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Venous Insufficiency: Causes, Symptoms, Treatment

Venous insufficiency is a chronic condition that affects how blood flows through the veins, particularly in the lower limbs. When the veins fail to efficiently return blood back to the heart, it can lead to a range of symptoms from minor discomfort to more serious complications. While often under-recognised, chronic venous insufficiency is common, especially in adults over the age of 50.

Understanding this condition can help you identify symptoms early, seek appropriate care, and prevent long-term damage.

What Is Venous Insufficiency?

Venous insufficiency occurs when the valves in the veins become weakened or damaged. These valves are designed to keep blood flowing in one direction toward the heart. When they malfunction, blood begins to pool in the legs, leading to increased venous pressure, swelling, and visible vein changes.

The condition can range from mild forms, like spider veins or varicose veins, to more severe complications such as venous ulcers and skin discolouration.

How the Venous System Works

The body’s venous system carries deoxygenated blood from various parts of the body back to the heart. In the legs, veins must work against gravity. They rely on one-way valves and muscle contractions (especially in the calves) to move blood upwards. When the valves stop working properly, blood leaks backward and accumulates in the lower legs. This is known as venous reflux or venous insufficiency.

Common Causes of Venous Insufficiency

Several factors can contribute to the development of venous insufficiency, including:

  • Genetics: A family history of varicose veins or vein disorders increases your risk.
  • Ageing: As we age, vein walls and valves naturally weaken.
  • Gender: Women are more likely to develop venous insufficiency, especially during pregnancy or menopause due to hormonal changes.
  • Obesity: Excess weight places added pressure on leg veins.
  • Prolonged Standing or Sitting: Occupations that involve long periods of standing or sitting can impair blood flow.
  • Deep Vein Thrombosis (DVT): Blood clots can damage vein valves, leading to post-thrombotic syndrome and chronic venous insufficiency.
  • Lack of Exercise: A sedentary lifestyle limits the calf muscle pump that assists venous return.

Signs and Symptoms

The symptoms of venous insufficiency can vary based on severity and how long the condition has been present. Common signs include:

  • Swelling in the lower legs or ankles
  • A feeling of heaviness, tiredness, or aching in the legs
  • Cramping or throbbing, especially after standing for long periods
  • Itching or burning around the affected veins
  • Visible varicose or spider veins
  • Skin changes such as dryness, redness, or a brownish discolouration
  • Thickening or hardening of the skin (lipodermatosclerosis)
  • Venous ulcers, typically around the ankles

When to See a Doctor

Many people dismiss leg swelling or varicose veins as purely cosmetic, but venous insufficiency can lead to progressive and irreversible changes if not addressed. You should seek medical evaluation if you experience:

  • Persistent leg swelling or discomfort
  • Skin changes or non-healing wounds
  • A sudden increase in varicose veins
  • Discomfort that interferes with daily activities

Diagnosis of Venous Insufficiency

To confirm a diagnosis, your doctor may begin with a physical examination and detailed medical history. Diagnostic tests may include:

  • Duplex ultrasound: This is the most common test to assess blood flow and check for valve dysfunction or blood clots.
  • Venous Doppler: Measures the direction and speed of blood flow.
  • Photoplethysmography (PPG) or air plethysmography: Measures venous pressure and reflux in the legs.

Treatment Options

Venous insufficiency is a manageable condition, and treatment is typically focused on relieving symptoms, improving circulation, and preventing complications. Options include:

Conservative Treatments

  • Compression stockings: These help reduce swelling, improve circulation, and relieve discomfort. They are often the first line of treatment.
  • Leg elevation: Raising the legs above heart level for 15–20 minutes several times a day helps reduce pooling.
  • Exercise: Walking or low-impact activities strengthen calf muscles, aiding venous return.
  • Weight management: Maintaining a healthy weight reduces pressure on veins.
  • Medications: Venoactive drugs may help reduce symptoms such as swelling and discomfort.

Minimally Invasive Procedures

If conservative treatments are not effective, your doctor may recommend:

  • Sclerotherapy: A chemical solution is injected into affected veins to close them off. Used primarily for smaller veins.
  • Endovenous laser ablation (EVLA) or radiofrequency ablation (RFA): Heat is used to seal off larger veins, typically done under local anaesthesia with minimal downtime.
  • Foam sclerotherapy: A foamed agent is injected to treat larger or deeper veins.

Surgical Treatments

In more advanced cases, particularly with venous ulcers or severely damaged veins, surgery may be considered:

  • Vein ligation and stripping: Removing or tying off the affected vein. This is less commonly performed today due to advances in minimally invasive methods.

Potential Complications

If left untreated, chronic venous insufficiency can lead to:

  • Venous ulcers, especially near the ankles
  • Skin infections (cellulitis)
  • Bleeding from superficial veins
  • Blood clots or deep vein thrombosis (DVT)
  • Poor wound healing and long-term skin changes

Proactive treatment and monitoring can help prevent these outcomes.

Prevention Tips

While some risk factors cannot be avoided, many lifestyle habits can help lower your risk or slow progression:

  • Take regular breaks from sitting or standing to stretch and walk
  • Wear compression socks if you work long hours on your feet
  • Stay active with regular walking or exercise
  • Avoid tight clothing around the legs
  • Elevate your legs when resting
  • Maintain a balanced diet and healthy body weight

These steps support healthy circulation and can delay the onset of symptoms.

Conclusion

Venous insufficiency is a common and often progressive condition that can impact your comfort, mobility, and skin health. If you're experiencing persistent leg swelling, discomfort, or visible vein changes, consult a vascular specialist at The Vascular & General Surgery Centre.

Hernia surgeon in Singapore Dr Sujit Singh Gill
meet our specialist Dr Sujit Singh Gill

Consultant Vascular & General Surgeon
MBBS (Singapore), MMed (Singapore), FRCS (Edinburgh)

Hernia surgeon Dr Sujit Singh Gill

A skilled vascular and general surgeon in Singapore with 25 years of experience, Dr Sujit Singh Gill’s main interests include the minimally invasive treatment of venous, arterial and diabetes-related vascular disorders. His expertise in general surgery also allows him to treat various colorectal, gastrointestinal and hepatobiliary conditions with good patient outcomes. Having trained in Singapore, Australia and the United Kingdom, Dr Sujit Singh Gill’s diverse background also helps put his patients at ease.

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The Vascular & General Surgery Centre
Unit 18-05, Paragon Medical Suites, 290 Orchard Road, Singapore 238859
Tel: +65 6736 2302 Fax: +65 6736 4186 Whatsapp : +65 8866 7837 Email: enquiry@tvgsc.sg
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