Showing posts with label Treatment. Show all posts
Showing posts with label Treatment. Show all posts

Whiplash - Treatment


Treatment-Whiplash




Whiplash will often get better on its own or after some simple treatment in a few weeks or months.
But sometimes it can cause severe and troublesome symptoms that last a long time.
The main treatments for whiplash are outlined below.

Keep your neck mobile

It's important not to rest your neck for prolonged periods if you have whiplash.
Your neck may be painful at first, but keeping it mobile will improve its movement and speed up your recovery. Any pain you experience when moving your neck is normal and won't cause further damage.
It's best to try to carry on with your normal activities and not use a neck brace or collar. Try to avoid staying in the same position, such as sitting or lying down, for long periods.
Doing some controlled neck exercises may also help reduce stiffness. Read an NHS leaflet on whiplash (PDF, 259kb) for some simple exercises you can try.

Self-care advice

The following measures can also help reduce your pain and aid your recovery:
  • Ice packs – for the first few days, holding an ice pack (a bag of frozen peas wrapped in a towel will also work) to your neck for up to 10 minutes several times a day may help reduce pain and swelling.
  • Warm compress – after a few days, holding a warm hot water bottle to your neck for up 15 minutes several times a day may be better at soothing your pain.
  • Good posture – always maintain a good, upright posture by keeping your back straight while sitting, standing and walking. If you spend a lot of time using a computer, adjust your chair and computer screen correctly.
  • Supportive pillow – some people find a firm, supportive pillow helps when sleeping. Avoid using more than one pillow and don't sleep on your front.

Painkillers

Painkillers can help relieve the pain of a whiplash injury.
Over-the-counter painkillers are usually recommended first, such as paracetamol or ibuprofen. These should be used regularly rather than only when the pain is most severe.
Always read the leaflet that comes with your medication to check whether it's suitable for you. For example, ibuprofen shouldn't be taken by anyone with a history of stomach ulcers.
If one of these medicines doesn't relieve your pain, you can try taking both together. Read more about taking paracetamol and ibuprofen together.
If your neck pain is more severe, your GP can recommend a stronger painkiller, such as codeine. This can be used on its own or in combination with other painkillers.

Physiotherapy

Physiotherapy may be recommended if your symptoms continue for several weeks.
A physiotherapist may use a range of physical techniques to help improve your symptoms, such as:
  • neck exercises
  • massage
  • gentle manipulation of your neck
You may be able to get a referral for NHS physiotherapy through your GP, or you can choose to pay for private treatment.
Read more about accessing physiotherapy.

Long-term whiplash

Whiplash that lasts for six months or more is known as chronic whiplash or late whiplash syndrome.
There's little in the way of scientific evidence to suggest which treatments are most effective for long-term whiplash. Continuing with the treatments above is often recommended.
If you have long-term pain, ask your GP about a referral to a specialist NHS pain clinic for further treatment and support.
If you're struggling to cope with your symptoms, talk to your GP about medication and psychological support – such as cognitive behavioural therapy (CBT) – that may help.
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Vulval cancer - Treatment


Treatment-Vulval cancer




Treatment for vulval cancer depends on factors such as how far the cancer has spread, your general health, and personal wishes.
The main options are surgery, radiotherapy and chemotherapy. Many women with vulval cancer have a combination of these treatments.
If your cancer is at an early stage, it's often possible to get rid of it completely. However, this may not be possible if the cancer has spread.
Even after successful treatment, there is a chance the cancer will return at some point later on, so you'll need regular follow-up appointments to check for this.

Your treatment plan

Most hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT will probably include a specialist surgeon, a specialist in the non-surgical treatment of cancer (clinical oncologist) and a specialist cancer nurse.
Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Surgery to remove vulval cancer

In most cases, your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer.
There are three surgical options to treat vulval cancer:
  • radical wide local excision – the cancerous tissue from your vulva is removed, as a well as a margin of healthy tissue, usually at least 1cm wide, as a precaution
  • radical partial vulvectomy – a larger section of your vulva is removed, such as one or both of the labia, and possibly the clitoris
  • radical vulvectomy – the whole vulva is removed, including the inner and outer labia, and possibly the clitoris
The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For extensive operations, such as a pelvic exenteration (see below), it may be many weeks or months before you start to feel better.
You surgeon will talk to you about the possible risks associated with the type of procedure you're having. Possible risks include infection, bleeding, blood clots, altered sensation in your vulva, and problems having sex.

