Varicose veins of the pelvis 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. In addition, enlarged 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 become overloaded. The liquid part of the blood leaks through the walls, which leads to tissue swelling.
Causes of pelvic varicose 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 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 vein wall.
Some women have valves that are underdeveloped or absent from birth. A significant role of heredity in the occurrence 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 vein wall or valve failure.
Pregnancy can be a trigger for the development of varicose veins of the small pelvis. In a pregnant woman, the hormonal level changes, and the amount of blood circulating in the body increases by 30%. Moreover, the capacity of the pelvic veins increases by 60% due to the mechanical compression of the veins by the enlarged uterus and the increased production of progesterone. The vessels remain dilated throughout pregnancy and for another month after childbirth.
In addition to uterine compression, other risk factors include:
- endometriosis;
- long-term sitting or standing position (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 pelvic varicose veins
Dilated pelvic veins are accompanied by the following syndromes:
- Varicose veins syndrome.It manifests itself as visually noticeable enlarged vessels of the vulva and perineum. In addition, in some women, the veins of the buttocks, pubis and groin increase. By the end of the day, the lips may be swollen.
- Pain syndrome.In the case of enlarged varicose vessels of the small pelvis, this becomes the main reason for going to the doctor and getting treatment. Characteristics of pain: constant, painful, localized in the lower abdomen (connected to the uterus) and radiating to the thighs and perineum. The pain is intensified by physical activity and prolonged static position of the body. They decrease after resting in a horizontal position. It is possible that the pain may increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
- Dysfunction of the pelvic organs.Most often, due to enlarged pelvic veins, the menstrual cycle is disturbed. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with the overflow of 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 common group of symptoms is dysuria. Increased urination usually occurs, less often - urinary incontinence.
- Psychoemotional 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 varicose veins. That is, symptoms can be absent in severe forms of pathology, and vice versa: they can be very pronounced even in the initial phase.
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 containers.
The effectiveness of diagnosing varicose veins is increased by modern ultrasound options: color mapping and power Doppler.
- X-ray with contrast - phlebography of the pelvis 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 complements 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 vein 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);
- physiotherapy;
- physiotherapy.
The leading method of treatment of varicose veins is taking medication. All other methods are only auxiliary.
Medicines are good first of all because they affect the veins of the whole body, not just the pelvis. They increase their tone and reduce the permeability of the blood vessel wall. Diosmin preparations are most often used for varicose veins. According to indications, hormonal agents are included in the treatment regimen. Nonsteroidal anti-inflammatory drugs are prescribed for symptomatic therapy - they reduce pain. Many patients require antidepressants.
Compression therapy is most often used for varicose veins on the legs. When the pelvic veins are involved, it is rarely used. If, when the veins of the legs are affected, compression stockings or socks are used, which tighten the lower part of the limbs, then when the veins of the small pelvis are enlarged, on the contrary, compression is needed in the upper part. Compression shorts are used that compress the upper third of the thighs, the pelvic area and the front abdominal wall. Please note that the effectiveness of this method has not been confirmed and does not provide long-term results: it can be used only for symptomatic purposes.
Surgical treatment of pelvic varicose veins
Invasive procedures and operations help to eliminate the manifestations of varicose veins of the pelvis and reduce the risk of complications. They are performed on different vessels of the pelvis, depending on the characteristics of the disease.
Interventions on the vessels of the perineum
Miniphlebectomy is used to remove veins in the perineum and buttocks. This is a minimally invasive intervention that involves the removal of 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 on the labia majora and labia minora. Veins must be removed through longer incisions. In the case of varicose veins of the labia minora, their resection may be necessary, followed by plastic surgery.
Minimally invasive procedures are also used: scleroobliteration of vulvar 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 treatment methods for dilating blood vessels are very effective: 95% of patients are satisfied with the result. The disadvantage is a high relapse 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, the doctor must eliminate pelvic-subcutaneous venous reflux during treatment.
Interventions on gonadal vessels
The goal of treating varicose veins is to eliminate retrograde (backward) blood flow in the ovarian vessels. As a result, blood flow to the venous plexuses of the pelvis is reduced. These interventions are considered the most effective.
The operation to remove varicose veins is technically simple and not very traumatic. Trauma is further reduced by using the 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. Sclerosing (sticky) drugs or a coil are introduced through the blood vessels into the ovarian vein, which causes the formation of blood clots, removes the dilation and closes the vein completely. According to different authors, the efficiency 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 to the treatment of pelvic varicose veins in women.
Interventions on renal and iliac vessels
Have 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 renal and inferior vena cava. He also does 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 (placing 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 operations. Interventions are performed by experienced doctors using the latest equipment. All women have pelvic pain after surgery.
Causes of pelvic varicose veins
The most common risk factors for varicose veins are:
- sedentary, sedentary lifestyle;
- "aorto-mesenteric forceps" syndrome;
- history of pregnancy and childbirth;
- genetic predisposition;
- congenital anatomical characteristics of renal veins;
- endometriosis;
- pelvic injuries etc.
Treatment of varicose veins of the small pelvis in women
Varicose veins of the pelvis 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. In addition, enlarged pelvic veins cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.
