These symptoms are the signs of venous insufficiency, which may or may not be accompanied by varicose veins or thread veins.
In order to alleviate the symptoms and prevent complications, you should:

• Fight against the pooling of blood in the legs by easing the blood flow returning to the heart
• Avoid anything that can enlarge the veins

WHAT YOU SHOULD DO:

• Exercise regularly and practise a sport if possible
• Relieve your legs: rest with legs elevated and raise the foot of the bed
  
• Wear elastic stockings or compression hosiery with strength adapted to the importance of your varicose veins and amount of pain
• Correct your plantar arches if your feet are flat or too arched
  
• Use extra fatty soaps, since dry skin is conducive to skin lesions
  
• Use venotonic creams and cool your legs by sprinkling cold water on them. The cold improves the tone of your veins.
  

WHAT YOU SHOULD AVOID:

• Avoid sources of heat: baths, saunas, floor heating, prolonged exposure to the sun
  
• Avoid excessive weight gains: limit the consumption of sugar and fat
• Avoid constipation by eating balanced meals rich in fibres
  
• Avoid wearing shoes with heels too high or too low
  
• Avoid physical inactivity and standing still
  
• Avoid wounds and traumas, the scarring process can be slowed down by circulatory problems
  
• Avoid tight-fitting clothes or clothes constricting calves or thighs
  

If your symptoms persist, see your doctor or angiologist. There are drugs that could help you.

YOU HAVE VARICOSE VEINS AND/OR THREAD VEINS

It is a more advanced stage of venous insufficiencies of the lower extremities. A clinical and ultrasound evaluation are needed.

• The vast majority of varicose veins are due to a simple venous insufficiency without identifiable cause. Some varicose veins can be caused by anomalies in the deep venous system. These anomalies must be detected and identified.
  
• Thread veins are usually benign and only cause cosmetic problems. Their evaluation sometimes leads to the detection of more important varicose veins deep underneath which are invisible to the naked eye and are behind the small superficial veins.
  
• After a special clinical exam and a Duplex-scan, a precise evaluation of your venous insufficiency will be made, its cause found and a treatment offered with or, most likely, without surgery.
  

YOUR LEGS ARE SWOLLEN (OEDEMAS)

Oedemas of the lower extremities are a clinical sign of venous insufficiency but, be careful, not all oedemas are linked to superficial circulatory problems.

Typically, oedemas linked to superficial circulatory problems have, in their initial stage, the following characteristics: they are

• Developing progressively
  
• Moderate and bilateral
  
• More pronounced at the end of the day, worsening when standing or exposed to heat, improving when the legs rest flat
  
• Usually found in the ankles, rarely in the calves
  
• Not very painful but often accompanied by a feeling of heaviness in the legs, cramps or restlessness
  
• Not accompanied with noticeable redness of the skin
  
• Not accompanied with any other symptoms such as general weakness, breathlessness, temperature...

If you have this type of oedema, a superficial venous origin is likely but if the symptoms persist or the appearance of your oedema is different, contact your doctor or your angiologist: there are also oedemas with thrombotic, cardiac, hepatic or renal causes.

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YOU ARE PREGNANT

Il It is important to watch your legs carefully during pregnancy.

The influence of estrogens produced during pregnancy and certain mechanical constraints upset the phlebo-lymphatic circulation of the body and especially the lower limbs.

Depending on the shape of your legs before you became pregnant, the number of previous pregnancies and the stage of the current pregnancy, this can lead to:

Swelling of the extremities

• Feeling of heaviness in the legs
  
• Thread veins
  
• Varicose veins in the legs, vulvar varicose veins, haemorrhoids
  
• Rupture of varicose veins and haemorrhages
  
• Superficial and deep venous thromboses.

It is therefore important to:

• Wear appropriate elastic support from the start of the pregnancy (force 1, then 2)
  
• Follow usual measures of good venous health (see above)
  
• Exercise daily
  
• Watch your weight and eat a healthy diet
  
• Rest with legs elevated during the day
  
• Massage the legs with lotions, creams or venotonic gels.