Assessing and removing groin lymph nodes

An additional operation may also be required to assess whether the cancerous cells have spread into one or more lymph nodes in your groin, and remove these if they're found to contain cancer. This may involve one or more of the procedures outlined below.

Sentinel node biopsy

If the cancer has spread to nearby lymph nodes, it's sometimes possible to only remove certain lymph nodes, known as sentinel nodes.
Sentinel nodes are identified by injecting a dye at the site of the tumour and studying its flow to locate the nodes closest to the tumour. These are then removed and checked for cancerous cells.

Groin lymphadenectomy

In some cases, some or all of the nodes in your groin may need to be surgically removed. This is called a groin or inguinofemoral lymphadenectomy. Further treatment with radiotherapy may also be recommended.
Removing cancerous lymph nodes reduces the risk of the cancer returning, but it can make you more vulnerable to infection and cause swelling in your legs from a build-up of lymphatic fluid (lymphoedema).

Pelvic exenteration

In cases of advanced vulval cancer or where the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel. This is a major operation and isn't carried out very often these days.
If a section of your bowel is removed, it will be necessary for your surgeon to divert your bowel through an opening made in your tummy (a stoma). Stools then pass along this piece of bowel and into a bag you wear over the stoma. This is known as a colostomy.
If your bladder is removed, urine can be passed out of your body into a pouch via a stoma. This is known as a urostomy. Alternatively, it may be possible to create a new bladder by removing a section of your bowel and using it to create a pouch to store urine in.

Reconstructive surgery

If only a small amount of tissue has been removed during surgery, the skin of the vulva can often be neatly stitched together.
Otherwise, it may be necessary to reconstruct the vulva using a skin graft, where a piece of skin is taken from your thigh or tummy and moved to the wound in your vulva. Another option is to have a skin flap, where an area of skin near the vulva is used to create a flap and cover the wound.
These reconstructive procedures are usually carried out at the same time as the operation to remove the cancer.

Radiotherapy

Radiotherapy involves using high-energy radiation to destroy cancerous cells. There are several ways it can be used to treat vulval cancer:
  • before surgery to try to shrink a large cancer – this is to help make the operation possible without removing nearby organs
  • after surgery to destroy any cancerous cells that may be left – for example, for cases where cancer cells have spread to the lymph nodes in the groin
  • as an alternative to surgery, if you're not well enough to have an operation
  • to relieve symptoms in cases where a complete cure is not possible – this is known as palliative radiotherapy
In most cases, you'll have external radiotherapy, where a machine directs beams of radiation on to the section of the body that contains the cancer.
This is normally given in daily sessions, 5 days a week, with each session lasting a few minutes. The whole course of treatment will usually last a few weeks.

Side effects

While radiation is effective in killing cancerous cells, it can also damage healthy tissues. This can lead to a number of side effects, such as:
  • sore skin around the vulva area
  • diarrhoea 
  • feeling tired all the time
  • loss of pubic hair, which may be permanent
  • swelling of the vulva
  • narrowing of your vagina, which can make sex difficult
  • inflammation of your bladder (cystitis)
In younger women, external radiotherapy can sometimes trigger an early menopause. This means they will no longer be able to have any children.
Read more about the side effects of radiotherapy.

Chemotherapy

Chemotherapy is where medication is used to kill cancer cells. It's usually given by injection.
It's usually used if vulval cancer comes back or to control symptoms when a cure is not possible. Sometimes it may be combined with radiotherapy.

Side effects

The medicines used in chemotherapy can sometimes damage healthy tissue, as well as the cancerous tissue. Side effects are common and include:
  • tiredness
  • feeling and being sick
  • hair thinning or hair loss
  • sore mouth and mouth ulcers 
  • an increased risk of infections – tell your care team if you develop any symptoms of an infection, and try to avoid close contact with people known to have an infection
These side effects should pass once treatment has finished.
Read more about the side effects of chemotherapy.

