FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

EXERCISE ONE OF THE FIRST STEPS IN TREATING VARICOSE VEINS

Question: I wear prescription support hose for my varicose veins. They help a lot, but my legs still swell. I've heard that walking helps this problem, but I don't know how much to walk or how often. Also, does other exercise such as using a stationary bicycle, rowing machine or working out help, too?

Answer: As I'm sure you know, our veins are the low-pressure conduits for returning blood to the right side of the heart. This low-pressure system works very well when we are in a horizontal position. Assuming the upright posture, however, causes some challenges for the veins. When the feet are downhill from the heart, gravity helps hold blood in the legs. This increases the pressure in the leg veins and tends to dilate them because veins, unlike arteries, have no muscles in their walls. A solution to this problem is provided by one-way valves that block blood from flowing backward toward the feet. Another assistance is afforded by the contraction of leg muscles. This muscle action compresses veins and thereby sends blood on its way back to the heart.

Varicose veins are ones that become swollen and also twisted in their appearance. The valves within the veins create the appearance of a chain of "knots" within the course of the swollen veins. And this unpleasant disorder isn't rare. It afflicts about 40 million Americans -- most of them over the age of 40. It causes them to have a generalized aching or tired feeling in the legs. It can even create swelling in the feet and lower legs, particularly after standing or sitting for long periods of time.

Varicose veins occur principally in the feet and legs. They are more common in those who are obese and who stand for prolonged periods. The greatest predictor of whether you will develop this problem, however, is your family history. Over 50 percent of individuals with varicose veins have blood relatives with the disorder. Abdominal and pelvic tumors and hormonal changes, such as menopause or pregnancy, also increase the chance of having this problem. Women are troubled with them about three times as often as are men.

Varicose veins are a progressive disorder. That is, they get worse with the passage of time, but there are a number of treatments that can make the swollen, knotted veins less of a problem. Support hosiery, like you wear, is the proper initial treatment. Elevating the legs whenever possible helps as does keeping your weight near the ideal level. Rhythmic leg muscle contractions as occur with walking or riding a bicycle help, particularly if this is a daily activity that breaks up periods of sitting or standing. As example, eat a light lunch and then go for a 20-minute walk. Also, walk the stairs instead of taking the elevator and park at the far end of the parking lot.

You may derive some benefit from eating a diet rich in dark green vegetables to provide chemicals called bioflavonoids. Vitamin and herbal treatments may help as well. This might include taking 200 units of vitamin E twice daily or 500 mg of vitamin C two or three times daily. Another popular, conservative treatment is 500 mg of horse chestnut three times each day. There are several surgical treatments that can destroy a particular varicose vein. This simply shifts the burden of returning blood to the heart to other less visible veins without causing any circulatory difficulties. Unfortunately, all of these treatments only slow the progression of this disorder and the appearance of new varicose veins. We haven't figured out how to prevent the problem yet.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.