urologist consult is warranted. Embolisation or minor surgery are treatment options.
Where to go for Varicose Vein Treatments?
For the treatment and management of varicose veins of the pelvis, testicles, rectum, and other non-leg areas, seek medical advice from your GP for a suitable referral to the right specialist.
For varicose veins of the legs, Dr Nicole James is a leading vein specialist seeing patients at Crows Nest Cosmetic & Vein Clinic. She offers minimally-invasive, gold-standard vein treatments including sclerotherapy, microsclerotherapy, endovenous laser ablation, or a combination of these when most appropriate.