Why Varicose Veins Develop: How the Disease Works in Plain Language

When patients come to see me at M-Clinic, they often say: 「Doctor, I just have tired legs — that's not varicose veins, is it?」 Or, on the contrary: 「My veins are visible — does that mean it's already advanced?」 In reality, between these two extremes lies an entire mechanism that develops gradually, sometimes over years. Let's examine it honestly and without unnecessary alarm.

How Blood Travels Upward — and Why That's No Easy Task

The heart pumps blood downward through the arteries with ease: gravity helps. But the veins have a harder job — they must return blood to the heart against the force of gravity. To accomplish this, nature devised two mechanisms:

1. 1Venous valves — thin folds inside the vein that act like one-way valves: they allow blood to pass upward and then close, preventing it from falling back down.
2. 2The calf muscle-venous pump — when we walk, the calf muscles contract and literally 「squeeze」 blood upward through the veins, like a pump.

Under normal conditions, this system works in harmony. But if the valves weaken, blood begins to flow not only upward but also downward — a phenomenon known as reflux (from the Latin *refluxus* — backflow).

What Is Reflux and Why It Damages Veins

Reflux is the key concept in phlebology. It is precisely what we look for on vein duplex ultrasound when a patient presents with complaints of heaviness, swelling, or visible veins.

Imagine: a valve has stopped closing tightly. With each step, blood partially flows back down, and pressure inside the vein builds. The vein wall stretches — and over time it deforms: first it becomes tortuous, then it dilates, forming nodules. This is varicose dilation.

It is important to understand: varicose veins are a consequence, not a cause. The cause is dysfunction of the valvular apparatus and chronic venous pressure.

The longer reflux continues, the more veins become involved in the process. This is why the disease progresses if left untreated.

Risk Factors: Why Some People Are Affected and Others Are Not

Varicose veins are a multifactorial condition. No single factor 「guarantees」 disease on its own, but their combination substantially increases the risk.

Heredity

This is the most significant factor. If your mother or father had varicose veins, your own likelihood of developing them increases approximately 2–3 times. What is inherited is not the varicose veins themselves, but rather the structural characteristics of the venous wall and valves — their elasticity and ability to withstand pressure.

Pregnancy

During pregnancy, pressure on the pelvic veins rises sharply — the growing uterus compresses the major venous trunks. In addition, the hormone progesterone relaxes vessel walls. For this reason, many women notice their first symptoms during this period. After delivery, some changes may regress, though this does not always occur.

Lifestyle and Occupation

• Jobs that require prolonged standing (surgeons, teachers, salespeople, hairdressers) — the muscle pump is nearly inactive, and blood 「pools.」
• Sedentary work — the effect is similar: the calf muscles remain still, and venous outflow is impaired.
• Excess weight — increases intra-abdominal pressure and the load on the leg veins.
• Heat and hot baths — cause venous dilation, placing greater strain on the valves.

Hormonal Factors

Estrogens influence venous wall tone. This is why varicose veins are more common in women than in men, and why hormonal contraceptives or hormone therapy may accelerate the development of the disease in those who are predisposed.

Why the Disease Progresses

Many people think: 「Let's wait — it will go away on its own.」 Unfortunately, varicose veins are a chronic condition with a tendency to progress. Here is why:

• A dilated vein loses tone → the valves gap even further → reflux intensifies → additional veins become involved.
• Chronic pressure impairs the nutrition of the skin and subcutaneous tissue → swelling, leg heaviness, and pigmentation develop.
• In advanced cases — trophic changes and ulcers.

This does not mean there is cause for panic. It does mean that seeking medical attention early makes it possible to manage the condition with minimal intervention and halt its progression.

If, against a background of varicose veins, you notice sudden redness, hardening, and pain along the course of a vein, or swelling and pain in the calf without an obvious cause — seek medical attention within the next few hours: these may be signs of thrombosis.

How to Recognise That You Have Varicose Veins

Symptoms of varicose veins are not always obvious in the early stages. Most commonly, patients describe:

• heaviness and fatigue in the legs by evening;
• ankle swelling that resolves after a night's sleep;
• nocturnal calf cramps;
• visibly dilated veins or spider veins;
• itching or burning along the course of veins.

It is difficult to diagnose oneself — similar symptoms can be caused by other conditions. An accurate picture is provided only by vein duplex ultrasound: it makes it possible to visualise reflux, assess the condition of the valves, and determine the appropriate course of action.

What to Do Next

If you recognise yourself in the symptoms described, or simply want to make sure everything is in order — do not delay a visit to a phlebologist. The earlier the problem is identified, the broader the choice of varicose vein treatment methods — from compression and sclerotherapy to minimally invasive procedures without incisions.

I see patients at M-Clinic (Tashkent). If getting there is difficult, a home visit for an initial examination and consultation is available. Appointments can be made by phone at +998 99 883-93-21 or through the website phlebo.uz. Come in — we will work it out together, calmly and without unnecessary procedures.

This article is for informational purposes only and does not replace a consultation with a qualified physician. If you are experiencing symptoms, please see a specialist.