Understanding Venous Reflux Disease: Causes, Symptoms, and Treatment

Venous reflux disease, also known as chronic venous insufficiency, is a common condition affecting the leg veins.

The terms venous reflux and venous insufficiency are often used interchangeably. This chronic condition causes several painful symptoms and can lead to a variety of undesirable and challenging health complications, including pain, cramping, varicose veins, spider veins, swelling, or heaviness in the legs. 

Let’s take a look at exactly what venous reflux disease is, some of the common causes and symptoms of this condition, including what you can do to manage it — or even prevent it — through your everyday lifestyle. 

What is Venous Reflux and What Causes It?

Venous reflux is a condition that occurs when the walls of the veins in the legs slowly weaken and enlarge in size. One-way valves that are present in the veins then fail, allowing the blood to pool in the legs instead of being pumped back to the heart. As a result, blood flow becomes turbulent and eventually backs up and can even flow in reverse.

As venous reflux progresses, it leads to venous insufficiency, whereby the veins are unable to maintain sufficient blood flow to keep up with the flow of blood coming into them.

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Common Symptoms of Venous Reflux Disease

Venous reflux makes blood flow sluggish and inefficient, causing blood pressure to build up in the veins. Symptoms of chronic venous reflux disease are usually brought on by the blood pooling in the legs.  

These include:

• Swelling: Elevated blood pressure in the veins of the lower legs causes fluid to leak out of the veins into surrounding tissues, causing swelling.
• Dull, Aching Pain: As pressure accumulates in the legs from the swelling it causes the legs to ache.
• Heavy Sensations: Feelings of heaviness can also occur due to swelling and pressure.
• Cramping: As venous blood flows out of the legs slows, the ability of the veins to receive fresh, oxygenated blood diminishes. As a result, the leg muscles may cramp due to poor oxygenation.

If left untreated, as venous reflux disease progresses, advanced signs and symptoms may appear, including:^[1]

• Varicose Veins: Varicose veins are swollen, discolored, distended, or twisted veins just beneath the skin’s surface, often appearing bluish. Be aware of varicose vein stages and perform regular skin checks.
• Discoloration of the Skin: Along with leakage of fluids from the veins, increased venous blood pressure can push red blood cells out of the veins. As the cells die, they release hemosiderin (iron) which deposits in the skin surface, leading to a dark, bluish-to-reddish-brown appearance. This usually appears around the ankles.
• Venous Ulcers: These are open sores on the skin that occur from continued fluid build-up and pressure in the legs, which weakens and erodes the skin. Venous ulcers often occur around the ankles. They are slow to heal and, even with diligent treatment, can take up to 11 months to fully mend. 

Risk Factors for Venous Reflux Disease

While increased venous blood pressure is the direct cause of venous reflux disease, there are other underlying factors that contribute to elevated venous blood pressure. Some of the most significant risk factors include the following^[5]:

• Family History of Varicose Veins: Some of the strongest genetic links that increase the risk for venous reflux have to do with genes involved with regulating blood pressure and genes involved in the development of your vascular system^[6]. You may also inherit weak valves. Vein valves are made of a protein called collagen. The characteristics of collagen vary slightly from person to person, with some people producing more flexible collagen while others produce a version that is relatively stiffer. If you are in the latter group, your valves may be more susceptible to wear and tear and may be more easily damaged.
• Being Overweight: Obesity is associated with chronic low-grade inflammation, which damages blood vessel linings, leading to further impaired blood flow^[7]. Additionally, if you are obese and have venous reflux disease, you are more likely to experience venous ulcers^[7].
• Being Pregnant: Pregnancy contributes greatly to the increased risk of venous reflux in women. There are several factors unique to pregnancy that are responsible for this increased risk:
  • Hormones released during pregnancy, particularly progesterone, make the veins more expandable, and this places stress on veins and makes it more difficult to move blood back to the heart^[8].
  • The increased blood volume in pregnancy places added physical stress on blood vessels^[8].
  • As the baby grows, the increased weight within the mother’s pelvis compresses pelvic veins, increasing blood pressure in the leg veins^[8].
  • Estrogen and progesterone receptors in the large veins of the legs are thought to contribute to the dilation of the veins and impaired function of the vein valves^[8].
• Lack of Exercise: There are many important health benefits to be gained by exercising regularly, and several of them directly or indirectly improve the health of your veins and decrease your risk of developing venous reflux disease. Exercise improves blood flow in your veins, and exercises that use your leg muscles are especially helpful in promoting strength and circulation in the legs. Strong leg muscles promote healthy venous circulation by gently massaging the veins, which helps push blood through them. Also, regular exercise helps you maintain a healthy weight, which can reduce your risk for venous reflux disease by preventing high blood pressure.
• Smoking: Smoking significantly increases the risk of venous reflux disease. Smoking damages blood vessels, reduces blood oxygen levels, and promotes inflammation. While both male and female smokers are at risk, one study reported a difference in symptoms between men and women, with swelling being more common in female smokers, while skin changes were reported to occur more frequently in male smokers^[9].
• Prolonged Standing or Sitting: Both standing and sitting impair the return of blood flow to the heart. Standing in place hinders blood flow in the legs because the veins must overcome the effects of gravity without the benefit of the muscular pump of the calf muscles, relying only on the valves, which can be faulty. One study found that venous insufficiency among medical operating room personnel and laundry workers, occupations that require a lot of standing with little walking, was as high as 76%^[10]. Sitting for long periods of time, in addition to the effects of gravity, also places the hips in a flexed position, which can further impede blood flow, even more so if clothing is tight or binding.
• Age: As you age, the connective tissues in your veins become weaker, and your body’s ability to produce collagen and elastin, the proteins that form these connective tissues decreases, leading to poorer quality structural proteins. As a result, your blood vessels become stiffer and less able to accommodate normal fluctuations in blood flow. Age is also tied to gender in terms of its effect on risk for venous reflux disease, with women experiencing a greater increase in risk as well as more symptoms if they develop venous insufficiency as they age compared to men^[11]. Past the age of 65, women have been found to have an 83% chance of developing venous insufficiency, about 28% greater likelihood than men of the same age range^[11].

