• Fifty percent of middle-aged adults are affected. • Subcutaneous veins of legs are most commonly affected because of gravitational pressure that standing exerts on veins. Sanding for long periods increases pressure up to 10 times. Occupations requiring long periods of standing are greatest risk for varicose veins. • Women are affected four times as often as men. Obesity greatly increases risk. Risk increases with age because of the loss of tissue tone and muscle mass, weakening vein walls. Pregnancy increases risk by increasing venous pressure in legs. • Pose little harm if involved vein is near surface, but they are cosmetically unappealing. Significant symptoms are uncommon, but legs may feel heavy, tight, and tired. • If varicose veins are associated with chronic venous insufficiency, leg ulcers may form that are often difficult to resolve. • Serious varicosities involve obstruction and valve defects of deeper veins of the leg. This can lead to thrombophlebitis, pulmonary embolism, myocardial infarction, and stroke. Phlebography and Doppler ultrasonography are the most accurate methods of diagnosing deep vein involvement. • Genetic weakness of veins or venous valves. • Excess venous pressure from increase in straining during defecation because of a low-fiber diet. • Long periods of standing and/or heavy lifting. • Damage to veins or venous valves as a result of thrombo-phlebitis. • Weakness of vascular walls from abnormalities in proteoglycans of interendothelial cement substance or excessive release of lysosomal enzymes, which break down ground substance, in-creasing capillary permeability and loss of integrity of the venous structure. • Fiber: varicose veins are rarely seen in parts of world with high-fiber, unrefined diets. A low-fiber diet contributes to the development of varicose veins because of the need to strain more during bowel movements (smaller, harder stools are more difficult to pass). Straining increases abdominal pressure, obstructing return of blood through the legs. Long-term increased pressure may weaken the vein wall, causing varicosities or hemorrhoids, or may weaken wall of large intestine, producing diverticuli. A high-fiber diet is the most important treatment and preventive measure for varicose veins (and hemorrhoids). • Bulking agents: psyllium seed, pectin, and guar gum have a mild laxative action. They attract water and form a gelatinous mass, keeping feces soft, promoting peristalsis, and reducing straining during defecation.
Varicose Veins
GENERAL DISCUSSION
Etiology
THERAPEUTIC CONSIDERATIONS
Dietary Factors
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