Varicose vein disease is a common and often underappreciated cause of leg pain. Varicose veins may be overlooked as a cause of leg pain because not all varicose veins bulge on the surface; some are invisible and located deeper in the leg. Leaking varicose veins cause blood to pool and waste products to accumulate in the leg. Due to the buildup of pressure and toxins in the leg, persons with vein problems can experience leg aching, heaviness and fatigue of the leg, which typically worsens as the day progresses. Some feel like their legs are like “lead weights,” and may want to sit down at the end of the day and elevate their legs. Symptoms worsen with sitting or standing and may intensify during menstrual cycles or when exposed to heat. Elevating the legs or applying compression stockings usually improves the leg aching, although only temporarily. Unfortunately, in certain individuals with severe vein leakage a more advanced venous insufficiency develops.  This is a condition is called chronic venous insufficiency or CVI.   With CVI, swelling can become more pronounced and skin discoloration or even leg ulcerations can occur. Again, not all varicose veins bulge or rise above the surface of the skin. Many varicose veins are internal. However, these hidden internal veins can cause just as many problems as superficial, bulging varicose veins. Patients can develop outright leg ulcerations, without showing a single, visible varicose vein. If you are experiencing leg aching, swelling or fatigue, especially if it is worse with standing or sitting, you deserve to be evaluated for vein disease regardless of whether you have visible bulging veins or not.