HealthVaricose Veins in Men: Recognizing and Addressing Gender-Specific Risks

Varicose Veins in Men: Recognizing and Addressing Gender-Specific Risks

Understanding Varicose Veins in Men

Varicose veins are not usually serious, though they can cause aching discomfort and may lead to more serious problems. Primarily, there is a risk of a deep vein thrombosis forming within a varicose vein. This is when a blood clot forms in a deep vein, which may then travel up the leg and become trapped in the lungs. Deep vein thromboses can cause chronic pain, swelling, and skin discoloration in the affected limb. Skin damage may also occur with long-standing varicose veins. This usually takes the form of a brownish discoloration near the ankle, caused by small specks of blood leaking from the varicose vein into the surrounding tissues. In rare cases, a severe type of skin sore known as a venous leg ulcer can develop on the skin near a varicose vein. This can be painful and difficult to heal and requires specialized treatment.

Varicose veins occur when the valves in the superficial veins stop working properly. Normally, blood is pushed up the legs towards the heart by the action of the leg muscles. The blood flow within the veins is kept to a single direction by a series of valves. If the valves become weak or break, the blood can flow backwards and collect in the vein, eventually causing it to become swollen and twisted. It is not certain why the valves stop working, but it may be due to a combination of weak vein walls and a loss of elasticity in the veins, often found in older people.

Varicose veins generally affect half of people aged 50 and over and are more common in women than in men. However, they can affect men too, and in severe cases, can cause skin damage. Veins are blood vessels that carry blood from the body’s organs back to the heart. There are two types of veins. Superficial veins lie close to the skin, and the deep veins lie in groups of muscles. The two are linked by connecting veins, which are the perforator veins.

Causes of Varicose Veins in Men

At the most basic level, varicose veins are caused by the increased pressure on the feet and legs. The heart pumps blood around the body in vessels called arteries. These blood vessels travel the body, transporting oxygenated blood to all areas to keep the body healthy. The now deoxygenated blood must return back to the heart via the veins, which have the tough job of pushing the blood ‘uphill’ back to the chest and lungs. Veins in the leg do this mainly by the action of the leg muscles squeezing them, and the one-way valves in the veins stopping the blood from falling back down. If the pressure in the veins increases, there is a danger that the valves will not be able to hold the blood in place and will start to leak, resulting in a condition called venous reflux. This increased pressure on the veins is a result of weight on the legs, and it’s here that we first see why varicose veins are particularly likely to affect the male half of the population.

This section provides a brief overview of the causes of varicose veins in men; particular attention will be given to areas where males are most at risk from vein disease. Vein disease can affect anybody at any time of life, and many cases are relatively low risk. However, while the stereotype might be of the well-past middle-aged lady, varicose veins are just as likely to affect men as women, and certainly not limited to the elderly. An understanding of the causes of varicose veins gives us the best chance of prevention, both for ourselves and in those who may be more vulnerable.

Symptoms of Varicose Veins in Men

High pressure in the veins, especially in the region of the inner ankle, can cause damage to the skin, which over the years can result in discoloration and eczema. Eczema can be a debilitating problem that can cause the leg to be hot, dry, itchy, and scaly, possibly with some oozing and crusting. If varicose veins are ignored and the condition is allowed to progress, brown stains may appear around the lower leg and, at worst, an ulcer may develop. A healed venous ulcer is the final stage of CVI. Ulcers can be painful and distressing, and often have a major socioeconomic impact. Their management can be difficult and may sometimes require input from specialist nurse teams and surgery.

Swelling is a common problem, which can be caused by venous reflux and also from the body trying to reduce damage caused by high pressure in the veins. Sometimes there is clear evidence of ankle swelling at the end of the day, and usually quite a lot of swelling is required before it becomes obvious to the patient. At worst, this swelling can cause boots and other footwear to become uncomfortable to wear. Often the problem is related to swelling in one leg as a result of the varicose veins, but mild ankle swelling can be a sign of heart failure or kidney disease and should be investigated.

Varicose veins are a very common condition, and men are affected almost as frequently as women. The progression of venous disease is slow and insidious. It is not unusual for the condition to become advanced before symptoms are significant enough to cause concern and seek medical attention. Symptoms usually affect the legs and can cause a variety of problems, which can be helped by the treatment that we offer. Treatment has a better chance of being successful if it is undertaken in the earlier stages of venous disease. This can prevent further problems such as leg ulcers from occurring. Early treatment often delays the progression of the condition, obviating the need for more invasive treatments at a later stage.

Risk Factors for Varicose Veins in Men

Risk factors for varicose veins in men have shown some variance, but the basic considerations are generally accepted. Factors related to increased time standing, including occupation and personal habits, have been associated with the development of varicose veins. In a study, over 85% of men diagnosed with varicose veins had occupations that required long periods of standing and/or heavy lifting. This is compared to the general male population, in which only 1/3 have venous reflux issues. Other activities associated with increased time standing, such as regular heavy lifting and gardening, have also been associated with the development of varicose veins. This is believed to be due to increased pressure within the abdomen, which is then transmitted down the veins in our legs. This pressure makes it more difficult for blood in the leg veins to return to the heart. When this happens, the pressure in the leg veins abnormally increases, and the body compensates by dilating the size of the veins in an effort to reduce this pressure. Over time, the veins will stay dilated and become varicose veins.

