When to worry about varicose veins: the short answer
Most people with varicose veins never have a serious problem. But a few signs mean it is time to stop waiting and get your legs checked, and one set of signs means you should get urgent help. This page sets out which is which. If you need the basics first, our varicose veins overview covers what the condition is.
In the sections below, the signs are grouped by how quickly they need attention.
Call 995 or go to the emergency department
These may be signs of a deep vein thrombosis (DVT), which is a clot in a deep vein, or of a clot travelling to the lungs (pulmonary embolism):
- Sudden pain, swelling, warmth or redness in one leg
- Sudden breathlessness
- Chest pain, especially sharp pain that is worse when you breathe in
- Coughing up blood
- Feeling faint or collapsing
A DVT is not the same thing as a varicose vein, and varicose veins on their own do not mean you have one. But a swollen, painful leg should never be dismissed as “just my veins”. Do not massage the leg, and do not wait to see whether it settles.
Also call 995 if a bleeding vein will not stop after 10 minutes of firm pressure with the leg raised.
See a doctor soon (days, not weeks)
Arrange an appointment promptly if you notice:
- A hard, red, tender cord along a vein. This can be superficial thrombophlebitis, a clot in a surface vein. It often settles, but it needs examining because it can occasionally extend into the deeper veins.
- Bleeding from a varicose vein, even if it stopped. Veins that have bled once may bleed again.
- A sore on the lower leg, especially near the ankle, that has not improved in a couple of weeks. This may be a venous ulcer.
- Skin that is red, hot, swollen and spreading, particularly with fever, which can mean infection (cellulitis).
- Sudden new swelling in either leg, even without pain.
See a doctor to arrange a routine check
These changes suggest the veins are under more strain and are worth assessing even if nothing hurts:
- Brown or purple staining of the skin around the ankle
- Dry, itchy, eczema-like skin on the lower leg that keeps returning
- Hard, tight, shiny skin above the ankle
- Swelling that is there most days
- Veins that are getting bigger or more numerous
- Leg symptoms that disturb sleep, work or exercise
Doctors grade these changes as stages of chronic venous disease, which our guide to varicose veins stages explains. Skin changes in particular are the signal guidelines take most seriously, and NICE CG168 recommends referral to a vascular service for people with skin changes, venous ulcers or troublesome symptoms.
Are varicose veins dangerous?
On their own, most varicose veins are not dangerous. They are a visible sign of venous reflux, where faulty valves let blood flow backwards. The concern is not the vein you can see, but what long-standing high pressure can do over time. In some people it leads to:
- Persistent swelling
- Skin damage and eczema
- Leg ulcers that are slow to heal
- Bleeding from thin-walled surface veins
- Clots in surface veins
Many people never develop any of these, and there is no reliable way to predict who will. That uncertainty is why symptoms, skin changes and ulcers are treated as reasons to look more closely, not as inevitable outcomes. A duplex ultrasound shows how severe the reflux is and what, if anything, is needed.
Do varicose veins hurt?
Sometimes. The pain people describe is usually an ache or heaviness, sometimes throbbing, burning, tingling or cramping, that:
- Builds up through the day
- Is worse after long periods of standing or sitting
- Is worse in warm weather, which includes most of the year in Singapore
- Eases with walking, raising the legs or removing tight clothing
Plenty of people have large, obvious veins and no discomfort at all.
Should varicose veins be painful?
No. Pain is not required, and the size of the vein does not tell you how much it will hurt. So the better question is whether the pain you have fits the usual pattern.
Be cautious if the pain:
- Starts suddenly or is severe
- Affects one leg only, with swelling or heat
- Comes with redness, fever or a hard tender lump
- Wakes you at night or does not ease when you raise the leg
- Does not match where the veins are
Leg pain has many other causes, including nerve problems, arthritis, muscle strain and artery disease, and these need different treatment. This is one reason to get a proper assessment rather than assume veins are to blame.
Varicose vein pain: what helps in the meantime
While you arrange to be seen, simple measures can ease aching veins:
- Walk regularly and avoid standing or sitting still for long periods
- Raise your legs above hip level when resting
- Consider graduated compression stockings, which a pharmacist or doctor can fit
- Keep a healthy weight
More on these is in our guide to preventing and easing varicose veins. Compression is generally unsuitable if you have poor arterial circulation, so check before starting.
Lifestyle measures help symptoms but do not repair damaged valves. If symptoms continue, varicose vein treatments compared sets out the options.
Worried by something you have heard?
Many fears about varicose veins, and many reasons for putting off a check, come from common misunderstandings. Our guide to varicose vein myths fact-checks the most common ones.
When to see a doctor
In short: see a doctor if your veins ache most days, if your skin around the ankle is changing, if a vein has bled, if a leg sore is slow to heal, or if a vein is hard, red and tender.
For emergency signs, call 995 straight away: sudden swelling, pain, warmth or redness in one leg, especially with breathlessness, chest pain or coughing up blood.
If you would like help choosing who to see, read about finding a vein specialist or try the two-minute vein symptom check. Unfamiliar terms are explained in the glossary.
This article is general information, not personal medical advice. It cannot tell you whether your own leg is safe. If in doubt, get it checked.
Frequently asked questions
When should I worry about varicose veins?
Worry less about how the veins look and more about what they are doing. See a doctor for skin changes around the ankle, a sore that is slow to heal, bleeding, a hard red tender vein, or symptoms that affect sleep or daily life. Call 995 for sudden one-leg swelling with breathlessness or chest pain.
Are varicose veins dangerous?
Usually not in themselves, but they reflect venous reflux, which can progress in some people and lead to swelling, skin damage and ulcers. Bleeding and clots in surface veins can also occur. A scan shows which category you fall into.
Do varicose veins hurt?
Some do and some do not. Aching, throbbing, burning and heaviness are common, especially after standing, and ease with walking or raising the legs. Many people with large veins have no pain at all.
Should varicose veins be painful?
They do not have to be, and size does not predict pain. Pain that is sudden, severe, on one side only, or comes with redness, heat or swelling should not be assumed to be "just varicose veins" and needs assessment.
Can a varicose vein burst?
A vein close to the skin can bleed if it is knocked or scratched, sometimes heavily. Lie down, raise the leg and press firmly on the spot with a clean cloth, and seek medical care. If bleeding will not stop, call 995.
Sources and further reading
This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.
