A Varicose veins usually develop in the legs. When the valves in the veins do not function properly, the blood pools in the veins, especially when standing for long periods, resulting in these swollen veins. Apart from being cosmetically unsightly, they can be painful - causing throbbing or cramping - and may cause itching or a burning sensation on the skin.

The goal of any treatment for varicose veins is to improve blood flow to the heart. The usual medical line is that the only alternative is surgery, in which the physician ‘strips’ out the offending vein and creates a tiny circulation bypass in place of the vein. However, there are a huge number of disadvantages:

* Surgery for varicose veins is neither curative nor preventative. Even early surgery of uncomplicated veins will not prevent the development of future varicosities (J R Coll Surg Edinburgh, 2001; 46: 154-8)

* Varicose veins recur in 10 per cent of those who have had them surgically stripped, in 10 per cent of those who have had radiofrequency ablation (using heat to seal off the vein), in 6 per cent of those who have had them removed by lasers and in up to 50 per cent of those who have undergone sclerotherapy (injecting an irritant solution into the vein, causing it to scar over and eventually become absorbed by the surrounding tissues (Healthwatch, CBS News, 22 January 2003)

* The surgery itself has risks, including blood clots, haematomas, nerve injury and, with sclerotherapy, an obstructed blood flow or leaking of the irritant solution into surrounding tissues

* A greater risk of deep vein thrombosis (DVT), but only if you are having major abdominal or pelvic surgery (BMJ, 1996; 312: 198).

Thankfully, there is a host of alternative measures that can help prevent or treat varicose veins without the need for surgery, including:

* all the simple measures that work the legs and avoid blood-pooling - elevating the legs while sitting; avoiding tight clothing around the ankle, calves and groin; avoiding high heels, which don’t work the calf muscles as much as low heels do; avoiding standing or crossing your legs for long periods of time; and losing weight if you are overweight

* walking, cycling and rowing - all of which cause the leg muscles to contract and push blood back to the heart. Best of all is swimming, as the water pressure helps drive the blood back to the heart. Also, being horizontal while you swim allows the veins to empty

* all the simple measures that work the legs and avoid blood-pooling - elevating the legs while sitting; avoiding tight clothing around the ankle, calves and groin; avoiding high heels, which don’t work the calf muscles as much as low heels do; avoiding standing or crossing your legs for long periods of time; and losing weight if you are overweight

* walking, cycling and rowing - all of which cause the leg muscles to contract and push blood back to the heart. Best of all is swimming, as the water pressure helps drive the blood back to the heart. Also, being horizontal while you swim allows the veins to empty

* a judicious use of compression therapy, usually support hosiery - preferably the pantyhose-type of stockings - to control symptoms, although some people may find wearing such tight garments rather uncomfortable (BMJ, 2002; 324; 689-90).

The best alternative treatments include:

* bilberry as supplements or even the fruit itself. These reduce the fragility of the blood vessels and, added to the daily diet of pregnant women, can prevent and treat varicose veins (Minerva Ginecol, 1981; 33: 221-30). These fruit are also antiangiogenic - they can reduce the growth of blood vessels that may lead to varicose veins and tumours (Biochemistry [Mosc], 2004; 69: 75-80). Take 80-160 mg three times a day (standardised to contain 25 per cent anthocyanidins)