Addressing Gender-Specific Risks

A simple analogy helps to explain the cause of varicose veins and the difference between normal veins and varicose veins. Veins are like a set of postboxes with valves situated at each end. If you imagine filling one of the postboxes with blood, the valve at the bottom will close, preventing the blood from leaking out. This is what happens when you are contracting the calf muscle so the blood in the postbox (vein) does not fall back down the leg. If the vein becomes varicose, the valves are broken, whereby the impulse to close the valve is not followed through correctly. This causes the blood to leak back down the leg and the greater the extent of valve damage, the more severe the varicose veins will become.

Varicose veins are a common problem in both men and women. In the past, many men with varicose veins have been overlooked or undertreated because the condition has been considered to be more common in women. In fact, it is important for men with varicose veins to seek medical advice as they have more severe symptoms on average than women. Healing rate after varicose vein surgery is also slower in men than women. This slower healing may be attributable to the fact that the men treated in the SFJ trial had skin changes for longer on average than the women in the trial.

Prevention and Lifestyle Changes

The lifestyle and preventive measures that can be taken are the same for men as for women. Sun avoidance and use of a broad-spectrum sunscreen is advisable for all fair-skinned individuals, especially those who are at risk for skin cancer. Although it is true that more women than men use tanning beds, such behavior is known to be harmful to the skin and should be discouraged for both sexes. Smoking cessation is important for prevention because of the link between smoking and the development of the aged yellow-grey complexion and premature skin aging. The effects of smoking on the skin often provide a powerful incentive for smokers to quit. Any life changes that decrease mobility, such as bed rest or inactivity due to occupation or choice, should be discouraged, as the propensity for thrombosis increases in less mobile individuals. Obesity aggravates venous disease and increases the risk of developing chronic venous insufficiency. This being the case, weight loss is an important measure to prevent chronic varicose veins from developing. Regular moderate exercise is beneficial for the maintenance of good venous tone and can help to prevent the onset of venous disease. Unfortunately, high-impact activities such as weight lifting and certain competitive sports can exacerbate venous disease while causing trauma to the vein wall and high intra-abdominal pressure. This can lead to increased transmission of central venous pressure to the lower extremities, thus causing reflux. Individuals with a strong family history of venous disease, who have one or more of the other risk factors, can probably help themselves to avoid venous disease by using medically graded graduated compression hosiery, although there are no actual studies showing that such prophylactic treatment is effective. Because graduated compression is known to prevent swelling it is likely to be more effective as a preventive measure in those with an associated risk factor.

Treatment Options for Varicose Veins in Men

Sclerotherapy is a technique where a liquid is injected into the veins, causing them to close up. The liquid is a detergent and makes the vein lining sticky. Over a period of days, the vein turns into scar tissue and fades away. This is an attempt to repair the damaged vein, to break the cycle of high pressure and reflux that causes vein dilation. Lymphatic capillary channels then drain the blood that was in the varicose vein out of the leg. This technique is most commonly used for small varicose veins and is also used for thread veins. High-dose sclerotherapy, using the detergent in foam form and ultrasound guidance, is also a technique used for treating major venous reflux in the saphenous and other large leg veins. Sclerotherapy is effective if performed properly, although a skilled doctor can greatly improve results. The main factors affecting success are accurate needle placement, the use of the right strength of detergent, with the right degree of vein dilution, and avoiding the leakage of sclerosant into undesired areas.

Support stockings are the first approach to treatment. They improve symptoms and prevent the condition from getting worse. These are tight elastic stockings that squeeze the veins and stop excess blood from flowing backwards. They are useful for alleviating symptoms in the short term, although many patients find them unsatisfactory because they are difficult and uncomfortable to use, and they can be hot and hard to put on.

Treatment for varicose veins in men is similar to that for women, although there are some considerations specific to men. Varicose veins are not just a cosmetic issue, and many of the men who seek treatment do so for relief of symptoms. The available treatments range from those that can be done in the doctor’s office to those requiring hospitalization.

Importance of Seeking Medical Advice

At present, there is no data to show that men seek medical advice for vein problems less often than women. However, with women comprising the majority of patients with varicose veins, the impression is that men are much less likely to come forward. This is a concern because a consensus conference on chronic venous disease held in 1995 noted that many people with CVI are treated too late for effective management of their skin damage. At the latest stages of severe CVI (active or healed ulcer), treatment is aimed at preventing recurrence of the ulcer and even here rates of ulcer recurrence within two years of treatment have been quoted as over 50%. Through effective management at early stages of skin damage, recurrence of ulcers can be virtually eliminated.

Although previous research has shown that women are more likely to seek medical advice, the reasons behind this are not well understood. Considering the seriousness of health problems associated with varicose veins, such as swelling of the ankles and lower leg, brown pigmentation of the skin near the ankles, inflammation of the vein or bleeding, and the relatively equal rates between the sexes on many vein problems, it is important for men as well as women to seek advice from a healthcare professional. This is especially urgent when changes in the pattern of the veins or skin ulcers near the ankles or on the lower leg are noted.

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