Emotional support

The emotional impact of living with vulval cancer can be significant. Many people report experiencing a kind of rollercoaster effect. You may feel down at receiving a diagnosis, feel up when the cancer has been removed from your body, and then feel down again as you try to come to terms with the after-effects of surgery.
Some people experience feelings of depression. If you think you may be depressed, contact your GP or care team for advice. There are a range of treatments that can help.
You may also find it useful to contact one of the main cancer charities, such as:
  • Macmillan Cancer Support – the helpline is available on 0808 808 00 00, Monday to Friday, 9am to 8pm
  • Cancer Research UK – a cancer nurse helpline is available on 0808 800 4040, Monday to Friday, 9am to 5pm
Read more about living with cancer.
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Vitiligo - Treatment


Treatment-Vitiligo




Treatment for vitiligo is based on improving the appearance of the skin by restoring its colour.
However, the effects of treatment aren't usually permanent, and it can't always control the spread of the condition.
Your GP may recommend:
Further treatment may not be necessary if, for example, you only have a small patch of vitiligo or you have very fair skin anyway.
You may be referred to a dermatologist (a specialist in treating skin conditions) if further treatment is needed.

Protection from the sun

Sunburn is a real risk if you have vitiligo. You must protect your skin from the sun and avoid using sunbeds.
When skin is exposed to sunlight, it produces a pigment called melanin to help protect it from ultraviolet light. However, if you have vitiligo there isn't enough melanin in your skin, so it isn't protected.
Always apply a high-factor sunscreen, ideally with a sun protection factor (SPF) of 30 or above, to protect your skin from sunburn and long-term damage. This is particularly important if you have fair skin.
Protecting your skin from the sun will also mean you don't tan as much, which will make your vitiligo less noticeable.

Vitamin D

If your skin isn't exposed to the sun, there's an increased risk of vitamin D deficiency. Vitamin D is essential for keeping bones and teeth healthy.
Sunlight is the main source of vitamin D, although it's also found in some foods, such as oily fish.
It might be difficult to get enough vitamin D from food and sunlight alone. You should therefore consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D.

Skin camouflage

Skin camouflage creams can be applied to the white patches of skin. The creams are specially made to match your natural skin colour. The cream blends in the white patches with the rest of your skin, making them less noticeable.
For advice about skin camouflage, your GP may refer you to the Changing Faces skin camouflage service.
You need to be trained in using the camouflage creams, but the service is free (although donations are welcome) and some creams can be prescribed on the NHS.
Camouflage creams are waterproof and can be applied anywhere on the body. They last for up to four days on the body and 12 to 18 hours on the face.
You can also get skin camouflage cream that contains sun block or has an SPF rating.
Self-tanning lotion (fake tan) may also help cover vitiligo. Some types can last several days before they need to be reapplied. Self-tanning lotion is available from most pharmacies.

Topical corticosteroids

Topical corticosteroids are a type of medication that contain steroids. You apply them to your skin as a cream or ointment.
They can sometimes stop the spread of the white patches and may restore some of your original skin colour.
A topical corticosteroid may be prescribed to adults if:
  • you have non-segmental vitiligo on less than 10% of your body
  • you want further treatment (sun protection advice and camouflage creams are enough for some people) 
  • you aren't pregnant
  • you understand and accept the risk of side effects
Topical corticosteroids can be used on the face, but care should be taken in selecting and using this type of medication on your face.
Read more about topical corticosteroids.

Using topical corticosteroids

Your GP may prescribe a cream or an ointment, depending on what you prefer and where it will be used. Ointments tend to be greasier. Creams are better in your joints – for example, inside your elbows.
Possible corticosteroids that may be prescribed include:
  • fluticasone propionate
  • betamethasone valerate 
  • hydrocortisone butyrate
Your GP will tell you how to apply the cream or ointment to the patches and how much you should use. You normally need to apply the treatment once a day.
Topical corticosteroids are measured in a standard unit called the fingertip unit (FTU). One FTU is the amount of topical steroid squeezed along an adult's fingertip. One FTU is enough to treat an area of skin twice the size of an adult's hand.
Read more about fingertip units.

Follow-up

After one month, you'll have a follow-up appointment so your GP can check how well the treatment is working and whether you have any side effects. If the treatment is causing side effects, you may need to stop using corticosteroids.
After another month or two, your GP will check how much your vitiligo has improved. If there's no improvement, you may be referred to a dermatologist (see below).
If it's improved slightly, you may continue treatment, but have a break from treatment every few weeks. You may also be referred to a dermatologist.
Treatment will be stopped if your vitiligo has improved significantly.
Your GP may take photos of your vitiligo throughout your treatment to monitor any signs of improvement. You may also want to take photos yourself.

