Excess blood and pressure within the veins cause the vessels to become abnormally enlarged and swollen. The engorged veins may appear purple or bluish, twisted, ropey, and knotted. Some individuals may have significant back-flow, but show little sign of varicosities. However, they might experience symptoms similar to those with visual signs of disease. These symptoms include aching, swelling, itching, throbbing, fatigue and in more severe cases, ulceration or bleeding. Frequently these symptoms worsen as the day progresses.