Summer can't end soon enough for many of the 40 million Americans with varicose veins. They swelter in pants and ankle-length dresses to cover up the unsightly tracks of purple and blue on their legs.

Though medically benign, varicose veins are more than cosmetic issues for some patients.

Wanda Cowell opted for surgery in June to remove a large, bulging vein in her leg.

"I would not have done this for cosmetic reasons," said Cowell, 71, of Columbus. "The back of my knee hurt so badly."

Pressure in the veins sometimes causes pain and discomfort, and, in rare cases, skin rashes and ulcers.

"Generally, we tell people not to worry about them," said vascular surgeon Bhagwan Satiani of the Ohio State University Medical Center and Vein Solutions in Worthington. "Patients get treatment either for appearance or symptoms."

About half of Americans 50 and older have varicose veins, according to the Office of Women's Health in the U.S. Department of Health and Human Services.

A curse of middle age, the condition also develops during pregnancy because of circulatory changes in support of the fetus.

Crystal Olinger waited until after the birth of her fourth -- and final -- child this year to have her legs treated.

"They were starting to bother me daily," said the Reynoldsburg resident, 34. "If I stood or walked too long, I had a constant, sharp pain."

Olinger had a large vein surgically removed from her right leg in January, followed by laser treatments in May to close veins in her left leg.

"I assumed that the laser would be my option for everything," she said. "I was surprised to learn that it wasn't."

Lasers receive most of the hype, but physicians commonly use other methods, based on preferences and the nature of diagnoses.

"The laser has been great, but it is not right for certain patients," Satiani said. "You have to know when to use it."

It might not work, he said, for deep veins in the leg or large spider veins -- the milder form of varicose veins that appear as star bursts or spider webs.

Dr. Ernest de Bourbon, of the Artemis Laser and Vein Center of Columbus in Worthington, recommends ultrasound imaging to find the cause and severity of the problem.

"Each person has a different type of disorder that we have to look at before we determine course of treatment," de Bourbon said. "Every person and situation is different."

In addition to being sealed shut with laser energy, veins can be surgically removed through a variety of techniques or diminished with injections of a hardening solution.

The goal, regardless of the method, is to eliminate the "bad" veins, forcing blood to flow through the remaining healthy veins.

Legs are especially susceptible to varicose veins because they fight the force of gravity and the pressure of body weight to carry blood back to the heart.

The cost of treatment varies from several hundred to several thousand dollars, depending on how many veins are treated and how many treatments are needed for each vein, according to the Federal Trade Commission.

The agency cautions consumers to be wary of advertisements that tout "unique, permanent, painless or absolutely safe" methods.

"All techniques have failures and recurrence rates," Satiani said.

The possible side effects from all procedures include bruising, discoloration, burns, scars and numbness; and, with the most invasive surgeries, wound infection, nerve damage, bleeding, clotting and the risks associated with anesthesia.

Insurance companies typically require conservative measures before they cover procedures needed to relieve pain, rashes or ulcers.

Most policies don't pay for elective cosmetic treatments.

Radiologists, dermatologists, family physicians, plastic surgeons and even some cardiologists treat varicose veins, usually with one procedure.

Vein specialists are more likely to offer the full menu of options.

Although consumers are confronted with a baffling array of treatments from various specialists, less-invasive techniques allow most to be performed on an outpatient basis with short recoveries.

Cowell began mall-walking three days after she had a large leg vein extracted through an incision in her groin.

"I was scared at first," she said, "but it was a piece of cake."