Bleeding Varicose Veins: First Aid, Causes and Why It Should Be Treated

What should I do if a varicose vein is bleeding?

1. Lie down and raise the leg on cushions or against a wall, so the foot is higher than the heart. This alone drops the pressure in the vein dramatically.
2. Press directly on the bleeding point with a clean cloth, towel or dressing. Keep firm, steady pressure for a full ten minutes by the clock. Do not keep lifting it to check.
3. Do not apply a tourniquet and do not tie anything tightly around the leg. Venous bleeding is stopped by pressure on the spot, not by blocking the circulation.
4. Once it has stopped, cover with a firm dressing or bandage, keep the leg raised for an hour and avoid standing for long periods for the rest of the day.
5. Call 995 or go to the nearest emergency department if bleeding continues after ten minutes of firm pressure, if you feel faint or dizzy, if you are on anticoagulants or antiplatelet medication, or if a large amount of blood has already been lost.

Why do varicose veins bleed?

A varicose vein near the ankle or shin sits under high pressure because the valves above it have failed, and over time the skin covering it becomes thin and fragile. It takes very little to breach that skin: a scratch, a knock against furniture, shaving, a hot shower that dilates the vein, or sometimes nothing at all. Because the vein is under pressure and the opening does not clamp down the way an artery would, the bleeding is steady and can be heavy, particularly when the person is standing. People are often frightened by how much blood appears on the floor. The volume looks worse than it is, but repeated or prolonged bleeds can cause real blood loss, especially in older people and those on blood thinners.

Who is most at risk?

• People with varicose veins low on the leg, around the ankle and over the shin, where the pressure is highest and the skin thinnest.
• People with skin changes such as brown staining, eczema or hardening, which mean the skin is already damaged. See skin darkening and ulcers from vein disease.
• Older adults, whose skin is thinner, and anyone taking anticoagulant or antiplatelet medication.
• People who have bled before. A vein that has bled once is likely to bleed again from the same spot.

What happens after a bleed?

The bleeding point usually heals within a few days, but the cause remains. International guidelines list bleeding among the complications that make treatment of varicose veins a medical rather than cosmetic matter, and the ESVS guideline recommends that a bleeding episode should prompt treatment of the underlying reflux. The assessment is a duplex ultrasound, which identifies which saphenous vein is feeding the bleeding varicosity and whether the deep veins are healthy. The bleeding vein itself is often treated directly with ultrasound-guided foam sclerotherapy or microphlebectomy, while the refluxing trunk above it is closed with radiofrequency or laser ablation or medical glue, depending on the scan. Treating the surface vein alone without the source tends to lead to another varicosity, and another bleed, nearby.

Dr Choong discusses this in his short video on bleeding varicose veins, and the accompanying blog post covers the first-aid steps again.

Common questions about bleeding varicose veins

How much blood can a varicose vein lose?

Enough to matter. Case reports describe serious blood loss when a person has been alone, standing, or asleep when a vein bled, and it is one of the few ways varicose veins can be dangerous. With the leg raised and pressure applied, bleeding normally stops within minutes.

Should I go to hospital even if the bleeding stopped?

If it stopped quickly with pressure and you feel well, same-day emergency care is not usually needed, but you should arrange a vascular assessment within the next week or two. If you are on blood thinners, felt faint, or the bleed was heavy or prolonged, be seen the same day.

Will compression stockings prevent another bleed?

Stockings reduce the pressure in the vein and the chance of a bleed while you are waiting for treatment, and they are worth wearing. They do not change the underlying reflux, so they are a bridge rather than a solution.

Can the bleeding vein be treated on the same day as the scan?

Sometimes. If the scan shows a straightforward pattern, foam sclerotherapy of the bleeding vein can often be done at the same visit, with closure of the main refluxing vein planned as a separate short procedure. The sequence depends on what the scan shows.