Side effects

Side effects of topical corticosteroids include:
  • streaks or lines in your skin (striae)
  • thinning of your skin (atrophy)
  • visible blood vessels appearing (telangiectasia)
  • excess hair growth (hypertrichosis)
  • contact dermatitis (inflammation of your skin)
  • acne

Referral

Your GP may refer you to a dermatologist if:
  • they're unsure about your diagnosis
  • you're pregnant and need treatment 
  • more than 10% of your body is affected by vitiligo 
  • you're distressed about your condition 
  • your face is affected and you want further treatment 
  • you can't use topical corticosteroids because of the risk of side effects
  • you have segmental vitiligo and want further treatment 
  • treatment with topical corticosteroids hasn't worked
Children with vitiligo who need treatment will also be referred to a dermatologist.
In some cases, you may be prescribed strong topical corticosteroids while you're waiting to be seen by a dermatologist.
Some treatments your dermatologist may recommend are described below.

Topical pimecrolimus or tacrolimus

Pimecrolimus and tacrolimus are a type of medicine called calcineurin inhibitors, which are normally used to treat eczema.
Pimecrolimus and tacrolimus are unlicensed for treating vitiligo, but they can be used to help restore skin pigment in adults and children with vitiligo.
They can cause side effects, such as:
  • a burning or painful sensation when applied to the skin
  • making the skin more sensitive to sunlight
  • facial flushing (redness) and skin irritation if you drink alcohol
However, unlike corticosteroids, pimecrolimus and tacrolimus don't cause thinning of the skin.

Phototherapy

Phototherapy (treatment with light) may be used for children or adults if:
  • topical treatments haven't worked 
  • the vitiligo is widespread
  • the vitiligo is having a significant impact on quality of life
Evidence suggests that phototherapy, particularly when combined with other treatments, has a positive effect on vitiligo.
During phototherapy, your skin is exposed to ultraviolet A (UVA) or ultraviolet B (UVB) light from a special lamp. You may first take a medicine called psoralen, which makes your skin more sensitive to the light. Psoralen can be taken by mouth (orally), or it can be added to your bath water.
This type of treatment is sometimes called PUVA (psoralen and UVA light).
Phototherapy may increase the risk of skin cancer because of the extra exposure to UVA rays. The risk of skin cancer is lower with UVB light. Your dermatologist should discuss the risk with you before you decide to have phototherapy.
Sunlamps that you can buy to use at home for light therapy aren't recommended. They're not as effective as the phototherapy you'll receive in hospital. The lamps are also not regulated, so may not be safe. 

Skin grafts

A skin graft is a surgical procedure where healthy skin is removed from an unaffected area of the body and used to cover an area where the skin has been damaged or lost. To treat vitiligo, a skin graft can be used to cover the white patch.
Skin grafts may be considered for adults in areas that are affecting your appearance if:
  • no new white patches have appeared in the last 12 months 
  • the white patches haven't got worse in the last 12 months 
  • your vitiligo wasn't triggered by skin damage, such as severe sunburn (known as the Koebner response)
An alternative to skin grafting involves taking a sample of normal skin, removing the melanocytes from it and then transplanting them onto the areas of vitiligo.
These types of treatments are time-consuming, carry a risk of scarring and aren't suitable for children. They're also not widely available in the UK and aren't funded by the NHS.

Depigmentation

Depigmentation may be recommended for adults who have vitiligo on more than 50% of their bodies, although it may not be widely available.
During depigmentation, a lotion is painted on to the normal skin to bleach away the remaining pigment and make it the same colour as the depigmented (white) skin. A hydroquinone-based medication is used, which has to be applied continuously to prevent the skin from re-pigmenting.
Hydroquinone can cause side effects, such as:
  • redness
  • itching 
  • stinging
Depigmentation is usually permanent and leaves the skin with no protection from the sun. Re-pigmentation (when the colour returns) can occur, and may differ from your original skin colour. Applying depigmenting treatments in one area of skin can sometimes cause loss of pigmentation of skin on other parts of the body.