You should know that:

• Some varicose veins will regress spontaneously after you give birth and during the following weeks, but this process could be delayed by prolonged breast feeding or by hormonal treatments
  
• Sclerotherapy or surgery are useless during pregnancy
  
• Drugs can be useful if there is pain or if oedemas persist despite elastic support
  
• You should wait at least three months after giving birth before undergoing a new evaluation of your venous system
  

YOU ARE ON BIRTH CONTROL OR HORMONE REPLACEMENT THERAPY

This treatment has been prescribed by a doctor. It is therefore necessary. It is very important to let your doctor know about any personal or family history of deep or superficial venous thrombosis.

Any hormonal treatment can lead to, or exacerbate in vulnerable patients venous insufficiency symptoms such as leg heaviness, itching, restlessness, oedemas, thread veins.
If this is the case, you should talk to your doctor. The prescription of a venotonic treatment or light elastic support is often enough to solve the problem.

In rare cases, a hormonal treatment needs to be stopped for purely circulatory reasons. A change of medication may be necessary.

YOU ARE GOING TO TAKE A PLANE

Apart from leg pains and oedemas, the major risk for air travellers is the formation of blood clots (phlebitis) in the legs. For a long time that risk has been ignored by doctors, airlines, and the media. There is a lot of talk about it currently, maybe too much since the risk of a serious problem is low, and almost inexistent if one follows a few simple rules.

In which situations does the risk increase?

• The flight lasts more than 12 hours
  
• You take hormones
  
• You have a known clotting disorder
  
• You have had problems with phlebitis before or you have a family history of problems

Which precautions should you take?

• Move around when the aisles are free, twice during the night
  
• Donπt cross your legs
  
• Drink one litre of water per 6 hours of flying time
  
• Avoid alcohol
  
• Avoid sleeping pills
  
• From time to time, squeeze the calf muscles (by swinging the foot from tip to heel) or roll a bottle of water under the plant of your feet
  
• Wear loose-fitting clothes
  
• Wear elastic compression stockings

Should I consult my doctor before leaving?
Yes, if the risk is important, in particular if you have already had serious phlebitis or if you have had a phlebitis after taking a plane. A preventive treatment may sometimes be necessary.

YOU ARE SUFFERING FROM HAEMORRHOIDS

Haemorrhoids are enlargements of artero-venous clusters located inside the anal canal or around its opening. In order to alleviate haemorrhoids, you should:

Watch your diet

• Avoid spices such as pepper, mustard, harissa
  
• Cut your consumption of stimulants: tea or coffee
  
• Reduce the consumption of alcoholic drinks and drink a lot of water during and between meals
  
• Eat with moderation
  
• Favour food rich in fibres: green vegetables raw or cooked, dry fruits (apricots, figs), cereals (whole bread, all-bran bread)

Regularise the intestinal transit

• Avoid constipation by following the diet described above
  
• If constipated, use mild laxatives
  
• Avoid overly loose stools
  
• Move your bowels once a day, if possible at a regular time
  
• Avoid physical inactivity
  
• Be active and practise a sport regularly. Some sports such as biking, motorcycling, horse riding should be practised in moderation.
  

IF YOU ARE MODERATELY BOTHERED:
Venotonic drugs, along with anti-haemorrhoidal ointments, are often useful in relieving pain.

IF YOU HAVE A PAINFUL, ACUTE HAEMORRHOIDAL ATTACK:
You could have a thrombosis, that is a blood clot inside the haemorrhoid. In that case, pain killers and anti-inflammatory drugs are necessary, along with an eventual removal of the blood clot through a small incision done by your doctor under local anesthesia.

IF YOU ARE HAEMORRHAGING:
A clinical exam and additional tests are necessary to rule out another possible cause for the bleeding.

IF YOU ARE MODERATELY BOTHERED:
Venotonic drugs, along with anti-haemorrhoidal ointments, are often useful in relieving pain.

IF YOU HAVE A PAINFUL, ACUTE HAEMORRHOIDAL ATTACK:
You could have a thrombosis, that is a blood clot inside the haemorrhoid. In that case, pain killers and anti-inflammatory drugs are necessary, along with an eventual removal of the blood clot through a small incision done by your doctor under local anesthesia.