How Is Venous Reflux Disease Diagnosed?

Venous reflux disease is diagnosed using ultrasound imaging, a painless, non-invasive procedure. An ultrasound can determine the speed of blood flow and the diameter of the blood vessels, showing precisely where the blood flow in your legs is reduced, turbulent, or blocked. 

An ultrasound imaging study, combined with a thorough health history and physical examination, helps your doctor arrive at an accurate diagnosis and choose the best course of treatment for your individual needs.

Preventive Measures for Venous Reflux Disease

The best way to prevent venous reflux disease from developing is to incorporate habits that focus on improving circulation and reducing the strain on your veins. In addition to aging and genetics, some of the most common venous reflux disease causes are lifestyle-related. 

Here are some everyday things you can do to help lower the odds of venous reflux disease: 

• Maintain a healthy weight: Carrying excess weight puts additional pressure on your legs, veins, and overall circulation. If you think losing weight could benefit your veins and overall health, consider how you can make improvements to your nutrition and exercise routine or speak to your healthcare provider for guidance.
• Get regular physical activity: Exercise is an important tool for supporting our overall physical and mental well-being, but it’s also key for improving circulation and venous health. Prioritize movements that engage your leg muscles, like walking, swimming, playing tennis, or dancing, to support your circulation and help keep your blood pressure within normal levels.
• Elevate your legs: Throughout the day, try to elevate your legs periodically. This helps reduce venous pressure and improve your blood circulation. It might be helpful to set an alarm to remind you to put your feet up every hour, for example. 
• Wear compression stockings: Wearing a good pair of compression stockings (socks) is one of the best ways to keep blood from pooling in your legs and offer support for healthy blood flow. These can be especially helpful when you’re sitting for longer periods than usual, like on a road trip or flying on a plane. A good place to start is to find stockings with a compression of 20–30 mm Hg.^[3][4]
• Avoid sitting or standing too long: When your legs are in these positions for too long, you’re more likely to experience blood pooling and pain. Try to move around and stretch your muscles every so often. For example, if you have a desk job, it’s a good habit to get up and walk around at least once every hour to get your blood flowing. It’s also best to avoid sitting with one leg crossed over the other, as this can disrupt blood flow. 
• Avoid tight-fitting clothing: If your clothing is too tight, this can restrict blood flow. Instead, opt for looser-fitting pants that don’t squeeze your thighs, calves, ankles, or waist. 
• Avoid high-heeled shoes: High heels promote vein-related issues because of how they hold your foot and ankle and put pressure on your leg muscles. Consider choosing shoes that allow your feet to stay in a more comfortable position, like sneakers or flats with a supportive arch. 

Managing Symptoms at Home

It’s important to do things at home to help manage your everyday venous reflux disease symptoms. This involves prioritizing practices that improve your blood flow and keep circulation-related issues to a minimum. Many of these will also help prevent the development of venous reflux disease among higher-risk individuals. 

