VENOUS DISEASE

Venous return refers to the flow of deoxygenated blood from the body's tissues back to the heart.

Venous disease can be triggered by factors such as genetics, aging, and prolonged periods of standing or sitting. Obesity, pregnancy, and hormonal changes also contribute to the risk. Additionally, lack of physical activity, injury, smoking, and blood clots can lead to the onset of various forms of venous disease³.

Venous disease involves the malfunctioning of the veins, particularly the venous valves.

Venous valves are small flaps within the veins that open and close to help blood move towards the heart. They prevent the backward flow of blood, ensuring a one-way system.

When valves become weak or damaged, they do not close properly, making it difficult for blood to flow through vein walls and back to the heart. This is called Venous Insufficiency.

Chronic Venous Insufficiency can lead to varicose veins, which are swollen, twisted veins that lie just under the skin. They usually occur in the legs. This is the first stage of Chronic Venous Disease. 

People with Chronic Venous Disease may present heaviness, tired legs, feelings of swelling, itching of the skin, nocturnal cramps, throbbing, burning pain, aching of the legs, which is exacerbated by prolonged standing or sitting, or difficulties during exercise³.

The most common cause of Chronic Venous Disease are: ^3;4

Many established risk factors are involved in CVD, especially age, excess weight, heredity, occupations associated with orthostasis. CVD prevalence has been shown to be higher in a population with family history of the disease.

Not dissimilar to sedentary habits, i.e., any behavior characterized by a low energy expenditure (≤ 1.5 kcal/kg/hour), while in a sitting, reclining, or lying posture, chronic venous disease is induced by the following risk factors:

• Prolonged sitting/standing

• Sedentary lifestyle

• Obesity

• Excessive heat

• Age (veins gradually contract less easily)

• Pregnancy with the heightened risk of varicose veins and deep vein thrombosis.

• Family history and genetics

• Thromboembolic disorders

• High heels

Venous disorders often present comorbidities which can be ⁵:

• Type 2 diabetes,
• Arterial hypertension,
• Heart failure,
• Joint leg diseases,
• Inflammatory bowel disease,
• Renal insufficiency,
• Pulmonary diseases
• Malignant disease.    

What symptoms do patients experience^1;3?

Patients' symptoms are the leading cause of clinical consultation in vascular medicine, experienced in early Chronic Venous Disease stages.

• Heavy legs with pain

• Swelling in the legs

• Night cramps

Other symptoms include:

• Sensations of 'pins and needles', burning and tightness in the legs

• Itching in the legs, with or without visible cutaneous ulcers

• Grogginess and fatigue

• Restless legs syndrome (RLS)

Symptoms are most felt in the lower calves and tend to increase

• As the day goes on and during hot weather

• After prolonged sitting/standing

• At the end of the day and/or nighttime

These symptoms can indicate conditions other than venous disease, but their absence does not exclude Chronic Venous Disease. 

Diagnosis is made by combining a visual examination of the legs and patients’ symptoms⁶.

 Your doctor must also perform a Doppler or Duplex Ultrasound to determine venous reflux and/or obstruction as well as the severity.

The CEAP classification (Clinical-Etiology-Anatomy-Pathophysiology) will help categorize chronic venous insufficiency, which is heterogenous among patients. The Clinical aspect ranges from C0 (no clinical sign) to C6 (open ulcer) based on disease severity.

Categorizing the condition of your legs:

Chronic Venous Insufficiency conditions can manifest from spider veins (reticular veins) to leg ulcers. It is considered an established CVD from the emergence of varicose veins.

Venous stasis - when blood pools in the veins - poses the risk of developing venous thrombosis, which can be of serious concern.

Deep vein thrombosis (DVT) is the detection of a blood clot in the deep veins, occurring mostly in the legs. It includes limb swelling, pain, discoloration, itching, and ulcer formation.

A more dramatic scenario is when the blood clot moves up from deep veins in the legs to obstruct the pulmonary artery thus causing pulmonary embolism. The latter is one of the major causes of mortality worldwide.

Prevention of DVT thereby decreases the incidence of a pulmonary embolism⁷.

There is a local and systemic approach to CVD. Always remember to preapare thoroughly and consult your doctor before starting treatment⁶.

Hemorrhoidal disease⁸ is a type of varicose vein occurring in the rectum and anus, causing itching, bleeding, and pain during bowel movements. Hemorrhoidal disease development is still poorly understood.

 Nowadays, the origin of hemorrhoidal disease is considered to be local tissue deterioration.

Hemorrhoids’ risk factors include⁹:

• Obesity
• Prolonged defecating /sitting
• Increased abdominal pressure - heavy lifting
• Insufficient intake of dietary fibers and oral fluids
• Transit dysregulation - constipation, chronic diarrhea
• Family history and genetics
• Pregnancy
• Aging
• Local impairment - anal intercourse, rectal pathology
• Straining for defecation
• Alcohol, fatty and spicy foods

Since prolonged physical inactivity promotes constipation, it is also a risk factor of hemorrhoidal disease.

