Varicose veins of the small pelvis is 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. In addition, varicose veins of the pelvic veins 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 stretch. The liquid part of the blood flows out through the walls, causing the tissues to swell.
Causes of pelvic varicose veins
Three main mechanisms of varicose veins of the small pelvis have been identified:
- failure of the valves of the pelvic veins - they should allow blood to pass only to the heart, but if the valve apparatus fails, part of the blood returns back;
- clogging of the pelvic vessels (clogging, 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 established. 50% of women have a burdened family history: cases of varicose veins of the pelvic organs among close relatives. Some genes responsible for the development of uterine varicose veins have already been identified: FOXC2, TIE2, NOTCH3. Mutations in them lead to weakness of the venous wall or valvular insufficiency.
Pregnancy can be a trigger for the development of varicose veins of the small pelvis. 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 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 (leads to stagnation of blood in the pelvic organs);
- congenital structural characteristics 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 varicose veins
Varicose veins of the pelvis are accompanied by the following syndromes:
- Varicose veins syndrome.It manifests itself as visually noticeable dilated vessels of the vulva and perineum. In addition, in some women, the veins of the buttock, pubis and groin expand. By the end of the day, the labia may swell.
- Pain syndrome.In the case of enlarged varicose vessels of the small pelvis, this becomes the main reason to visit a doctor and undergo treatment. Characteristics of pain: constant, painful, localized in the lower abdomen (related to the uterus) and radiating to the thighs and perineum. The pain intensifies during physical activity and prolonged static position of the body. They decrease after resting in a horizontal position. It is possible that the pain will increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
- Pelvic organ dysfunction.Most often, due to varicose veins of the pelvis, the menstrual cycle is disturbed. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after intercourse. They are associated with overflowing the venous bed of the pelvic organs with blood. The pain can last from half an hour to 1 day after contact. The third most frequent group of symptoms is dysuria. Usually there is increased urination, less often - urinary incontinence.
- Psycho-emotional disorders.They arise due to prolonged pain and reduced quality of sexual life. Depression most often develops.
The peculiarity of varicose veins is that the severity of the symptoms does not have a direct relationship with the diameter of the dilated vessels. This means that the symptoms may be absent in severe forms of 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 vessels.
The effectiveness of the diagnosis of varicose veins is increased by modern ultrasound options: color mapping and powerful Doppler.
- X-ray 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. It also complements surgery. Varicose veins are not a local disease, but a systemic one. Veins can become enlarged, if not already enlarged, in other places, most commonly in the legs. The use of drugs and procedures can increase the tone of the venous wall and slow the progression of varicose veins.
- drugs for varicose veins of the small pelvis;
- compression jersey;
- herbs (most medicines for varicose veins of the small pelvis are created on a plant basis);
- physical therapy;
- physiotherapy.
The leading method of treating varicose veins is medication. All other methods are only auxiliary.
Medicines are good primarily because they affect the veins of the whole body, not just the pelvis. They increase their tone and reduce the permeability of the vascular wall. Most often, preparations with diosmin are used for varicose veins. According to the indications, hormonal agents are included in the treatment scheme. For symptomatic therapy, nonsteroidal anti-inflammatory drugs are prescribed - they reduce pain. Many patients require antidepressants.
Compression therapy is most often used for varicose veins in the legs. It is rarely used when affecting the pelvic veins. If compression stockings or stockings compressing the lower part of the limbs are used when the veins of the legs are affected, then in the case of 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 anterior abdominal wall. Keep in mind that the effectiveness of this method has not been confirmed and does not give long-term results: it can be used exclusively for symptomatic purposes.
Surgical treatment of varicose veins of the pelvis
Invasive procedures and operations help eliminate the manifestations of pelvic varicose veins and reduce the risk of complications. They are performed on different vessels of the small pelvis, depending on the characteristics of the disease.
Interventions of the vessels of the perineum
Miniphlebectomy is used to remove veins in the perineum and buttocks. It is a minimally invasive intervention that involves removing the 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 removing varicose veins of the labia majora and labia minora. Veins must be removed through longer incisions. In case of varicose veins of the labia minora, their resection with subsequent plastic surgery may be necessary.
