A Varicose veins usually develop in the legs. When the valves in the veins do not function properly, the blood pools in the veins, especially when standing for long periods, resulting in these swollen veins. Apart from being cosmetically unsightly, they can be painful - causing throbbing or cramping - and may cause itching or a burning sensation on the skin.

The goal of any treatment for varicose veins is to improve blood flow to the heart. The usual medical line is that the only alternative is surgery, in which the physician ‘strips’ out the offending vein and creates a tiny circulation bypass in place of the vein. However, there are a huge number of disadvantages:

* Surgery for varicose veins is neither curative nor preventative. Even early surgery of uncomplicated veins will not prevent the development of future varicosities (J R Coll Surg Edinburgh, 2001; 46: 154-8)

* Varicose veins recur in 10 per cent of those who have had them surgically stripped, in 10 per cent of those who have had radiofrequency ablation (using heat to seal off the vein), in 6 per cent of those who have had them removed by lasers and in up to 50 per cent of those who have undergone sclerotherapy (injecting an irritant solution into the vein, causing it to scar over and eventually become absorbed by the surrounding tissues (Healthwatch, CBS News, 22 January 2003)

* The surgery itself has risks, including blood clots, haematomas, nerve injury and, with sclerotherapy, an obstructed blood flow or leaking of the irritant solution into surrounding tissues

* A greater risk of deep vein thrombosis (DVT), but only if you are having major abdominal or pelvic surgery (BMJ, 1996; 312: 198).

Thankfully, there is a host of alternative measures that can help prevent or treat varicose veins without the need for surgery, including:

* all the simple measures that work the legs and avoid blood-pooling - elevating the legs while sitting; avoiding tight clothing around the ankle, calves and groin; avoiding high heels, which don’t work the calf muscles as much as low heels do; avoiding standing or crossing your legs for long periods of time; and losing weight if you are overweight

* walking, cycling and rowing - all of which cause the leg muscles to contract and push blood back to the heart. Best of all is swimming, as the water pressure helps drive the blood back to the heart. Also, being horizontal while you swim allows the veins to empty

* all the simple measures that work the legs and avoid blood-pooling - elevating the legs while sitting; avoiding tight clothing around the ankle, calves and groin; avoiding high heels, which don’t work the calf muscles as much as low heels do; avoiding standing or crossing your legs for long periods of time; and losing weight if you are overweight

* walking, cycling and rowing - all of which cause the leg muscles to contract and push blood back to the heart. Best of all is swimming, as the water pressure helps drive the blood back to the heart. Also, being horizontal while you swim allows the veins to empty

* a judicious use of compression therapy, usually support hosiery - preferably the pantyhose-type of stockings - to control symptoms, although some people may find wearing such tight garments rather uncomfortable (BMJ, 2002; 324; 689-90).

The best alternative treatments include:

* bilberry as supplements or even the fruit itself. These reduce the fragility of the blood vessels and, added to the daily diet of pregnant women, can prevent and treat varicose veins (Minerva Ginecol, 1981; 33: 221-30). These fruit are also antiangiogenic - they can reduce the growth of blood vessels that may lead to varicose veins and tumours (Biochemistry [Mosc], 2004; 69: 75-80). Take 80-160 mg three times a day (standardised to contain 25 per cent anthocyanidins)

* bioflavonoids, which have a long history of success for varicose veins. This includes rutin, found in citrus fruit, orange/yellow vegetables, buckwheat or as supplements (Am J Ophthalmol, 1948; 31: 671-8), and hesperidin (suggested therapeutic dose ranges are 50-500 mg/ day; for citrus: 500-5000 mg/day)

* pennywort (gotu kola, Centella asiatica) can reduce swelling and other symptoms of heaviness in the lower legs (Angiology, 1987; 38: 46-50), and significantly improve itching, swelling and night cramps (Clin Ther, 1981; 99: 507-13). For varicose veins, studies have used 30-60 mg twice a day

* red-vine-leaf extract (Folia vitis viniferae; grape leaf), reduced lower leg volume and calf circumference in patients with chronic venous insufficiency (Arzneim Forsch, 2000; 50: 109-17). The usual dose is 360-720 mg/day

* bromelain, the proteolytic enzyme in pineapples, can also be taken as a supplement. It can also help prevent the hardening and lumpiness of the tissues around the varicosities as it promotes fibrin breakdown. Take 500-750 mg two to three times a day

* butcher’s broom, which has a long history of use in countries around the Mediterranean for varicose veins and associated ulcers (Drugs Exp Clin Res, 1988, 14: 277-83). The herb can improve venous tone and poor circulation (Fortschr Med, 1989; 107: 52, 55-8). Take 100 mg three times a day (extract standardised for 9-11 per cent ruscogenin)

* oligomeric proanthocyanidins, or OPCs, are derived from pine bark and grape seed. These antioxidant free-radical scavengers can inhibit enzymes that damage connective tissue and vessel walls (Gaz Med France, 1985; 92: 96-100), and increase venous tone in varicose-vein sufferers (Sem Hop, 1981; 57: 2009- 13). Take 150-300 mg/day

* horse chestnut seed extract (Aesculus hippocastanum) is approved by the German government for venous diseases of the legs. This herb can ease both varicose veins and haemorrhoids, another form of varicosity, especially the swelling. It strengthens blood vessel walls and, as an astringent, can also tone and tighten tissues (Arzneim Forsch, 1979; 29: 672-5). For the best results, take it as early in the condition as possible (BMC Cardiovasc Disord, 2001, 1: 5). Take the equivalent of 50 mg/day of aescin (standardised)

* witch hazel in the form of an ointment is recommended by the German Commission E for varicose veins. Note, however, that the ointment may need to be applied three or more times a day for several weeks before there is any noticeable improvement

* pine bark extract (Pinus maritima) is at least as effective as horse chestnut seed extract for varicose veins. Those taking it have reported both symptomatic relief and a reduction in leg swelling (Phytother Res, 2002; 16 [Suppl 1]: S1-S5). Take 75-300 mg/day for three weeks, then 40-80 mg/day for maintenance

* dietary factors for varicose veins include a high-fibre diet and bulking agents to reduce straining during defaecation. Drinking at least six 8-oz cups of water a day will also help

* nutrients such as aortic glycosaminoglycans (100 mg/day), vitamin C (500-3000 mg/day), vitamin E (200-600 IU/ day) and zinc (15-30 mg/day) are also beneficial