Seeing blood can be alarming, especially when you don't know where it's coming from. It's not uncommon for people who have varicose veins to experience a sudden bleed, particularly while in the shower. The sight can be quite frightening, but it's important to know that this isn't usually a serious medical emergency. In this post, I'll address why varicose veins can sometimes bleed, what is happening inside your leg, and what you can do about it.
Key Takeaways
- A bleeding varicose vein, while alarming, is usually not a serious emergency and can be managed with direct pressure and leg elevation.
- Bleeding occurs because the high pressure from a vein condition (venous reflux) thins the skin over time, making it easy to break.
- The warm water and friction from washing in the shower are common triggers for a rupture, but it can also happen from a simple bump or scratch.
- If a vein bleeds, the most important steps are to stay calm, apply direct pressure to the exact spot, and elevate your leg above your heart.
- The only way to prevent future bleeding is to treat the underlying vein condition, which eliminates the high pressure that causes the problem.
Why Do Varicose Veins Rupture?
To understand why a vein might suddenly start bleeding, it helps to know what's happening beneath the surface of your skin. A vein condition begins when the tiny, one-way valves inside your lower leg veins weaken and fail to close properly. This is called vein reflux. These valves are supposed to act like little gates, helping to push blood upward toward your heart against the pull of gravity. When these valves stop working correctly, blood flows backward and pools in the lower legs.
Over time, this trapped blood dramatically increases the pressure inside your veins. Normally, the pressure in your leg veins is quite low, less than 15 mmHg (millimeters of mercury). With venous reflux, that pressure can skyrocket to around 100 mmHg which is about the same as the pressure inside your arteries.
Over time, this intense, sustained pressure causes the vein walls to stretch and bulge, creating the visible varicose veins you might see. But it also has a significant effect on the skin covering these veins. The high pressure weakens the protective layers of the skin, causing it to become thin, fragile, and less resilient.
Why Do Varicose Veins Tend to Rupture in the Shower?
The shower is a very common place for a bleeding episode to occur, and there are a few reasons for this. First, the warm water causes the blood vessels near the surface of your skin to dilate, or widen. This brings more blood closer to the already fragile skin. Second, the simple act of scrubbing with a washcloth or loofah can be enough to break the delicate, thinned-out skin over a superficial vein.
When the skin breaks, the high pressure from the pooled blood is suddenly released, and it can escape with surprising force. Many people who have experienced this tell me it looked like a crime scene, and their first thought was that they were going to bleed to death. Because the skin is so thin and the break is so small, there's often no pain associated with it. You might not even notice you're bleeding until you see the blood on the floor of the shower.
This bleeding almost always comes from a tiny, dark blue or black spider vein, usually located around the lower calf, ankle, or top of the foot. It rarely comes from a very large, bulging varicose vein unless that vein has a dark, almost black spot on it, which indicates that the skin there is extremely thin and fragile.
While the shower is a common trigger, this combination of high pressure and weakened skin means a rupture can happen at any time. It could be caused by:
- Bumping your leg against a piece of furniture.
- Scratching an itchy spot on your leg.
- A minor injury or scrape from a fall.
What to Do When a Varicose Vein Ruptures
If this happens to you, the most important thing is to remain calm. It may look like a lot of blood, but it is almost always manageable.
- Apply Direct Pressure Immediately: Use your thumb or a finger to apply firm, direct pressure to the exact spot that is bleeding. Don't just place a large towel over the area, as this diffuses the pressure and the bleeding will likely continue from the tiny hole. You need to focus the pressure on the precise source of the bleed.
- Elevate Your Leg: As soon as it is safe to do so, get out of the shower, sit or lie down, and elevate your leg above the level of your heart. This simple action uses gravity to your advantage, immediately reducing the pressure in the vein and helping to stop the flow of blood.
- Hold the Pressure: Continue to apply direct pressure for several minutes. This gives your body's natural clotting mechanisms time to work and seal the tiny break in the vein. Most of the time, the bleeding will stop completely within 5 to 10 minutes.
- Bandage the Area: Once the bleeding has stopped, you can cover the spot with a simple adhesive bandage.
If you are taking blood thinners, or if the bleeding is very heavy and does not stop after 10-15 minutes of direct pressure and elevation, you should call 911 or go to the nearest emergency room.
After an episode of bleeding, it is a very good idea to be evaluated by a vein care specialist. While you are waiting for your appointment, you can place a simple band-aid over the site to protect the fragile skin and prevent it from re-bleeding, especially while you are sleeping.
How to Prevent a Ruptured Varicose Vein
The good news is that venous reflux, the root cause of these bleeding veins, is a highly treatable condition. The only way to truly eliminate the risk of a rupture is to treat the underlying problem. Modern vein treatments are minimally invasive and focus on closing down the abnormal, high-pressure veins.
For bleeding spider veins, a procedure called sclerotherapy is often used. This involves numbing the skin and injecting a special solution into the targeted vein, which causes it to seal shut. Once the faulty vein is closed, the blood is naturally rerouted to healthier veins, and the high pressure is eliminated.
When you treat the underlying condition, you not only prevent future bleeding episodes but also address other symptoms you may be experiencing, such as leg swelling, pain, aching, heaviness, and fatigue. Many patients find that their legs look better, but also feel dramatically better.
Frequently Asked Questions (FAQs)
1. Is a bleeding varicose vein a medical emergency?
In most cases, no. While it can be very frightening to see, the bleeding can almost always be stopped at home with direct pressure and leg elevation. However, if the bleeding is heavy and does not stop after 15 minutes, or if you are on blood thinners, you should seek immediate medical attention.
2. Why did it bleed so much if it was just a tiny vein?
The amount of bleeding is due to the high pressure inside the vein, not the size of the vein itself. Because of venous reflux, the pressure can be extremely high, causing the blood to exit with significant force when the skin is broken.
3. Will the vein that bled come back?
The specific spot that bled may heal over, but the underlying high-pressure problem in your veins will remain. This means that the same spot or another nearby spot is at risk of bleeding again in the future. The only way to prevent it is to treat the source of the pressure.
4. Can I just be more careful to prevent it from happening again?
Being careful can help, but it's not a foolproof solution. The skin over these veins is so thin and fragile that even a minor, accidental bump or scratch that you might not even notice can cause a rupture.
5. Are the treatments to fix this painful?
Modern vein treatments are minimally invasive and designed for patient comfort. Procedures like sclerotherapy involve tiny needles and are very well tolerated. Your provider will ensure you are comfortable throughout the entire process.