YOU HAVE A LEG ULCER

Leg ulcers often have a deep and/or superficial venous cause; they are then generally found on the external side of the ankle. There may be other causes such as arteritis of the lower limbs, or some genetic or infectious blood disorders. These causes are more unusual. In those cases, ulcers can be found anywhere on the leg.
Healing is slow whatever their causes.

A clinical exam and a Duplex-scan are always required to determine the cause of a leg ulcer, choose the treatment and avoid a relapse, which happens frequently.


Leg ulcers often have a deep and/or superficial venous cause; they are then generally found on the external side of the ankle. There may be other causes such as arteritis of the lower limbs, or some genetic or infectious blood disorders. These causes are more unusual. In those cases, ulcers can be found anywhere on the leg.
Healing is slow whatever their causes.

A clinical exam and a Duplex-scan are always required to determine the cause of a leg ulcer, choose the treatment and avoid a relapse, which happens frequently.

TREATING ULCERS AND AVOIDING COMPLICATIONS

• Protect the leg from blows that could worsen the situation
  
• Protect the leg from infections which slow down the scarring process, are painful and can even increase its size. If the ulcer and its surrounding area are red, oozing and painful, it may be necessary to take antibiotics.
  
• Treat the pain: if there is no infection, regular analgesics work well. An anaesthetic ointment can be applied before the ulcer is cleaned.
  
• Make sure you are immunized against tetanus (especially in the countryside). Ulcers are an open source of infections.
  
• Avoid swollen feet, ankles, legs. Oedemas slow down the scarring process. Relieve your legs by raising them regularly throughout the day. At night, raise the foot of your bed with blocks. Avoid prolonged standing or sitting as well as heat exposure.
  
• Wear elastic bandages or stockings. Compression support is not recommended if you have a serious arteritis of the lower limbs. Its advantage is to avoid swelling of the leg and to tighten the whole leg in order to speed up the blood flow and prevent the pooling of blood in the varicose veins. It also protects the leg from external traumas.
  
• Walk regularly, alternately tighten and relax your muscles to improve circulation
  
• Avoid trying to treat your ulcer on your own. A nurse will be better able to clean it and disinfect it, which will speed up cicatrisation
  

AVOIDING RELAPSES

Venous ulcers often recur when their cause is not treated. Once cicatrisation is reached, it is therefore important to treat the varicose vein either by wearing for life an efficient elastic bandage, or by undergoing sclerotherapy (injection of a sclerosing product that shrinks the vein), or surgery if the varicose veins are too large.

In any case, a Duplex-scan is necessary to determine the best treatment.

YOU HAVE HAD A PHLEBITIS

A blood clot has obstructed one or several superficial or deep veins; a Duplex-scan is necessary to confirm the diagnosis, direct the evaluation and adapt the treatment.

THE PHLEBITIS IS SUPERFICIAL

You have significant varicose veins:
The removal of the blood clot may be necessary if the thrombosis is widespread. This removal requires a small incision on the varicose vein. In the majority of cases, an anticoagulant treatment is not necessary.

You have few or no varicose veins:
An anticoagulant treatment may be necessary as well as a full clinical and blood evaluation. It is always abnormal to develop a superficial venous thrombosis without the presence of visible varicose veins.

In all cases:

• One should apply topical anti-inflammatory ointments
  
• An elastic support should be worn (bands, stockings, compression hosiery)
  
• Strict bed rest is not advised (if the Duplex-scan has ruled out a deep phlebitis).
  

THE PHLEBITIS IS DEEP:

An anticoagulant treatment (to thin the blood) is required. The role of the anticoagulant treatment is to dissolve the blood clot obstructing the venous network, to prevent if from spreading or breaking down and entering the general circulatory system, which would lead to a pulmonary embolism. This treatment must generally be followed for three to six months.

What should be done:

• Wear compression hosiery, with good strength, force 2, 3 or 4
  
• Follow your anticoagulant treatment as prescribed by your doctor, without skipping a day
  
• follow all the steps of your anticoagulant treatment (see ≥anticoagulant treatment≤)
  
• walk regularly as soon as you get permission
  
• avoid violent sports and trauma
  
• get in touch quickly with your doctor if pain comes back in the leg or in case of abnormal breathlessness or chest pains
  
  

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