Varicose Veins that Bleed After a Shower

man singing in the shower with a beard a blue shower cap

It's not uncommon for people with varicose veins, particularly bulging blue spider veins that are near the surface of the skin, for the skin to rupture and bleed while in the shower. While this can be alarming, it isn't serious. In this post, I'll address bleeding varicose veins to help you understand what is happening and what you can do about it.

A vein condition exists when the tiny valves in your lower leg veins loosen and separate. When this happens, they no longer work to stop the backflow of blood as it is pumped back to your heart. This is a condition called vein reflux. Blood then pools in your lower legs, pressing against the vein walls and causing them to expand. This results in visible leg veins known as blue/black spider veins or varicose veins. These bulging veins occur because of the buildup of pressure in the veins around the ankles. Pressure can increase to about 100 mmHg - about the same as your artery. Normally, it's less than 15 mmHg. This pressure can also cause the protective layer of the skin to weaken and deteriorate.

In the shower, hot water causes the blood vessels close to the surface of the skin to dilate. This, plus the abrasion from scrubbing with a washcloth or loofah causes this skin to break open. This, plus pressure from trapped blood then causes the vein to rupture. The trapped blood is released, sometimes with tremendous force. Because the skin is so thin, there's no pain associated with it and people may not at first notice they are bleeding. People who have had this happen to tell me it looks like a crime scene, and they thought they were going to bleed to death. 

The bleeding always comes from a tiny black spider vein around the lower calf, ankle or foot. Bleeding rarely if ever comes from a large bulging vein unless they have a black spot which indicates very thin skin. 

Because of the combination of pressure and weakened skin, the rupture can actually happen at any time:

  • Bumping your leg against a piece of furniture
  • Scratching your leg vein 
  • Injury from a fall that grazes the skin


What To Do When a Varicose Vein Ruptures

The most important thing is to stay calm. Use your thumb, fingers or a towel and apply pressure immediately. Just the tip of your finger on the spot with gentle pressure is all that's needed. Don't use a giant wad of paper or a towel because it will likely continue to bleed at the tiny spot. Most of the time, the bleeding will stop after a few minutes. Continue to apply pressure until your body's natural clotting reaction stops the flow of blood. Get safely out of the shower, sit down and elevate your leg above your heart. This will stop the effect of gravity on the vein. 

From there, a simple bandage should be enough to cover the wound and help it heal. If you are on blood thinners or if the bleeding is significant and doesn't stop, call 911 or go to the emergency room. If you've had a blood vessel bleed, you should be evaluated by a vein care specialist. While you are waiting to be evaluated by the vein care specialist, I recommend wearing a simple bandaid over the dry skin at the bleeding site to prevent additional bleeding while you are sleeping. 

How to Avoid or Treat a Ruptured Varicose Vein

The good news is that vein reflux is a highly treatable condition. Vein treatment will address the underlying root cause of the varicose and spider veins. When you deal directly with bulging veins, you eliminate the likelihood of a rupture. Treatment involves closing the abnormal vein down with sclerotherapy which involves numbing the skin and injecting solution to seal the vein off. 

Vein treatment is easy, and people notice a visible difference in the look of their legs immediately. It is likely that, where there are bulging veins, there are also other symptoms: leg swelling, leg pain, and fatigue to name a few. The good news is that with vein treatment, these additional symptoms go away as well. 

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