If you experience painful and uncomfortable vein-related symptoms at home, try these tips to support healthy circulation: 

• Wear compression stockings to apply gentle pressure to your legs, reduce swelling, and improve blood flow.
• Take time for low-impact exercise each day, such as swimming, riding your bike, or doing aerobics at the gym.
• Move your legs throughout the day, especially if you tend to sit or stand for long periods.
• Elevate your legs above your heart every so often using a pillow or chair.
• Do some light stretching to engage your leg muscles and support healthy blood flow.
• Stay hydrated.
• Eat plenty of fiber-rich foods (fruits, vegetables, whole grains, nuts, seeds, and legumes) to help prevent constipation.
• Practice good skin hygiene, including skin checks, regular washing, and moisturizing, to help prevent flaking and cracks that could become infected.

Effective Treatments for Venous Reflux Disease

If conservative management is not working or improving your symptoms, Empire Vein and Vascular Specialists offers the most up-to-date, office-based, nonsurgical venous reflux disease treatment options. These procedures can eliminate problem veins and the symptoms that go along with them. 

The best treatment option for you depends on your symptoms and what your ultrasound reveals. The two most effective choices for treating venous reflux disease are VenaSeal™ and ClosureFast™:

• VenaSeal™ uses a medical-grade adhesive to treat the affected vein(s) and redirect the flow of blood to healthy veins. VenaSeal™ takes just 20 minutes, and you will be able to walk out of the office after your procedure. Empire Vein and Vascular Specialists is the #1 provider of VenaSeal™ in the U.S.
• ClosureFast™ uses radiofrequency energy to seal off affected veins. It results in less pain and bruising and faster recovery time compared to laser therapy. Recovery is rapid, you should be able to resume normal activities within five days.^[2]

Why Choose Empire Vein and Vascular Specialists for Treatment

Empire Vein and Vascular Specialists is the top provider of VenaSeal™, the leading outpatient vein treatment in the USA. All our physicians are board-certified and specialize in helping people with venous reflux disease. Empire Vein and Vascular Specialists serve the greater Inland Empire area with three convenient clinic locations, including Inland Empire, Riverside, San Bernardino, Moreno Valley, and surrounding areas of California, each fully equipped with state-of-the-art technology. 

Our Victorville clinic is open to serve the residents in the area. From your initial phone call to follow-up care and beyond, our friendly and helpful staff will answer any questions you may have and provide you and your family members with unparalleled vascular health services. Most of our treatments are covered by insurance, so we work with your insurance to ensure coverage. Helping you keep healthy veins is our priority. 

To schedule a free consultation, please call 1-800-VARICOSE today.

References

1. Ortega MA, Fraile-Martínez O, García-Montero C, et al. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med. 2021;10(15):3239. Published 2021 Jul 22. doi:10.3390/jcm10153239
2. Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res. 2019;96(6):313-318. doi:10.4174/astr.2019.96.6.313
3. Attaran RR, Carr JG. Chronic Venous Disease of the Lower Extremities: A State-of-the Art Review. J Soc Cardiovasc Angiogr Interv. 2022;2(1):100538. Published 2022 Nov 26. doi:10.1016/j.jscai.2022.100538
4. McArdle M, Hernandez-Vila EA. Management of Chronic Venous Disease. Tex Heart Inst J. 2017;44(5):347-349. Published 2017 Oct 1. doi:10.14503/THIJ-17-6357
5. Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2024 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430975/
6. Fukaya E, Flores AM, Lindholm D, et al. Clinical and Genetic Determinants of Varicose Veins. Circulation. 2018;138(25):2869-2880. doi:10.1161/CIRCULATIONAHA.118.035584
7. Davies HO, Popplewell M, Singhal R, Smith N, Bradbury AW. Obesity and lower limb venous disease – The epidemic of phlebesity. Phlebology. 2017;32(4):227-233. doi:10.1177/0268355516649333
8. Smyth RM, Aflaifel N, Bamigboye AA. Interventions for varicose veins and leg oedema in pregnancy. Cochrane Database Syst Rev. 2015;2015(10):CD001066. Published 2015 Oct 19. doi:10.1002/14651858.CD001066.pub3
9. Gourgou S, Dedieu F, Sancho-Garnier H. Lower limb venous insufficiency and tobacco smoking: a case-control study. Am J Epidemiol. 2002;155(11):1007-1015. doi:10.1093/aje/155.11.1007
10. Jawien A. The influence of environmental factors in chronic venous insufficiency. Angiology. 2003;54 Suppl 1:S19-S31. doi:10.1177/0003319703054001S04
11. Vuylsteke ME, Colman R, Thomis S, Guillaume G, Degrande E, Staelens I. The influence of age and gender on venous symptomatology. An epidemiological survey in Belgium and Luxembourg. Phlebology. 2016;31(5):325-333. doi:10.1177/0268355515589224