The Connection Between Varicose Veins and Restless Legs Syndrome | Causes, Symptoms and Treatment

When your legs won’t settle even at night during sleep, you might have restless legs syndrome (RLS). This condition increasingly recognized in recent years prompts an uncontrollable urge to move the legs. Is fidgeting while waiting at the doctor’s office or during an exam RLS? To answer, we first need to understand what RLS is and its symptoms.

What Is Restless Legs Syndrome and How Does It Develop

Restless legs syndrome (RLS) is a sensory-motor neurological disorder causing discomfort in the legs leading to an intense uncontrollable urge to move them. Research suggests causes include genetic, metabolic or environmental factors. RLS is classified as:

• Primary RLS: No clear cause linked to genetics or dopamine system issues more common starts gradually in youth (even children), worsens with age, managed through symptom control.

• Secondary RLS: Caused by specific conditions or triggers starts suddenly more common in older age treatable by addressing the underlying cause.

Diagnosis requires reviewing family history, medications, blood tests, neurological exams and leg vein ultrasounds.

The exact mechanism of RLS is unclear but theories include:

• Neurological Circuit Dysfunction: Increased central nervous system sensitivity sends abnormal signals from the spinal cord to the brain.

• Oxidative Stress and Inflammation: An imbalance where free radicals outnumber antioxidants damages cells potentially linked to chronic inflammation.

• Venous Insufficiency: Conditions like varicose veins cause blood pooling, inflammation and nerve irritation triggering RLS symptoms.

Causes of Restless Legs Syndrome

Primary RLS stems from genetic or dopamine-related issues:

• Genetic Dopamine/Iron Metabolism Issues: Genes affecting iron metabolism and dopamine production (essential for brain reward systems) can cause involuntary leg movements.

• Central Nervous System Sensitivity: Abnormal sensitivity in the brain and spinal cord increases RLS symptoms.

Secondary RLS causes include:

• Iron and Ferritin Deficiency: Low iron levels the most common cause can be resolved with supplements.

• Kidney Disease: Especially in dialysis patients increasing RLS risk.

• Pregnancy: Common in the third trimester due to iron deficiency, hormonal changes or vascular pressure usually resolving post-delivery.

• Thyroid Disorders: Hyperthyroidism or hypothyroidism can trigger RLS.

• Diabetes: Neuropathy from diabetes mimics RLS symptoms.

• Parkinson’s Disease: Dopamine dysfunction in Parkinson’s can cause RLS.

• Medications: Antidepressants (e.g., fluoxetine), antihistamines (e.g., diphenhydramine) or anti-nausea drugs (e.g., metoclopramide) may induce RLS.

• Severe Varicose Veins or Venous Insufficiency: Severe varicose veins or vascular insufficiency can be related to factors such as blood pooling in the legs and pressure on the nerves with restless leg syndrome. A study titled restless legs syndrome in patients with chronic venous disorders has confirmed this relation.

What Are Varicose Veins and Their Causes?

Varicose veins are swollen twisted veins often in the legs caused by faulty vein walls or valves (venous valves) that prevent proper blood flow to the heart. Blood pools, increasing pressure, leading to inflammation and varicose veins. Causes include genetics, prolonged standing/sitting, obesity, pregnancy, hormonal changes, aging, injuries, unhealthy lifestyle (sedentary habits, poor diet, smoking, alcohol) or prior blood clots.

Symptoms include:

• Fatigue and heaviness in legs

• Muscle cramps

• Swelling and inflammation

• Bulging, twisted veins

• Skin discoloration

• Ulcers or bleeding

Learn more in What Is Varicose Vein Pain Like and What Are Its Symptoms?

Connection Between RLS and Varicose Veins

Severe varicose veins can trigger RLS due to:

• Blood pooling and congestion

• Increased inflammation

• Poor circulation

• Reduced oxygen to leg tissues

• Nerve irritation causing burning or restlessness

Symptoms of Restless Legs Syndrome

RLS diagnosis requires four main symptoms:

• Unpleasant Sensations: Burning, tingling, aching, pulling or a crawling sensation inside the legs (not on the skin) sometimes in arms.

• Worsening During Rest: Symptoms start or worsen when sitting or lying especially at night or during long flights.

• Relief with Movement: Walking, stretching or massaging temporarily relieves symptoms.

• Evening/Night Worsening: Symptoms peak between 10 PM and 4 AM.

These can lead to involuntary limb movements during sleep, sleep disturbances, fatigue, reduced focus, irritability or social issues.

How to Treat Restless Legs Syndrome

Treatment includes non-pharmacological, pharmacological and advanced options:

• Non-Pharmacological:

  • Address iron deficiency with supplements if confirmed.

  • Lifestyle changes: regular exercise, avoiding alcohol, smoking, caffeine and maintaining a sleep schedule.

  • Home remedies: stretching, massage, warm/cold compresses, calming teas (chamomile, lavender, valerian), meditation, yoga, stress management.

• Pharmacological:

  • Dopamine-enhancing drugs

  • Anti-seizure medications

  • Pain relievers

• Advanced Treatments (mostly experimental):

  • Nerve electrical stimulation

  • Transcranial magnetic stimulation

  • Botox injections in calf muscles

If RLS Is Caused by Varicose Veins What to Do?

If RLS is linked to varicose veins a vascular specialist should diagnose venous insufficiency using Doppler ultrasound or blood tests. Treating varicose veins can reduce RLS symptoms as reported in a phlebology study where patients saw RLS improvement after varicose vein treatment. Treatment options include:

• Compression Stockings: Prescribed based on varicose vein severity to improve blood flow.

• Vein-Strengthening Medications: Enhance vein wall function.

• Sclerotherapy: Injecting a sclerosant chemical via a fine needle closes varicose veins, non-invasive with minimal side effects like bruising.

• Laser Therapy or Radiofrequency Ablation: Advanced methods using laser or radio waves to seal veins, minimally invasive with quick recovery.

• Phlebectomy: Small incisions remove varicose veins, used for severe cases.

Tips to Manage RLS and Varicose Veins Together

• Elevate legs for 30 minutes before bed.

• Use a warm (not hot) compress on calves as excessive heat worsens varicose veins.

• Gently massage legs with herbal oils like peppermint, avoiding intense pressure.

• Maintain a healthy diet and hydration.

• Avoid prolonged sitting/standing.

• Wear supportive shoes.

• Limit salt, caffeine, alcohol, smoking.

• Strengthen leg muscles.

Conclusion

Restless legs syndrome (RLS) can be linked to varicose veins due to blood pooling, inflammation, poor circulation and nerve pressure. If standard RLS treatments fail, consider evaluating and treating varicose veins to alleviate symptoms.

FAQs

Is restless legs syndrome dangerous?

RLS is usually not dangerous but can disrupt sleep, reduce quality of life and cause anxiety or depression over time.

Will I get RLS if I have varicose veins?

Not necessarily, but a small percentage of severe varicose vein patients develop RLS symptoms.

Can RLS cause varicose veins?

No, but it may worsen vein inflammation and varicose vein symptoms.

How can I prevent RLS with varicose veins?

Treat varicose veins, exercise regularly, maintain a healthy diet, use compression stockings and avoid triggers like caffeine or prolonged inactivity.