If you suffer from burning, itching, throbbing, tingling, or a “creeping” sensation in your legs that makes it difficult to rest, then you may be one of the roughly 7-10% of Americans who suffer from restless leg syndrome (RLS).

What is restless leg syndrome?

Restless leg syndrome is a condition which causes uncomfortable sensations in the legs (and, in rare instances, the arms or chest). The sensations are described as aching, throbbing, pulling, itching, crawling, or creeping.

The discomfort tends to get worse in the evening and at night when you are trying to rest, which is why people with RLS often have difficulty sleeping (and RLS is sometimes categorized as a sleep disorder).

RLS symptoms are usually eased with movement which leads to pacing, leg twitching, and nighttime tossing and turning (which is why RLS is sometimes categorized as a movement disorder).

What causes RLS?

The exact cause of RLS is unknown. A variety of risk factors have been identified including:

Genetics (if members of your family have it, you are at higher risk)
Anemia (if you have too little iron in your blood)
End stage renal disease and hemodialysis (if you have kidney disease)
Diabetic neuropathy (if you have nerve damage)
Pregnancy (especially in the third trimester although relief often occurs soon after delivery)

There are also certain medications that can trigger or aggravate RLS such as:

antinausea drugs (e.g. prochlorperazine or metoclopramide)
antipsychotic drugs (e.g. haloperidol or phenothiazine derivatives)
antidepressants (e.g., fluoxetine or sertraline)
and some cold and allergy medications (e.g. diphenhydramine)

However, research suggests that there is another potential cause of RLS that is often overlooked: varicose veins.

What are varicose veins?

Varicose veins are blood vessels that have become twisted and enlarged. They tend to bulge out from the skin and may appear bluish or red in color. Although varicose veins can appear anywhere on the body, they most commonly occur on the legs.

Varicose veins are caused by a condition called chronic venous insufficiency (a.k.a. CVI or vein disease). Inside your veins are tiny, one-way valves that keep blood moving toward your heart. When these valves become weak or damaged (either from age or injury) the blood can flow backwards and begin to pool inside the vein. Over time, the pooled blood can lead to swelling of the limb, thickened or discolored skin, and leg wounds.

Chronic venous insufficiency isn’t always visible. Sometimes the affected vein is deeper under the skin and you might not know that it’s there unless a doctor examines your leg(s) with an ultrasound.

Symptoms of CVI include aching, throbbing, itching, and discomfort in the legs…sound familiar?

The connection between varicose veins and RLS

Due to the similarities in symptoms, researchers have been studying the connection between CVI and RLS for some time.

As far back as the 1940s, Dr. Karl A Ekbom proposed vein disease as a possible cause for restless leg syndrome.

In 1995, researchers studied whether patients seeking varicose vein treatment (a) had RLS, and (b) found relief of their RLS symptoms once their varicose veins were treated. The result was that 22% of patients screened did have RLS, and of those treated, 98% reported relief from their RLS symptoms.

In 2019, another study treated 35 patients with both RLS and CVI for their varicose veins and found an average 63% decrease in RLS symptoms after treatment.

Other studies have consistently had similar findings.

Does this mean varicose veins cause RLS?

In 15-20% of cases, there is a strong correlation between RLS and varicose veins. This is referred to as “secondary RLS.” In these instances, getting treatment for your varicose veins may relieve some or all of your symptoms.

For many others, however, the cause of RLS remains undetermined. This is called “primary RLS” and it is believed to be related to a dysfunction in the part of the brain that controls movement. This form of RLS is frequently treated with a combination of medications and lifestyle changes.

How are varicose veins treated?

The best way to treat varicose veins is to close the diseased vein and allow the blood to be redirected to nearby, healthy veins. This is accomplished with one of several minimally invasive procedures that can be done in a doctor’s office:

These procedures do not require general anesthesia. You will be back up and on your feet the same day and will begin to feel relief from your symptoms anywhere from a few hours to a few weeks later.