Minimally invasive procedures are also used: scleroobliteration of the vulva and perineal veins. Doctors inject liquid or foam sclerosants into the veins. As a result, these veins stick together, become invisible, and the blood flow through them stops.
These methods of treatment for expanding 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. In order to reduce the risk of recurrence, during treatment, the doctor must eliminate the pelvic-subcutaneous venous reflux.
Interventions of the gonadal vessels
The goal of treating varicose veins is to eliminate retrograde (reverse) blood flow in the ovarian vessels. As a result, the blood supply to the pelvic venous plexuses decreases. These interventions are considered the most effective.
The operation to remove varicose veins is technically simple and not very traumatic. Trauma is further reduced when using an endoscopic technique - 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. Through the blood vessels in the ovarian vein, sclerosing (gluing) drugs or an IUD are introduced, which causes the formation of blood clots, removes the dilatation 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 of the renal and iliac vessels
It has limited use. Clinical situations in which these types of interventions are needed are uncommon.
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 kidney and the inferior vena cava. He also performs ovarian vein resection.
Left iliac vein operations are performed in May-Turner syndrome. Doctors perform intravascular stenting of the left common iliac vein (placing a frame in the vein). This is a rare operation that is performed only in specialized centers.
Where shall we go
For the treatment of varicose veins, contact the SOYUZ clinic. We perform minimally invasive procedures and operations. Interventions are performed by experienced doctors with the latest equipment. All women experience pelvic pain after surgery.
Causes of varicose veins of the small pelvis
The most common risk factors for varicose veins are:
- a sedentary, sedentary lifestyle;
- "aorto-mesenteric forceps" syndrome;
- history of pregnancy and childbirth;
- genetic predisposition;
- congenital anatomical features of the renal veins;
- endometriosis;
- injuries of the pelvis, etc.
Treatment of varicose veins of the small pelvis in women
Varicose veins of the small pelvis is 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. In addition, varicose veins of the pelvic veins cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.
Causes of varicose veins of the small pelvis
According to international studies, almost a third of all women experience chronic pelvic pain. The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian pathology or varicose veins of the small pelvis. The symptoms of venous stasis in the small 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 don't close properly. This allows blood to flow back through the ovarian vein, which increases venous pressure and causes varicose veins. The outflow of blood is disturbed by a similar mechanism, as in varicose veins of the legs. The dilated ovarian vein does not have the ability to regulate the return flow of venous blood due to insufficiency of the venous valves. An overpopulated venous system leads to stretching of the venous wall and secondary dilatation of the pelvic vessels, due to which the disease continuously progresses.
Because the cause of pelvic pain is often undiagnosed, no treatment is offered even though it exists. If you have pelvic pain that may worsen during the day when you stand, you may want to seek a second opinion from an endovascular surgeon to help find the cause of the problem. Varicose veins of the pelvis can be effectively treated by endovascular surgical methods. Gynecology does not offer effective treatments for this disease.
Treatment of varicose veins of the small pelvis in the clinic
Anticoagulants, vetotonics and vitamins are prescribed as part of conservative therapy. Efforts are aimed at reducing blood cholesterol levels and adjusting 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 impossibility to get pregnant or provoke problems during pregnancy. No matter at what stage of your life you have faced reproductive health problems, experienced gynecologists and obstetricians will help you deal 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 spirals are installed in the lumen of the vein, which prevent improper blood flow leading to varicose veins of the small pelvis.
No stitches are needed. 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
- Heaviness in the pelvis
- Radiating pelvic pain
These symptoms may increase with prolonged standing and sitting, during menstruation and sexual intercourse. Causing discomfort and distress to women.
The reason for the development of pelvic varicose veins (PVV) is weak connective tissue. But for the development of the disease, the presence of provoking factors is necessary.
These factors are:
- Physical exercises
- Prolonged standing and sitting
- Pregnancy and birth
- 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 intercourse
Varicose veins of the small pelvis have symptomatic and asymptomatic forms (that is, they can occur without symptoms). The asymptomatic form usually does not require treatment
Symptoms of pelvic varicose veins in men and women
Visual symptoms are scarce. During the examination, expansion of the superficial veins in the area of the perineum and buttocks is rarely noted. Disturbances of urination 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 can complain of pain of varying intensity in the lower abdomen during intercourse.