The symptoms⁸ of hemorrhoids depend on the type you have. 

If you have extenal hemorrhoids, you may have :

• Anal itching
• One or more hard, tender lumps near your anus, anal ache or pain, especially when sitting. 

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

If you have internal hemorrhoids, you may have: 

• Bleeding from your rectum ––bright red blood in your stools, on toilet paper, or in the toilet bowl after a  bowel movement
• A hemorrhoid that has fallen through your anal opening, called prolapse

Internal hemorrhoids that are not prolapsed most often are not painful. Prolapsed internal hemorrhoids may cause pain and discomfort. 

Hemorrhoidal disease is not considered as serious condition, but its symptoms can affect the quality of life or interfere with daily activities. 

The most common presentation of hemorrhoidal disease is painless rectal bleeding during defecation with or without prolapse. The blood is bright red and normally on the outer surface of stool. The blood can also be seen during cleansing. 

However, during a hemorrhoidal crisis, severe anal pain may be felt. A precise history and thorough physical examination, including digital rectal examination and anoscopy, are imperative for the diagnosis of hemorrhoids. 

Unless bright red blood is clearly seen from hemorrhoids, if you have rectal bleeding, you should talk about it to your doctor immediately, they may then schedule a colonoscopy to exclude more serious conditions¹⁰. 

The complications of Hemorrhoidal disease are⁹: 

• Anemia
• Blood clots in external hemorrhoids
• Infection
• Skin tags (flap of tissue that hangs off skin)
• Strangulated hemorrhoids (muscles in the anus cut off blood flow to a prolapsed internal hemorrhoid).

TREATMENT METHODS¹⁰ 

• LIFESTYLE AND DIETARY CHOICES

Purpose: to prevent/reduce the pathological development or symptoms of hemorrhoidal disease. 

Examples include regular exercise, zero anal intercourse and reduced alcohol consumption 

Transit regulation is critical to your body. Remember to prepare your questions and visit the doctor before administering treatment. 

• INSTRUMENTAL AND SURGICAL TREATMENT

Purpose: to induce fibrotic scarring of internal hemorrhoids.

Examples include rubber band ligation and infrared coagulation. 

Despite the range of technical surgery, it is restricted to severe cases of hemorrhoids.

• PHARMACOLOGICAL TREATMENT

Purpose: to relieve symptoms.

• Intestinal transit modifiers help regulate stool frequency
• Non-steroidal anti-inflammatory drugs (NSAIDS), analgesics, and cortisone derivatives can be used in case of pain caused by thrombosed hemorrhoids. However, they should be used carefully for safety reasons.
• Another option is localized topical treatments (suppositories, creams, ointments) combining applied corticosteroids, anesthetics, lubricants, protectors and phlebotonics.
• Sitz baths also reduce hemorrhoidal pain.
• Specific medication must be carefully administered to pregnant women. 

Pregnancy and delivery predispose women to develop hemorrhoids because of hormonal changes and increased intra-abdominal pressure. It has been estimated that 25% to 35% of pregnant women are affected by this condition.  In certain populations, up to 85% of pregnancies are affected by hemorrhoids in the third trimester.

What’s more, and unsurprisingly, age is a compounding factor, not to mention adults with obesity, strained bowel movements and those suffering from alcoholism¹¹.

What is physical activity? ^{13 ; 14}

Physical activity is defined as any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above the resting metabolic rate.

MODERATE-INTENSITY	VIGORОUS-INTENSITY	MUSCLE-STRENGTHENING
Moderate-intensity physical activities require some effort, but you can still speak easily while doing these activities : Brisk walking Recreational swimming  Household chores Riding a bike  Gardening	Vigorous-intensity physical activities require more effort, making you breathe harder and faster : Aerobics  Running team sports or hard manual labor Fast cycling or swimming.	Muscle-strengthening activities cause the body’s muscles to work or resist an applied force or weight : Yoga Regular aquatic activities (swimming, aquabiking)  to strengthen various muscle groups Working with resistance bands

Describe the amount and types of physical activity that offer substantial health benefits.

The WHO (World Health Organization) recommends that each adult aged 18-64 should accumulate at least.

Practical advices

Physical activity needs to be a regular permanent habit. There are many ways to notch up the total of 150 minutes per week of moderate-intensity physical activity.

MOVE MORE…

• Do what you can, some physical activity is better than none!
• Integrate physical activity into your daily routine: spread it throughout the week.
• Start slowly if you have been inactive for a long time and gradually build up the amounts.
• Speak with your doctor or a health professional if you're unsure about your health or how active to be.
• Wear appropriate clothing and footwear, eat well and drink enough water.

… SIT LESS!

• Plan your physical activity. Make a regular time for it in your diary.
• Set some realistic and reachable goals and break into smaller ones.
• Track your progress using step-counting devices (e.g. podometer) or any other apps (e.g. Map my walk/hike/ride under armour) to motivate yourself.

Physical activity practical advices