Other treatments

Your dermatologist may recommend trying more than one treatment, such as phototherapy combined with a topical treatment. Other possible treatments include:
  • excimer lasers – high-energy beams of light that are used in laser eye treatment, but may also be used in phototherapy (not available on the NHS) 
  • vitamin D analogues – such as calcipotriol, which may also be used with phototherapy
  • azathioprine – a medicine that suppresses your immune system (the body's natural defence system)
  • oral prednisolone – a type of corticosteroid, which has also been used with phototherapy; it can cause side effects

Complementary therapies

Some complementary therapies claim to relieve or prevent vitiligo. However, there's no evidence to support their effectiveness, so more research is needed before they can be recommended.
There's very limited evidence that ginkgo biloba, a herbal remedy, may benefit people with non-segmental vitiligo. There's currently not enough evidence to recommend it.
Check with your GP if you decide to use herbal remedies. Some remedies can react unpredictably with other medication or make them less effective.

Counselling and support groups

If you have vitiligo, you may find it helpful to join a vitiligo support group. It can help you understand more about your condition and come to terms with your skin's appearance.
Charities, such as The Vitiligo Society, may be able to put you in touch with local support groups (you may need to become a member first). Your GP may also be able to suggest a local group.
If you have psychosocial symptoms – for example, your condition is causing you distress – your GP may refer you to a psychologist or a counsellor for treatment such as cognitive behavioural therapy (CBT).
CBT is a type of therapy that aims to help you manage your problems by changing the way you think and behave.

Unlicensed medicines

Many treatments used for vitiligo are unlicensed. 'Unlicensed' means the medicine's manufacturer hasn't applied for a licence for it to be used to treat your condition. The medicine hasn't undergone clinical trials to see whether it's effective and safe in treating your condition.
Doctors may recommend using an unlicensed medicine if they think it will be effective, and the benefits of treatment outweigh any associated risk. Before prescribing an unlicensed medicine, they should inform you it's unlicensed, and discuss the possible risks and benefits with you.
Read more about unlicensed medicines.
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Vitamin B12 or folate deficiency anaemia - Treatment

Treatment-Vitamin B12 or folate deficiency anaemia




The treatment for vitamin B12 or folate deficiency anaemia depends on what's causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins.

Treating vitamin B12 deficiency anaemia

Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12.
There are 2 types of vitamin B12 injections:
  • hydroxocobalamin
  • cyanocobalamin
Hydroxocobalamin is usually the recommended option as it stays in the body for longer.
At first, you'll have these injections every other day for 2 weeks or until your symptoms have started improving.
Your GP or nurse will give the injections.
After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet or whether the deficiency is causing any neurological problems, such as problems with thinking, memory and behaviour.
The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which is not related to your diet.

Diet-related

If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals.
Or you may need to have an injection of hydroxocobalamin twice a year.
People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.
Although it's less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.
Good sources of vitamin B12 include:
  • meat
  • salmon and cod
  • milk and other dairy products
  • eggs
If you're a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products.
Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain.

Not diet-related

If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you'll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life.
If you have had neurological symptoms that affect your nervous system, such as numbness or tingling in your hands and feet, caused by a vitamin B12 deficiency, you'll be referred to a haematologist and may need to have injections every 2 months.
Your haematologist will advise on how long you need to keep taking the injections.
For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.
If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every 3 months.
Cyanocobalamin injections are not routinely available on the NHS as hydroxocobalamin is the preferred treatment.
But if you need replacement tablets of vitamin B12, these will usually be in the form of cyanocobalamin.

Treating folate deficiency anaemia

To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels.
They may also give you dietary advice so you can increase your folate intake.
Good sources of folate include:
  • broccoli
  • brussels sprouts
  • asparagus
  • peas
  • chickpeas
  • brown rice
Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life.
Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal.
This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.
If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

Monitoring your condition

To ensure your treatment is working, you may need to have further blood tests.
A blood test is often carried out around 10 to 14 days after starting treatment to assess whether treatment is working.
This is to check your haemoglobin level and the number of the immature red blood cells (reticulocytes) in your blood.
Another blood test may also be carried out after approximately 8 weeks to confirm your treatment has been successful.
If you have been taking folic acid tablets, you may be tested again once the treatment has finished (usually after 4 months).
Most people who have had a vitamin B12 or folate deficiency will not need further monitoring unless their symptoms return or their treatment is ineffective.
If your GP feels it's necessary, you may have to return for an annual blood test to see whether your condition has returned.
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Varicose veins - Treatment

