Pelvic varices are a relatively new disease, which doctors learned about only at the end of the twentieth century, when the ultrasound diagnostic method became widespread. This is one of the most common causes of chronic abdominal pain. Varicose veins of the pelvic veins, moreover, cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.
What are pelvic varicose veins?
The essence of the pathology is that the veins expand, fill with blood and expand. The liquid part of the blood flows through the walls, which leads to tissue swelling.
Causes of enlarged pelvic veins
Three main mechanisms of varicose veins of the small pelvis have been established:
- insufficiency of the valves of the pelvic veins - they should allow blood to pass only towards the heart, but if the valve apparatus fails, part of the blood goes back;
- obstruction of pelvic vessels (blockage, obstruction);
- hormonal changes in a woman's body that increase the permeability of the venous wall.
Some women have valves that are underdeveloped or absent from birth. A significant role of heredity in the development of varicose veins of the small pelvis has been proven. 50% of women have a heavy family history: cases of varicose veins of the pelvic organs in close relatives. Several genes responsible for the development of uterine varicose veins have already been identified: FOXC2, TIE2, NOTCH3. Mutations in them lead to weakening of the venous wall or valve failure.
Pregnancy can be a trigger for the development of pelvic varicose veins. A pregnant woman's hormone levels change and the amount of blood circulating in the body increases by 30%. In addition, the capacity of the pelvic veins increases by 60% due to the mechanical compression of the veins by the enlarged uterus and increased progesterone production. The vessels remain in a dilated state throughout pregnancy and for another month after birth.
In addition to uterine compression, other risk factors include:
- endometriosis;
- prolonged sitting or standing position (leads to blood stagnation in the pelvic organs);
- congenital structural features of blood vessels.
In 3% of women, the direct cause of the disease is May-Turner syndrome. This is compression of the left common iliac vein by the right common iliac artery.
Symptoms of enlarged pelvic veins
Varicose veins of the pelvis are accompanied by the following syndromes:
- Varicose syndrome.It manifests as visually visible enlarged vessels of the vulva and perineum. In addition, in some women, the veins of the buttocks, pubis and groin are enlarged. At the end of the day, the labia may swell.
- Pain syndrome.With enlarged varicose veins of the small pelvis, this becomes the main reason to see a doctor and undergo treatment. Characteristics of pain: constant, painful, localized in the lower abdomen (connected to the uterus) and radiates to the thigh and perineum. The pain intensifies with physical activity and prolonged static position of the body. They decrease as they rest in a horizontal position. It is possible that the pain increases in the second phase of the menstrual cycle, which is associated with hormonal changes.
- Dysfunction of the pelvic organs.Most often, due to varicose veins of the pelvis, the menstrual cycle is interrupted. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with blood overflow of the venous bed of the pelvic organs. The pain may last from half an hour to 1 day after contact. The third most common group of symptoms is dysuria. Usually there is an increase in urination, less often - urinary incontinence.
- Psycho-emotional disorders.They arise due to prolonged pain and reduced quality of sexual life. Mostly depression develops.
The peculiarity of varicose veins is that the severity of the symptoms does not have a direct correlation with the diameter of the dilated vessels. That is, the symptoms may be absent in severe forms of the pathology, and vice versa: they may be very pronounced even in the initial stage.
Diagnosis of varicose veins
The main diagnostic method is ultrasound. It is performed transabdominally (through the abdomen) and transvaginally (through the vagina). Different methods allow you to see different ships.
The effectiveness of diagnosing varicose veins is enhanced by modern ultrasound options: color mapping and power doppler.
- X-rays with contrast - pelvic phlebography and selective oophorography.
- CT and MR venography are more informative diagnostic methods than conventional X-rays. In addition, they are less invasive: contrast can be injected into the cubital vein, and MRI is informative even without the use of contrast.
- Radionuclide techniques.
Conservative treatment of varicose veins
Conservative therapy is the main method if there are no indications for surgery to remove the pelvic veins. In addition, it completes the operation. Varicose veins are not a local disease, but a systemic one. Veins can be enlarged, if they are not already enlarged, in other places, most often in the legs. The use of drugs and procedures can increase the tone of the venous wall and slow the progression of varicose veins.
- medicines for varicose veins of the small pelvis;
- compression vest;
- herbs (most drugs for varicose veins of the small pelvis are created on a plant basis);
- physiotherapy;
- physiotherapy.
The main method of therapy for varicose veins is taking medications. All other methods are only auxiliary.
