Garth Rattray | No need to suffer in vein

April is being observed as Venous Month. One of the most common and troubling vascular diseases involves our veins. Veins carry blood back to our heart. As a rule, they transport deoxygenated blood. The only exception is the pulmonary vein (which carries oxygen-rich blood from your lungs to your heart). The most common vein problems are associated with varicose veins in the lower limbs, and haemorrhoidal veins (also called ‘piles’) in the rectum and/or protruding from the anus. Both conditions are considered as “chronic venous diseases”.

To explain varicose veins, I use a fish tank as an analogy when explaining how the veins in our lower limbs work. The pressure of the water on the sides of the glass near the bottom of a tall fish tank would break it open, unless the glass is very thick. Blood is much heavier than water, and the walls of our veins are relatively thin, so you can imagine the pressure placed on the walls of the veins in our lower limbs whenever we are seated or standing. Nature prepares us for this by using a system that employs a pumping action from the muscles of our legs, together with a system of valves that prevent back-flow of blood down our legs.

Whenever members of uniformed groups stand perfectly still for extended periods of time, their leg muscles do not assist in pumping blood back up to their heart, and they may experience ‘parade ground syncope’ (fainting). Veteran members of uniformed groups flex and extend their toes in their boots to activate the calf muscle pump and prevent fainting.

MALFUNCTION OF VALVES

Generally, when our lower limb venous system fails, due to malfunction of valves or blockage of the veins because of old thrombosis (blood clots), the pressure is increased, especially in the superficial veins. This not only leads to the development of varicosities, but also to oedema (collection of fluid), poor skin nutrition, resulting in damage to the cutaneous and subcutaneous tissues, with the possibility of eventual leg [trophic] ulcer formation, commonly around the ankle areas. The condition is colloquially called ‘sore foot’, which is chronic, very debilitating, embarrassing, expensive and time-consuming to treat.

People with varicose veins mightr therefore experience aching, heaviness, burning, discomfort, throbbing, spider-looking veins, bulging veins, swollen legs and/or feet, itchy skin, discolouration, fibrosis / coarsening of the skin at the ankles, and/or muscle cramps (especially at nights). More serious problems are ulcers, clots, or bleeding. Examination and imaging (especially Doppler ultrasound) complete the diagnosis.

Approximately 23 per cent of adults have varicose veins. If you include the more minor forms like spider telangiectasis and reticular veins, that figure rises to just over 80 per cent! Varicose veins are more common in women and older adults. Risk factors for developing varicose veins include age, female gender, long periods of standing or sitting, smoking, excess weight, pregnancy, family history, deep-vein thrombosis, being tall, and some congenital syndromes.

Interestingly, although horses and cows are quadrupeds (walk on all four limbs), they can also be affected by varicose veins. However, horses and cows do not get the complications of varicose veins because the skin on their legs does not stretch, so their leg veins are constantly being compressed.

Varicose vein disease is relentless and chronic; treatment must be initiated early because varicose veins will worsen over time. Non-pharmaceutical treatment of varicose veins includes regular exercise, leg elevation, weight control, cessation of smoking and, importantly, the consistent use of properly fitted elastic stockings for external compression. Pharmaceutical treatment is also considered helpful. It consists of oral medications that enhance the tone of veins by blocking the action of chemical messengers that cause inflammation /swelling of the veins.

SPECIALIST INTERVENTION

Specialist intervention includes local ablative therapies, like sclerotherapy, thermocoagulation, and cutaneous laser. Other modalities are endovenous ablative therapies (with radiofrequency or laser), and various types of surgery… if indicated. Thankfully, most procedures are either non-invasive or minimally invasive, and are available from surgeons and vascular specialists in Jamaica.

Haemorrhoids (piles) are vascular tissues at the end of the rectum. They are part of the haemorrhoidal plexus of veins and form vascular cushions and, along with the anal sphincter muscles, help to control bowel movements. They can be present without causing symptoms or behave like varicose veins and may become complicated by bleeding, prolapse (bulging through the anus), or by thrombosis. It is essential to note that, since bleeding from the rectum can have far more sinister (serious) causes, it must be properly investigated by a physician. No one should assume that rectal bleeding is simply due to ‘piles’.

The incidence of hemorrhoids increases with age, over 50 per cent of adults have haemorrhoids. Straining during bowel movements, sitting too long on the toilet, excess weight, pregnancy, low-fibre diet, and constipation can predispose to haemorrhoids. Haemorrhoids may be prevented or controlled by mitigating lifestyle modifications – increased fluid and fibre intake, physical activity, weight control, avoid straining, and avoid sitting on the toilet for long.

Medical interventions include the same oral medication used for varicose veins, and/or suppositories or creams. Surgical intervention includes – sclerotherapy, electrocoagulation or infrared coagulation, rubber band ligation, removal of large, external haemorrhoids, or haemorrhoid stapling.

If you are experiencing problems with varicose veins and/or haemorrhoids, seek medical help. The complications may be preventable and, if complications already occur, they are amenable to medical intervention. There is no need to suffer in vein.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com