Treatment-Varicose veins




Varicose veins don't always need treatment. If your varicose veins aren't causing you discomfort, you may not need to have treatment.
Treatment of varicose veins is usually necessary:
  • to ease symptoms – if your varicose veins are causing you pain or discomfort
  • to treat complications – such as leg ulcers, swelling or skin discolouration
  • for cosmetic reasons – but this kind of treatment is rarely available on the NHS, so you'll usually have to pay for it to be done privately
If treatment is necessary, your doctor may first recommend up to 6 months of self care at home.
This may involve: 
  • using compression stockings (your blood circulation will first be checked to see if these are suitable for you)
  • exercising regularly
  • avoiding standing up for long periods
  • elevating the affected area when resting
The various treatments for varicose veins are outlined below.

Compression stockings

Compression stockings aren't suitable for everyone. Before these can be recommended for you, you'll need to have a special test called a Doppler investigation to check your blood circulation.
Compression stockings are specially designed to steadily squeeze your legs to improve circulation. They're often tightest at the ankle and get gradually looser as they go further up your leg. This encourages blood to flow upwards towards your heart.
They may help relieve the pain, discomfort and swelling in your legs caused by your varicose veins. But it's not known whether the stockings help prevent your varicose veins getting worse, or if they prevent new varicose veins appearing.
The National Institute for Health and Care Excellence (NICE) only recommends using compression stockings as a long-term treatment for varicose veins if all other treatments aren't suitable for you.
If you're pregnant and have varicose veins, NICE says you may be offered compression stockings for the duration of your pregnancy.
Compression stockings are available in a variety of different sizes and pressures. Most people with varicose veins will be prescribed a class 1 (light compression) or class 2 (medium compression) stocking.
They are also available in:
  • different colours
  • different lengths – some come up to your knee, while others also cover your thigh
  • different foot styles – some cover your whole foot, and some stop before your toes
Compression tights are also available, but not on the NHS. They can be bought from pharmacies or directly from the manufacturers.
You may need to wear compression stockings for the rest of your life if you have deep venous incompetence (blockages or problems with the valves in the deep veins in your legs).
In these circumstances, you'll need to wear compression stockings even if you've had surgery to treat some varicose veins.

Wearing compression stockings

You usually need to put your compression stockings on as soon as you get up in the morning and take them off when you go to bed.
They can be uncomfortable, particularly during hot weather, but it's important to wear your stockings correctly to get the most benefit from them.
Pull them all the way up so the correct level of compression is applied to each part of your leg. Don't let the stocking roll down, or it may dig into your skin in a tight band around your leg.
Speak to your GP if the stockings are uncomfortable or don't seem to fit. It may be possible to get custom-made stockings that will fit you exactly.
If custom-made compression stockings are recommended, your legs will need to be measured in several places to ensure they're the correct size.
If your legs are often swollen, they should be measured in the morning, when any swelling is likely to be minimal.
If compression stockings are causing the skin on your legs to become dry, try applying a moisturising cream (emollient) before you go to bed to keep your skin moist.
You should also keep an eye out for sore marks on your legs, as well as blisters and discolouration.

Caring for compression stockings

Compression stockings usually have to be replaced every 3 to 6 months. If your stockings become damaged, speak to your GP because they may no longer be effective.
You should be prescribed 2 stockings (or 2 sets of stockings if you're wearing 1 on each leg) so that one stocking can be worn while the other is being washed and dried.
Compression stockings should be hand washed in warm water and dried away from direct heat.

Further treatment

If your varicose veins need further treatment or they're causing complications, the type of treatment will depend on your general health and the size, position and severity of your veins.
A vascular specialist (a doctor who specialises in veins) will be able to advise you about the most suitable form of treatment for you.

Endothermal ablation

One of the first treatments offered will usually be endothermal ablation.
This involves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins.
These treatments are described in more detail below.

