INTRODUCTION:

Varicose veins are a common, frequently encountered chronic disease in adults which is usually found in the lower limbs. Pain due to these veins increases in intensity with the progress of the disease [age related variations[1]. Raised venous pressure and structural weakness in the vein walls is attributed to the pathogenesis of varicose veins. Varicose veins are also associated with other symptoms which indicate weakness of the limbs. It is reported more in women than men[2]. Occupations involving standing for a long time and pregnancy are said to be the main risk factors for varicose veins[3].

This study focuses on the prevalence of varicose veins in a random population of Tamil Nadu. It aims to evaluate the frequency of occurrence of varicose veins in men and women of the population. The study also considers the severity of the condition and the treatment opted.

Received on 15.05.2015 Modified on 14.06.2015

Research J. Pharm. and Tech. 8(8): August, 2015; Page 1179-1183

DOI: 10.5958/0974-360X.2015.00215.2

MATERIALS AND METHODS:

The population for this study included 50 individuals selected randomly among the residents of Tamil Nadu. The subjects were of age 30-80 years. The information gathered about the prevalence of varicose veins was obtained through a questionnaire consisting of 11 multiple choice questions. The individuals ware asked to fill the questionnaire manually. In cases of uneducated subjects, their answers were jotted down as they replied verbally. The questions in the questionnaire were as follows :

1) Do you see twisted greenish veins (varicose veins)in your legs?

Yes No

2)Age
30 -40

40-50
50-60
60-80

3)Occurrence
Mild severe

4)Occupation as a cause

Teacher
policemen
occupations that involve standing for long hours

none

5) duration of standing hours per day

Less than 1 hour

Two hours

2-5 hours

More than 5 hours

6)Usage of stockings

Yes no

7)Whether treatment undergone

Yes no

8) Other treatments or remedies

Accupuncture
Excercise
Massage
None

9) Surgery undergone for varicose veins

Yes no

10) How long have you had varicose veins?

Years
months
weeks
days

11) Height

Short
tall
very short

very tall

Answering the questions in the questionnaire revealed information about the age, sex, height and occupation of the subject, presence or absence of varicose veins, whether the occurrence is mild or severe and the treatments undergone (if there are any). Among the 50 random individuals selected, 18 were men and 32 were women, the reason behind the predominance of women being the cooperation offered by them in filling questionnaires.

The statistics was made using SPSS software. Every question was tabulated to provide a statistical result. This included cross tabulations of age, gender, occupation, height, and number of hours. Frequency tables which displayed the cumulative percentage of severity, duration, use of stockings, surgery undergone and remedies were prepared.

RESULTS:
Varicose veins were prevalent in 52% (26 individuals) of the population. Varicose veins were reported more in women (56.3%) than men (44.4%). Varicose veins affected 72% of individuals in the age group 60-80. The occurrence of varicose veins was maximum in this age group. The prevalence percentage was minimal (10%) in the age group 30-40. Both tall and short individuals presented with almost same percentage (50%) of prevalence. 51.9% of individuals with varicose veins were short while the rest being tall or very tall.

The occurrence rate is found to be higher for those who stand for longer hours. It affects 68% of those in occupations that involve standing for long hours. Around 46% of housewives are affected. However, 20% of population whose occupations do not involve standing are also affected. Also, the occurrence of varicose veins is high in individuals who stand for more than 5 hours (64.3%) followed by those who stand for 2-5 hours (61.9%). Only 11% occurrence is reported in individuals who stand for less than one hour.

The number of individuals severely affected are less. Out of the 52% affected by varicose veins 36% individuals are mildly affected and only 16 % are severely affected. 44% of the total 52% have long duration (years) of prevalence of varicose veins irrespective of mild or severe forms.

The number of individuals who took treatment for varicose veins remained low. 57% of the individuals affected did not undergo any treatments which includes medical treatments, exercises or massage. Only 15.4% out of 52% wore stockings. However, 30% of the affected population were doing some prescribed exercises and 11% had leg massage done occasionally. Also, none of the 26 individuals affected, underwent surgery for the treatment of varicose veins.

Table 1 : Varicose veins- gender cross tabulation

		Gender			Total
			Female	Male
Varicose veins	No	N	14	10	24
		%	43,8%	55.65%	48.0%
	Yes	N	18	8	26
		%	56.3%	44.4%	52.0%
Total		N	32	18	50
		%	100.0%	100.0%	100.0%

Table 2 : Varicose veins-age cross tabulation

			Age				Total
			30-40	40-50	50-60	60-80
Varicose Veins	No	N	9	10	2	3	24
		%	90.0%	40.0%	50.0%	27.3%	48.0%
	Yes	N	1	15	2	8	26
		%	10.0%	60.0%	50.0%	72.7%	52.0%
Total		N	10	25	4	11	50
		%	100.0%	100.0%	100.0%	100.0%	100.0%