Medicines are good mainly because they affect the veins of the whole body, and not just the pelvis. They increase their tone and reduce the permeability of the blood vessel wall. Most often, diosmin preparations are used for varicose veins. According to indications, hormonal agents are included in the treatment regimen. For symptomatic therapy, non-steroidal anti-inflammatory drugs are prescribed - they reduce pain. Many patients need antidepressants.
Compression therapy is most often used for varicose veins in the legs. When pelvic veins are affected, it is rarely used. If, when the veins of the legs are affected, compression stockings or stockings are used, squeezing the lower part of the limbs, then when varicose veins of the small pelvis, on the contrary, compression is needed in the upper part. Compression shorts are used that compress the upper third of the thigh, the pelvic area and the front abdominal wall. Note that the effectiveness of this method has not been confirmed and does not provide long-term results: it can be used exclusively for symptomatic purposes.
Surgical treatment of enlarged pelvic veins
Invasive procedures and operations help eliminate the manifestations of pelvic varicose veins and reduce the risk of complications. They are performed in different vessels of the pelvis, depending on the characteristics of the disease.
Interventions in the vessels of the perineum
Miniphlebectomy is used to remove veins in the perineum and buttocks. This is a minimally invasive procedure that involves removing veins through minimal incisions. It has obvious advantages: quick recovery, minimal risk of complications, good aesthetic result.
But miniphlebectomy is not always possible. It is not suitable for the elimination of varicose veins in labia majora and minora. Veins must be removed through longer incisions. In case of varicose veins of the labia minora, their removal may be required followed by plastic surgery.
Minimally invasive procedures are also used: scleroblading of the vulvar and perineal veins. Doctors inject liquid or foam sclerosants into the veins. As a result, these veins stick together, become invisible, and blood flow through them stops.
These treatment methods for the expansion of blood vessels are very effective: 95% of patients are satisfied with the result. The disadvantage is the high recurrence rate - up to 60% within 7 years of observation after sclerotherapy, up to 40% within 7 years after surgical removal of varicose veins. To reduce the risk of relapse, during treatment, the doctor must eliminate pelvic-subcutaneous venous reflux.
Interventions in the gonadal vessels
The goal of treating varicose veins is to eliminate the retrograde (backward) flow of blood in the ovarian vessels. As a result, the blood supply to the venous plexuses of the pelvis decreases. These interventions are considered more effective.
The operation to remove varicose veins is technically simple and not very traumatic. Trauma is further reduced when an endoscopic technique is used - in this case, the operation is performed through minimal incisions. The surgical method is also very effective. Chronic pelvic pain after vein removal disappears in 100% of patients within 1-2 months after surgery. The risk of recurrence within 5 years of observation does not exceed 3%.
You can do without surgery. Embolization is used for treatment. Sclerosing drugs (glue) or a coil are inserted through the blood vessels into the ovarian vein, which causes the formation of a blood clot, eliminates the expansion and completely closes the vein. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical removal of veins, the advantage is minimal invasiveness, which is why endovascular procedures are among the standard approaches for treating pelvic varicose veins in women.
Interventions in the renal and iliac vessels
They have limited use. Clinical situations where these types of interventions are needed are rare.
Operations on the left renal vein in women are performed in case of compression, which leads to an increase in pressure in it. The doctor moves the vein and creates a new anastomosis (connection) between the left and inferior renal vena cava. He also performs ovarian vein resection.
Operations on the left iliac vein are performed for May-Turner syndrome. Doctors perform intravascular stenting of the left common iliac vein (installation of a frame inside the vein). This is a rare operation that is performed only in specialized centers.
Where to go
For the treatment of varicose veins, contact the SOYUZ clinic. We perform minimally invasive procedures and surgeries. Interventions are performed by experienced doctors using the latest equipment. All women experience pelvic pain after surgery.
Causes of pelvic varicose veins
The most common risk factors for varicose veins are:
- sedentary lifestyle;
- "aorto-mesenteric tweezers" syndrome;
- history of pregnancy and childbirth;
- genetic predisposition;
- congenital anatomical features of renal veins;
- endometriosis;
- pelvic area injuries etc.
Treatment of varicose veins of the small pelvis in women
Pelvic varices are a relatively new disease, which doctors learned about only at the end of the twentieth century, when the ultrasound diagnostic method became widespread. This is one of the most common causes of chronic abdominal pain. Varicose veins of the pelvic veins, moreover, cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.
Causes of pelvic varicose veins
According to international studies, almost a third of all women experience chronic pelvic pain. The causes of chronic pelvic pain are different, but they are often associated with the presence of ovarian pathology or varicose veins of the small pelvis. The symptoms of venous stagnation in the pelvis are similar to the symptoms of varicose veins in the legs.