Radiofrequency ablation

Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy.
The vein is accessed through a small cut made just above or below the knee.
A narrow tube called a catheter is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy.
This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins.
Radiofrequency ablation may be carried out under local anaesthetic (you are awake) or general anaesthetic where you're asleep.
The procedure may cause some short-term side effects, such as pins and needles (paraesthesia).
You may need to wear compression stockings for up to a week after having radiofrequency ablation.

Endovenous laser treatment

As with radiofrequency ablation, endovenous laser treatment involves having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position.
A tiny laser is passed through the catheter and positioned at the top of your varicose vein.
The laser delivers short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled along the vein using the ultrasound scan to guide it, allowing the entire length of the vein to be closed.
Endovenous laser treatment is carried out under either local or general anaesthetic.
After the procedure you may feel some tightness in your legs, and the affected areas may be bruised and painful. Nerve injury is also possible, but it's usually only temporary.

Ultrasound-guided foam sclerotherapy

If endothermal ablation treatment is unsuitable for you, you'll usually be offered a treatment called sclerotherapy instead.
This treatment involves injecting special foam into your veins. The foam scars the veins, which seals them closed.
This type of treatment may not be suitable if you've previously had deep vein thrombosis.
The injection is guided to the vein using an ultrasound scan. It's possible to treat more than one vein in the same session. 
Foam sclerotherapy is usually carried out under local anaesthetic, where a painkilling medication will be used to numb the area being treated.
After sclerotherapy, your varicose veins should begin to fade after a few weeks as stronger veins take over the role of the damaged vein, which is no longer filled with blood.
You may require treatment more than once before the vein fades, and there's a chance the vein may reappear.
Although sclerotherapy has proven to be effective, it's not yet known how effective foam sclerotherapy is in the long term. NICE found, on average, the treatment was effective in 84 out of 100 cases.
But in one study, the varicose veins returned in more than half of those treated.
Sclerotherapy can also cause side effects, including:
  • blood clots in other leg veins
  • headaches
  • lower back pain
  • changes to skin colour – for example, brown patches over the treated areas
  • fainting
  • temporary vision problems
You should be able to walk and return to work immediately after having sclerotherapy. You'll need to wear compression stockings or bandages for up to a week.
In rare cases, sclerotherapy has been known to have serious potential complications, such as strokes or transient ischaemic attacks.

Surgery

If endothermal ablation treatments and sclerotherapy are unsuitable for you, you'll usually be offered a surgical procedure called ligation and stripping to remove the affected veins.
Varicose vein surgery is usually carried out under general anaesthetic, which means you will be unconscious during the procedure.
You can usually go home the same day, but an overnight stay in hospital is sometimes necessary, particularly if you're having surgery on both legs.
If you're referred for surgery, you may want to ask your surgeon some questions, such as:
  • who will do my operation?
  • how long will I have to wait for treatment?
  • will I have to stay in hospital overnight?
  • how many treatment sessions will I need?
Read more about questions to ask your doctor.

Ligation and stripping

Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.
Two small incisions are made. The first is made near your groin at the top of the varicose vein and is approximately 5cm (2in) in diameter.
The second, smaller cut is made further down your leg, usually around your knee. The top of the vein (near your groin) is tied up and sealed.
A thin, flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in your leg.
The blood flow in your legs won't be affected by the surgery. This is because the veins situated deep within your legs will take over the role of the damaged veins.
Ligation and stripping can cause pain, bruising and bleeding. More serious complications are rare, but could include nerve damage or deep vein thrombosis, where a blood clot forms in one of the deep veins of the body.
After the procedure, you may need up to 3 weeks to recover before returning to work, although this depends on your general health and the type of work you do.
You may need to wear compression stockings for up to a week after surgery.

Transilluminated powered phlebectomy

Transilluminated powered phlebectomy is a relatively new treatment, and there's some uncertainty about its effectiveness and safety.
NICE doesn't recommend it as part of the normal treatment plan for varicose veins. But they say the treatment may be offered if your doctor thinks it'll help and the benefits and risks are explained.
During transilluminated powered phlebectomy, 1 or 2 small incisions are made in your leg.
Your surgeon will place a special light called an endoscopic transilluminator underneath your skin so they're able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.
Transilluminated powered phlebectomy can either be carried out under general anaesthetic or local anaesthetic. You may experience some bruising or bleeding afterwards.
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