Table 3 : Occupation cross tabulation

			Occupation			Total
			Housewife	None	Occupations that involve standing for long hours
Varicose veins	Yes	N	8	8	8	24
		%	53.33%	80%	32%	48%
	No	N	7	2	17	26
		%	46.7%	20%	68%	52%
Total		N	15	10	25	50
		%	100%	100%	100%	100%

Table 4 : Hours of work cross tabulation

			Hours of work				Total
			2-5 hours	Less than 1 hour	More than 5 hours	Two hours
Varicose veins	No	N	8	8	5	3	4
		%	38.1%	88.9%	35.7%	50%	48%
	yes	N	13	1	9	3	26
		%	61.9%	11.1%	643.%	50%	52%
total		N	21	9	14	6	50
		%	100%	100%	100%	100%	100%

Table 5 : Height cross tabulation

			Height				Total
			Short	Tall	Very short	Very tall
Varicose veins	No	N	13	10	0	1	24
		%	48.1%	50%	35.7%	50%	48%
	yes	N	14	10	1	1	26
		%	51.9%	50%	100%	50%	52%
Total		N	27	20	1	2	50
		%	100%	100%	100%	100%	100%

Frequency Tables

Table 6 : Severity of varicose veins

		Frequency	Percent (%)	Valid percent (%)	Cumulative percent (%)
Valid	Mild	18	36	69.2	69.2
	Severe	8	16	30.8	100
	Total	26	52	100
Missing	system	24	48
Total		50	100

Table 7 : Duration of persistence of varicose veins

		Frequency	Percent (%)	Valid percent (%)	Cumulative percent (%)
Valid	Months	4	8	15.4	15.4
	years	22	44	84.6	100
	Total	26	52	100
Missing	System	24	48
Total		50	100

Table 8 : use of stockings

		Frequency	Percent (%)	Valid percent (%)	Cumulative percent (%)
Valid	Yes	4	8	15.4	15.4
	No	22	44	84.6	100
	Total	26	52	100
Missing	System	24	48
Total		50	100

Table 9 : Remedies undergone for varicose veins

		Frequency	Percent (%)	Valid percent (%)	Cumulative percent (%)
valid	Exercise	8	16	30.8	30.8
	Massage	3	6	11.15	42.3
	None	15	30	57.7	100
	Total	26	52
Missing	System	24	48
Total		50	100

Table 10 : Whether surgery undergone for varicose veins.

		Frequency	Percent (%)	Valid percent (%)	Cumulative percent (%)
Valid	No	26	52	100	100
Missing	System	24	48
Total		50	100

DISCUSSIONS:
The study included a random population in Tamil Nadu. The prevalence of varicose veins 52% is significantly high when compared to previous studies in other regions [4-7]. In this study, the prevalence was higher in females than males similar to the previous studies [8-10] (table 1) . The prevalence of varicose veins was the highest in the age group 60-80 and lowest in the age group 30-40 as per this study. Other studies also show that youngest cohort had the lowest prevalence of varicose veins [11] (table 2).

In this study, the correlation between height and varicose veins was not significant. Both tall and short individuals presented with almost same percentage (50%) of prevalence (table 5). However, in the Jeruselam sample positive association was found between height, weight and varicose veins. According to the study, people with varicose veins tended to be taller and heavier [12,13]. However, the author also specified that the height became an insignificant factor when weight was controlled. The overall severity of the population in this study was mild (table 6) which explains why they did not undergo any treatment as in the study on population of Finland [2]. moreover, 84% had varicose veins which persisted for years (table 7).

According to this study, subjects whose occupations involve standing for long hours are more prone to varicose veins. This is similar to the results of previous studies too [14] (table 3). Prevalence is highest among those who stand for more than 5 hours (table 4).In England, the prevalence was highest among the shoe workers who stood all day[15]. However, a small population study in Cardiff showed no correlation between long hours of standing and varicose veins[16].

There are several treatment options and methods for management of pain caused by varicose veins. In this study, remedies such as exercise and massage was included but there was no attempt made to evaluate their efficiency (table 9). The efficiency of massage on varicose veins was assessed by another study and the effect of massage was proved positive [17]. Compression technique( wearing stockings) is also a part of treatment of varicose veins. 15% of the affected population used stockings (table 8).

There are many articles describing the surgical treatments of varicose veins. In the era of minimally invasive therapy, one of the most frequently used technique in the treatment of varicose veins is the endovenous laser ablation(EVLA) [18]. Conventionally, a surgical method which involved vein stripping was followed. Ultrasound-guided foam sclerotherapy is a more advance method. On comparing the two, the conventional method was found to have a greater success rate [19]. These treatment options are undergone by the patients only at severe stages. However, none of the subjects in the study had undergone surgical treatments (table 10). However, one of the subjects included in this study was advised to undergo a surgery which he refused, considering the expenses involved.

CONCLUSION:
The condition of varicose veins is significantly common in the population of Tamil Nadu, especially in older individuals and women. Individuals whose occupations involve standing for long hours are prone to varicose veins. A large portion of affected population failed to undergo treatment for varicose veins. The awareness about the treatments available for varicose veins may encourage the affected population to undergo the required treatment.

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