In both cases, the venous valves that help return blood to the heart against gravity weaken and do not close properly. This allows blood to flow backwards through the ovarian vein, which increases venous pressure and causes varicose veins. Blood flow is interrupted by a similar mechanism, as with varicose veins of the legs. The dilated ovarian vein does not have the ability to regulate the reverse flow of venous blood due to the insufficiency of the venous valves. An overcrowded venous system leads to stretching of the venous wall and secondary dilation of the pelvic vessels, so the disease progresses continuously.
Because the cause of pelvic pain is often undiagnosed, no treatment is offered, although treatment does exist. If you have pelvic pain that may worsen during the day when you are standing, you may want to seek a second opinion from an endovascular surgeon to help find the cause of the problem. Pelvic varicose veins can be effectively treated using endovascular surgical methods. Gynecology does not offer effective treatments for this disease.
Treatment of varicose veins of the small pelvis in the clinic
As part of conservative therapy, anticoagulants, vetotonics and vitamins are prescribed. Efforts are aimed at reducing blood cholesterol levels and correcting a woman's lifestyle. If surgical intervention is necessary, the use of minimally invasive techniques is preferred.
Sometimes the pathology in question can be the cause of the inability to conceive or provoke problems during pregnancy. No matter at what stage of life you have encountered reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you cope with them. The clinic creates the most favorable conditions and prescribes effective treatment so that women and their families are healthy.
With the help of special instruments, special coils are placed in the lumen of the vein, which prevent improper blood flow, leading to pelvic varicose veins.
No stitches are required. The duration of the procedure varies from 30 minutes to several hours depending on the complexity of the condition.
Symptoms of pelvic varicose veins include:
- Pelvic discomfort
- Importance in the pelvis
- Bursting pain in pelvis
These symptoms can intensify with prolonged standing and sitting, during menstrual periods and sexual intercourse. Causing distress and suffering to women.
The cause of the development of pelvic varicose veins (PVVV) is weak connective tissue. But for the development of the disease, the presence of provocative factors is required.
These factors are:
- Physical exercises
- Standing and sitting for a long time
- Pregnancy and childbirth
- Pelvic trauma
- Tumors of the uterus and ovaries
- Endometriosis
- Indications for embolization are:
- pelvic varicose veins with chronic pelvic pain syndrome
- painful menstruation
- varicose veins of the external genitalia
- pain during sexual intercourse
Varicose veins of the pelvis have symptomatic and asymptomatic forms (that is, they can occur without symptoms). The asymptomatic form usually does not require any treatment
Symptoms of pelvic varicose veins in men and women
Visual symptoms are few. During the examination, the expansion of the superficial veins in the area of the perineum and buttocks is rarely observed. Urinary disorders due to congestion of the venous plexus of the bladder.
The disease is accompanied by internal sensations. Patients complain of vague pain in the lower abdomen and inner thighs. There is a feeling of heaviness and swelling. Men and women may complain of pain of varying intensity in the lower abdomen during sexual intercourse.
Chronic pelvic pain:
- annoying and dull pain in the lower abdomen;
- pain in the area of the sacrum and coccyx;
- pain in the lower back and hips;
- frequent urination;
- urinary incontinence;
- false desire to empty the bladder.
Enlarged veins in the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin areas, on the back of the thigh, buttocks).
Enlarged vein in the inner thigh.
Varicose veins of the pelvis and its treatment
Painful varicose veins of the small pelvis are more often discovered in the fairer sex. The disease is quite common, but diagnosing the disease is a complex process. More women walk their entire lives with abdominal pain and treat an imaginary pathological process, without even thinking that they have pelvic varices.
What are pelvic varicose veins?
Pelvic varicose veins (PVVV) is a disease that affects the elasticity of blood vessels. In medicine, the disease is called differently: varicocele (found in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.
Usually women of reproductive age suffer and it is very important that the disease is treated at the right time.
What are pelvic varicose veins?
Varicose veins of the small pelvis are the expansion of the vessels through which blood flows from the genitals. With this disease, the veins expand to more than ten millimeters in diameter, which causes compression of nerve endings and pain. vienna
Why do pelvic varicose veins appear?
The causes of varicose veins of the small pelvis in women are considered to be:
- compression of blood vessels by the growing uterus during pregnancy;
- weight lifting and other physical activities;
- sedentary work, sedentary lifestyle;
- gynecological diseases: ovarian inflammation, endometriosis;
- irregular menstrual cycle;
- hormonal imbalances and treatment with estrogen-containing drugs;
- congenital abnormalities of the vascular wall;
- lack of orgasm or frequent protection from interrupted sexual relations.