Chronic pelvic pain:
- nagging and dull pain in the lower abdomen;
- pain in the sacrum and coccyx;
- pain in the lower back and groin;
- frequent urination;
- urinary incontinence;
- false urge to empty the bladder.
Varicose veins of the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin area, on the back of the thigh, buttocks).
A varicose vein on the inner thigh.
Varicose veins of the small pelvis and their treatment
Painful varicose veins of the small pelvis are found more often in the fairer sex. The disease is quite common, but diagnosing the disease is a complex process. More and more women walk all their lives with abdominal pain and treat an imaginary pathological process without even thinking that they have varicose veins of the small pelvis.
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 (occurs in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.
Women of reproductive age usually suffer and it is very important to treat the disease promptly.
What are pelvic varicose veins?
Varicose veins of the small pelvis are dilatation of the vessels through which blood flows from the genitals. In this disease, the veins expand to more than ten millimeters in diameter, which causes compression of the 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: inflammation of the ovaries, endometriosis;
- unstable menstrual cycle;
- hormonal imbalance and treatment with drugs that contain estrogens;
- congenital abnormalities of the vascular wall;
- lack of orgasm or frequent protection by interrupting intercourse.
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
- Varicose veins of the small pelvis in an advanced stage 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. At 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 pelvis. In addition, in the third stage, the diameter of the veins of the left and right ovary is almost the same.
Treatment of varicose veins
The therapeutic package depends on the degree of development of varicose veins. Doctors are supporters of conservative and sparing treatment: to achieve maximum effect through minimal intervention in the body. And when the disease can be managed without surgery, drugs, injections and vitamins are prescribed to reduce pain and other symptoms of pelvic varicose veins. Also to normalize blood flow and eliminate risk factors for clogging of blood vessels. Doctors accurately calculate the dose of drugs for each individual case to help the body cope with the disease almost on its own.
Strict compliance with normal working conditions is prescribed, with the exception of heavy physical exertion and prolonged standing in one position. Rest. This improves the patient's quality of life: physical and social activity increases, the psychological state normalizes.
It is recommended to adjust the nature of the diet, prescribe a diet with an increase in the level of fiber and moderate consumption of vegetables, fruits and vegetable oils. 80% of fatty and spicy foods are excluded from the diet, and alcohol is completely excluded. In overweight people, weight correction is recommended to reduce intra-abdominal pressure on organs and the venous system.
The phlebologist may also recommend stopping smoking and taking hormonal contraceptives to reduce the effect of the hormones estrogen and progesterone on the body. because these hormones reduce 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 treatments. 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 certain set of physical exercises.
The treatment complex includes the wearing of compression knitwear: tights or shorts of a certain compression class, suitable for a specific case. Wearing compression hosiery improves blood flow from the lower extremities, including the venous plexuses of the perineum and buttocks. On average, wearing is prescribed for 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, the phlebologist will give full information.
When the patient complains of frequent unbearable pain in the pelvis, the phlebologist prescribes non-steroidal anti-inflammatory drugs and pain relievers. 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 surgery and are surprised that it is completely absent. Therefore, do not be afraid, painlessness has been proven by the long-term experience of doctors. You will be able to return home the day after surgery.
In the absence of timely and correct treatment, the patient experiences worsening symptoms and quality of life. For women: impossibility of getting pregnant and giving birth independently. In men: heaviness and inability to lead an active lifestyle.
With conservative treatment, the patient's recovery occurs gradually, directly during treatment. After the operation, the patient recovers easily and quickly. You will be able to walk on your own the very next day after the operation.
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: walks, exercises. Moving your muscles keeps the blood flowing through your veins, which is why 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 the kettle on, take things off the shelf.
- It is recommended that women avoid strenuous and excessive sports activities: swinging, lifting weights, overcoming incredible distances. Such loads are unnatural for the female body.
- Follow the drinking regime. An adult needs 30 ml per 1 kg per day.
- Eat right. Eat more vegetables and fruits. Eat less fast, fatty, floury and spicy foods.
- Consult a phlebologist and perform a set of exercises at home.