You are at the pharmacy counter talking to Karina Begum, a teacher at the local secondary school, who you estimate to be in her early 50s.

"I haven't mentioned this to anyone, but I've been having trouble with my legs for quite some time now," she says.

"They are so sore at the end of the day that my ankles get horribly swollen, and I sometimes get cramps during the night.

"I haven't told my husband or children because they will only worry, and I've started wearing trousers almost all the time so they can't see how bad my legs look. But I'm starting to think that it might be more than just tired legs. Would you mind taking a look?"

You usher Mrs Begum into the consultation room and invite her to sit down. She rolls up her trouser leg and you immediately see the problem: the vein on the back of her calf is dark purple and bulging. After careful investigation and questioning to rule out a DVT, you suspect she has varicose veins.

What causes varicose veins?

Varicose veins are caused by failure of the valves inside the veins of the legs, leading to blood flowing backwards and pooling. The condition affects up to 30 per cent of the adult population, with women more likely to suffer than men.  

What do you suggest to Mrs Begum?

Mrs Begum should seek medical advice as the condition is causing her discomfort and distress. Her GP may refer her for tests such as an ultrasound or Doppler scan to establish whether any deeper leg veins are affected.

To relieve the swelling, Mrs Begum should be fitted for compression hosiery. Class 1 or 2 below knee stockings are usually sufficient. She should try to avoid standing for long periods of time, though her job as a teacher may make this tricky, and to elevate the legs when possible to ease discomfort. Regular exercise and maintaining a healthy bodyweight can improve circulation and help prevent the condition worsening.

Although varicose veins can be unsightly, complications – such as skin changes, venous leg ulcers and thrombophlebitis – are unusual. Any of these may warrant surgical removal (usually a technique called ligation and stripping), sclerotherapy to seal the affected veins, radiofrequency ablation or laser treatment . Not all of these techniques are available on the NHS.

For more information: ● Patient information is available at www.nhs.uk/conditions/varicose-veins/pages/treatment.aspx ● Nice is currently developing guidance on the diagnosis and management of varicose veins, which is due to be published in July 2013. More information is available at http://guidance.nice.org.uk/CG/Wave24/11

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