Types of varicose veins of the small pelvis
Phlebologists distinguish two types of varicose veins of the small pelvis:
- primary, caused by congenital or acquired dyspareunia
- Advanced varicose veins of the small pelvis can manifest with symptoms such as swollen veins in the groin, thighs and buttocks. Manual examination may also reveal venous nodules.
Thromboembolic processes can be a complication of varicose veins of the small pelvis.
The first stage of varicose veins is characterized by a vein diameter of up to 5-7 mm, located along the upper edge of the left ovary. In the second stage, veins (up to 8-9 mm in diameter) occupy the entire left ovary, and are also observed in the right ovary and uterus. In the third stage, veins with a diameter of 10-13 mm are identified, located under the lower edge of the left ovary with pronounced varicose veins of the right ovary, uterus and small pelvis. Moreover, in the third stage, the diameter of the left and right ovarian veins is almost the same.
Treatment of varicose veins
The treatment package depends on the degree of development of varicose veins. Doctors are fans of conservative and gentle treatment: to get the maximum effect through minimal intervention in the body. And, when the disease can be treated without surgery, medications, injections and vitamins are prescribed to reduce pain and other manifestations of symptoms of pelvic varicose veins. Also to normalize blood circulation and eliminate risk factors for blockage of blood vessels. Doctors accurately calculate the dose of drugs for each case to help the body cope with the disease almost independently.
Strict observance of normal working conditions is prescribed, with the exception of heavy physical exercises and prolonged standing in one position. Rest. This improves the patient's quality of life: physical and social activity increases and the psychological state returns to normal.
It is recommended to correct the nature of the diet; a diet with increased fiber levels and moderate consumption of vegetables, fruits and vegetable oils is recommended. 80% of fatty and spicy foods are excluded from the diet, and alcohol is completely excluded. For overweight people, weight correction is recommended to reduce intra-abdominal pressure on organs and the venous system.
A phlebologist may also recommend stopping smoking and taking hormonal contraceptives in order to reduce the effect of estrogen and progesterone hormones on the body. Because these hormones lower the tone of the blood vessel walls and reduce their elasticity.
A contrast shower in the perineal area is recommended. Breathing exercises: slow and deep inhalation and exhalation using the abdominal muscles. Water procedures. Various unloading exercises.
We strongly recommend not to self-medicate without consulting a phlebologist. Each patient requires an individual selection of a treatment package, including a specific set of physical exercises.
The treatment complex includes wearing compression stockings: tights or shorts of a certain compression class, suitable for a specific case. Wearing compression stockings improves blood flow from the lower extremities, including the venous plexuses of the perineum and buttocks. On average, the wear is prescribed up to 14 days: several hours a day. You will learn how to choose the size, compression class and manufacturer from the article Compression stockings or during a consultation, a phlebologist will provide complete information.
When a patient complains of frequent unbearable pain in the pelvic area, the phlebologist prescribes non-steroidal anti-inflammatory drugs and sedatives. Use should be in accordance with the doctor's recommendations.
If conservative treatment does not bring results or the disease is in an advanced stage, then the phlebologist prescribes sclerotherapy or phlebectomy (surgical intervention) to remove the affected veins. The procedure is absolutely painless and is performed under anesthesia. Many patients worry about pain during and after operations and are surprised that they are completely absent. Therefore, do not be afraid, pain-free has been proven by many years of experience of doctors. You will be able to go home the day after surgery.
In the absence of timely and appropriate treatment, the patient experiences a worsening of symptoms and quality of life. For women: inability to get pregnant and give birth on their own. For men: heaviness and inability to lead an active lifestyle.
With conservative treatment, the patient's recovery occurs gradually, directly during the treatment. After the operation, the patient recovers easily and quickly. The day after the operation you will be able to walk independently.
Measures to prevent varicose veins of the small pelvis
Prevention aims to eliminate the risk and symptoms of the disease. Here are some simple steps to help you:
- Moderate physical activity: walking, exercise. Moving your muscles keeps the blood flowing through your veins, so it's important to move.
- If you have a sitting or standing job, try to take breaks every 30 minutes to move around a bit. For example, take a walk, put on the kettle, take things to the shelf.
- It is advisable for women to avoid heavy and excessive sports activities: swings, lifting heavy weights and overcoming incredible distances. Such loads are unnatural for the female body.
- Stick to your drinking regimen. An adult needs 30 ml per 1 kg per day.
- Eat properly. Eat more vegetables and fruits. Eat less fast, fatty, floury and spicy foods.
- Consult a phlebologist and perform a set of exercises at home.