Leg swelling often caused by vein problems
By Howard LeWine, M.D.
Q: I recently saw my doctor because my ankles and lower legs swell. She says I have venous insufficiency. What does that mean? Is it serious?
A: Venous insufficiency means that the veins don’t work properly. Most people develop this condition in their legs. The veins are responsible for draining blood and fluid back to the heart. So people with venous insufficiency usually have symptoms caused by the buildup of fluid in their legs. These symptoms can include:
-Swollen or painful varicose veins.
-Swelling (edema) of the foot, ankle or calf. This swelling may get worse if you stand for long periods of time. And it usually improves when you lie down or raise the legs. Swelling may also get worse during a woman’s menstrual cycle.
-A sense of heaviness.
-Throbbing, achy or crampy pain.
-Redness and irritation of the skin. Over time, the skin may get thicker or become darker in color.
-In very severe cases, skin in the lower legs becomes so stretched that skin ulcers form or the skin may actually ooze fluid.
Venous insufficiency is very common. Women are affected more than men. The condition is more common as people age or become overweight. In many people, it develops after the veins have been damaged by an injury, surgery or a blood clot.
The treatment of venous insufficiency depends on why it has developed, where it develops, and the symptoms it causes:
-In mild cases, simply elevating the legs appears to help.
-Support stockings help to reduce swelling and discomfort. You can buy these at a medical supply store. Custom fit stockings are also available with a prescription from your doctor.
-A diuretic (water pill) such as hydrochlorothiazide or furosemide will control some of the fluid buildup.
-Mild steroid creams such as hydrocortisone cream can reduce redness and irritation of the skin.
-Skin ulcers often need careful attention. Special bandages help speed the healing process. Antibiotics are prescribed if the ulcers become infected.
(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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