Restless legs syndrome (RLS) is a common neurological condition characterized by an uncontrollable, often unpleasant, urge to move the legs. These sensations are frequently described as creeping, tingling, or aching, and they typically start or worsen during periods of rest. Varicose veins are swollen, twisted veins, most often appearing in the legs, which are a visible sign of underlying blood circulation issues. Many individuals experience both conditions and wonder if the two are truly linked.
The Definitive Link Between Veins and RLS
The answer is a definitive yes: varicose veins, or more precisely the underlying venous disease, can directly cause or significantly worsen RLS symptoms. When RLS is caused by a vascular issue, it is classified as Secondary RLS, or RLS secondary to Chronic Venous Insufficiency (CVI). CVI occurs when the valves within the leg veins fail to function properly, allowing blood to flow backward and pool. Treating the underlying vein issue often leads to a complete or near-complete resolution of the RLS symptoms.
Secondary RLS due to vein disease is distinct from the primary, or idiopathic, form of RLS, which is believed to be neurological in origin, involving dopamine system dysfunction. The connection between CVI and RLS is supported by studies showing a high prevalence of chronic venous disorders in patients presenting with RLS symptoms. For this specific subset of patients, the symptoms are a manifestation of poor circulation rather than a primary neurological disorder.
How Venous Insufficiency Triggers Symptoms
Varicose veins are a sign of CVI, a condition that impairs the return of blood to the heart. When the one-way valves inside the veins become damaged, they allow blood to pool in the lower legs, known as venous reflux. This pooling significantly increases the pressure inside the veins, referred to as venous hypertension.
This chronic increase in pressure and the stagnation of blood trigger RLS sensations. The accumulated blood and pressure cause inflammation in the surrounding tissues and irritation of nearby nerve endings. The distended, pressurized veins also physically stretch the sensitive tissues and nerves that run alongside them.
This nerve irritation manifests as the uncomfortable, restless sensations that compel movement. The symptoms are often worse when sitting or lying down because the leg muscles are inactive, and gravity maximizes the blood pooling and venous pressure. Movement, such as walking, temporarily activates the calf muscle pump, which helps to circulate the stagnant blood and briefly lowers the pressure, providing temporary relief.
Differentiating Secondary RLS from Primary RLS
A medical professional must determine whether RLS symptoms stem from a neurological cause (Primary RLS) or a vascular cause (Secondary RLS due to CVI). The location and timing of the symptoms offer significant clues. Primary RLS is typically a bilateral condition, affecting both legs equally, whereas vein-related RLS is often localized, sometimes affecting only one leg or one specific area where the damaged vein is present.
Primary RLS strictly follows a circadian rhythm, with symptoms reliably worsening in the late evening and throughout the night. Secondary RLS symptoms, while often worse at night when the person is at rest, may also manifest earlier in the day, especially after long periods of sitting or standing. This difference reflects the continuous nature of venous pressure, which increases with inactivity regardless of the time of day.
Diagnostic tools are used to confirm the underlying cause. A diagnosis of Primary RLS is based on clinical criteria and ruling out other causes. In contrast, Secondary RLS due to CVI is confirmed through a non-invasive Duplex ultrasound, which assesses blood flow and valve function in the leg veins. Temporary measures like wearing compression stockings or elevating the legs often provide noticeable relief for vein-related RLS, a phenomenon less common with the neurological form.
Treatment Approaches for Vein-Related RLS
The most effective treatment for Secondary RLS caused by CVI involves addressing the source of the venous hypertension. Closing the faulty, damaged veins redirects blood flow through the numerous healthy veins in the leg. This process eliminates the source of pressure and the chronic inflammation that irritates the nerves, leading to symptom relief.
Several minimally invasive, outpatient procedures are highly successful in treating CVI. These include Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA), and Sclerotherapy, which involves injecting a solution or foam into the faulty vein to seal it. Studies have shown a high degree of success, with some reporting that up to 98% of patients experienced a reduction in RLS symptoms following vein treatment.
Conservative management, such as the use of medical-grade compression stockings and elevating the legs, can offer preliminary relief by supporting the veins and reducing blood pooling. These methods are typically used as an initial step or in conjunction with the definitive procedures. Unlike Primary RLS, which may require neurological medications, vein-related RLS can often be resolved without the need for long-term drug therapy once the underlying vascular issue is corrected.