Restless, sore or aching legs and underlying vein problems
Restless legs and your veins
What is Restless Legs Syndrome?
Restless legs syndrome (RLS) or Willis-Ekbom disease is a condition that causes an uncontrollable urge to move your legs, to reduce an uncomfortable sensation. It most commonly occurs at night when sitting or lying down. It may be particularly annoying if you are in bed struggling to get to sleep. Moving the leg temporarily eases the unpleasant feeling but the restlessness can disrupt sleep not only for the RLS sufferer but also their sleeping partner.
Patients often have difficulty describing the unpleasant sensations associated with RLS. Terms that patients use to describe sensations include creeping, crawling, pulling, throbbing, aching, itching, "electric shocks", night cramps, twitchy legs, "legs that want to move on their own", and/or a constant need or urge to stretch and move. Symptoms usually may occur in both legs but may occur in one leg more than the other, and may also involve the upper limbs and body.
RLS is often neglected by patients and rarely diagnosed by doctors but is important because it can lead to significant impairment in quality of life for sufferers especially if severe.
Reported negative outcomes versus control patients include:
- Tired (35% vs. 20%),
- Pessimistic (16% vs. 10%),
- Prefer to be alone (34% vs. 22%),
- Stressed (37% vs. 21%)
- Angry (15% vs. 6%) during a typical day.
RLS symptoms often appear shortly after laying down at night and patients may kick, squirm, or massage their legs to lessen the sensation. Some people with RLS are compelled to get out of bed and pace or stretch.
As a result of RLS sleep disturbances, impaired sleep may occur. This often leads to fatigue and daytime sleepiness, poor concentration, reduced work performance and relationship conflicts . Sleep deficiency is also associated with depression, anxiety, heart disease, and obesity.
RLS and chronic venous insufficiency (CVI): the untold story
Whilst Phlebologists and Vascular Surgeons treating varicose veins are often familiar with the fact that restless leg symptoms resolve following treatment, this knowledge is not widely known in the broader medical community and relatively few scientific studies have addressed this connection.
The most important prospective study conducted by McDonagh et al showed the prevalence of RLS was higher in patients with CVI (98%) and that underlying CVI was present in 91% of patients having no CVI symptoms but in whom RLS was determined. In contrast only 9% of controls had RLS without CVD.
Recent published research by Yolgösteren et al has again highlighted a much-neglected link between restless leg syndrome and venous disease.
In patients presenting to a sleep clinic, nearly 8% meet the diagnosis of RLS on questioning and 50% of these had CVI on subsequent Doppler Ultrasound Investigation.
Response of RLS to treatment of CVI
Hayes et al showed that in patients with RLS and CVI, 89% of patients reported significant improvement post treatment with endovenous laser and foam sclerotherapy and 31% had complete RLS symptom relief following treatment.
They recommended exclusion of CVI in all patients with RLS before initiation or continuation of drug therapy.
An oral presentation at the Australasian College of Phlebology Scientific Meeting (7 May 2019) found that 40% of patients presenting for management of venous disease suffered from restless leg symptoms and that >80% of these patients had symptoms improve following either endovenous laser or ultrasound guided sclerotherapy for their vein disease. This paper also highlighted that research into restless legs has previously focused on neurological conditions and that many doctors are unaware of the connection between vein disease and restless legs and a detailed venous ultrasound is now recommended as the first investigation prior to deciding on treatment.
What can be done?
The majority of patients with RLS go undiagnosed and currently very few get investigated for CVI, denying many of them a chance of curing their RLS.
The Vein Clinic has successfully cured hundred of patients of their restless legs using a combination of treatments including Endovenous Laser Ablation, Ambulatory Phlebectomy and Ultrasound Guided Foam Sclerotherapy.
We are currently undertaking research in this area and look forward to contributing to the scientific literature and further the recognition of the importance of venous disease as a cause of RLS in the medical and wider community.
If you suffer with RLS please call us as we would like to help you get an accurate diagnosis and effective treatment plan to address this often overlooked medical condition. Ultrasound and clinical assessment is recommended. If venous reflux is found, it may well be worth treating this as 80% of patients will experience a significant improvement in restless leg symptoms following treatment of venous reflux.
Conservative lifestyle measures for RLS
Simple lifestyle changes and activities below may provide relief in persons with mild to moderate symptoms of RLS.
- Reduce/eliminate alcohol and tobacco use
- Maintain good sleep hygiene
- Regular moderate exercise
- Leg massage
- Warm baths
- Use of heating pad or ice pack
- Magnesium supplements.
- Foot wraps that put pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs.
- Yoga, Aerobic and leg-stretching exercises of moderate intensity
Risk factors for RLS
In most cases, the cause of RLS is unknown (called primary RLS). RLS may be familial and genetic links have been found in families where the onset of symptoms is before 40 years of age. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.
Medical textbooks and Journals list multiple risk factors for RLS including:
- Positive family history
- Female gender
- Pregnancy – symptoms peak near term and improve 4 weeks after delivery
- Low iron levels
- Lower socioeconomic status
- Poor health
- Sleep aponea and sleep deprivation
- Alcohol, Caffeine and Nicotine use
- Renal failure
- Cardiovascular disease
- Increasing age
- Low brain (basal ganglia) Dopamine levels ie. Parkinson’s disease
- Certain Medications may worsen RLS
- antinausea drugs
- antipsychotic drugs
- antidepressants that increase serotonin
- some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine)
- Peripheral neuropathy/ Spinal cord Injury
- Psychiatric disorders
Very few textbooks or publications however list what is emerging as by far the most important risk factor for RLS, namely CVI.
Most Effective Treatment for RLS
The two most important interventions for RLS are:
- Treating underlying venous reflux (CVI) if present (endovenous treatment using laser ablation is usually the most effective treatment)
- Correcting underlying iron deficiency if present (intravenous iron infusion is usually the most effective treatment).