Causes of pelvic varicose veins
According to international studies, almost a third of all women suffer from 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 become weakened and do not close properly. This allows blood to flow backwards through the ovarian vein, which increases venous pressure and causes varicose veins. The outflow of blood is disturbed by a similar mechanism, as in the case of varicose veins of the legs. A dilated ovarian vein does not have the ability to regulate the return 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 upright, you may want to seek a second opinion from an endovascular surgeon to find the cause of the problem. Varicose veins of the pelvis can be effectively treated with endovascular surgery 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 the level of cholesterol in the blood and correcting the woman's lifestyle. If surgical intervention is required, minimally invasive techniques are preferred.
Sometimes the pathology in question can be the cause of impossibility of conception or provoke problems during pregnancy. No matter at what stage of life you encountered reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you deal with them. The clinic creates the most favorable conditions and prescribes effective treatment to keep women and their families healthy.
With the help of special instruments, special spirals are inserted into the lumen of the vein, which prevent irregular blood flow, which leads to enlarged pelvic veins.
No stitches 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
- Bursting pain in pelvis
These symptoms can intensify with prolonged standing and sitting, during menstruation and sexual intercourse. Causing women discomfort and suffering.
The cause of the development of pelvic varicose veins (PVVV) is weak connective tissue. But the development of the disease requires the presence of provoking factors.
These factors are:
- Physical exercises
- Prolonged standing and sitting
- 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 appear without symptoms). The asymptomatic form usually does not require any treatment
Symptoms of pelvic varicose veins in men and women
Visual symptoms are scarce. During the examination, the expansion of the superficial veins in the area of the perineum and buttocks is rarely noticed. Urination disorders due to congestion of the venous plexus of the urinary bladder.
Illness is accompanied by inner feelings. 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:
- nagging and dull pain in the lower abdomen;
- pain in the area of the sacrum and coccyx;
- pain in the lower back and groin;
- frequent urination;
- urinary incontinence;
- false urge to empty the bladder.
Dilated veins on the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin area, on the back of the thighs, buttocks).
Enlarged vein on inner thigh.
Varicose veins of the pelvis and their treatment
Painful varicose veins of the small pelvis are more often detected in the fairer sex. The disease is quite common, but diagnosing the disease is a complex process. More and more women spend their whole lives walking around with abdominal pain and treating an imaginary pathological process, without thinking that they have varicose veins of the small pelvis.
What are pelvic varicose veins?
Varicose veins of the pelvis (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.
Women of reproductive age suffer most often and it is very important that the disease is treated on time.
What are varicose veins of the pelvis
Varicose veins of the small pelvis are enlargement of blood 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 occur?
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;
- unstable menstrual cycle;
- hormonal imbalance and treatment with drugs containing estrogens;
- congenital anomalies of the vascular wall;
- lack of orgasm or frequent protection with interrupted sexual 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
- Advanced varicose veins of the small pelvis can manifest with symptoms such as swollen veins in the groin, thighs and buttocks. Venous nodes can also be detected by manual examination.
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 phase, veins with a diameter of 10-13 mm are identified, which are located under the lower edge of the left ovary, with pronounced dilated 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 supporters of conservative and gentle treatment: to achieve maximum effect with minimal intervention in the body. And when the disease can be cured without surgery, drugs, injections and vitamins are prescribed to reduce pain and other symptoms of pelvic varicose veins. Also for normalizing blood flow and removing risk factors for clogging of blood vessels. Doctors accurately calculate the dosage of drugs for each case to help the body cope with the disease almost independently.
Strict adherence to normal working conditions is prescribed, with the exception of heavy physical exertion and prolonged stay in one position. Relax. 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, 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 food is 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 quitting 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 blood vessel walls and reduce their elasticity.
A contrast shower on the perineal area is recommended. Breathing exercises: slow and deep inhalation and exhalation using the abdominal muscles. Water procedures. Various relaxation exercises.
We strongly recommend that you do not 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 certain case. Wearing compression stockings 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 Compression Stockings article or during the consultation, the phlebologist will provide all the information.
When the patient complains of frequent unbearable pain in the pelvic area, the phlebologist prescribes non-steroidal anti-inflammatory drugs and painkillers. Use must be in accordance with the doctor's recommendations.
If conservative treatment does not give 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 are worried about pain during and after surgery and are surprised that it is completely gone. Therefore, do not be afraid, painlessness has been proven by many years of experience of doctors. You will be able to return home the day after surgery.
In the absence of timely and proper treatment, the patient experiences worsening symptoms and quality of life. For women: impossibility of independent pregnancy and childbirth. For men: weight and inability to lead an active lifestyle.
With conservative treatment, the patient's recovery takes place gradually, directly during the treatment. After the operation, the patient recovers easily and quickly. You will be able to walk independently the very next day after the operation.
Measures for the prevention of varicose veins of the small pelvis
Prevention aims to eliminate the risk of disease and symptoms. Here are some simple steps to help you:
- Moderate physical activity: walks, exercises. Muscle movement keeps blood flowing through the veins, which is why it's important to move.
- If you work sitting or standing, try to take breaks every 30 minutes to move around a bit. For example, take a walk, put the kettle on, take things to the shelf.
- It is recommended for women to avoid strenuous and excessive sports activities: swinging, lifting 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 right. Eat more vegetables and fruits. Eat less fast food, fatty, floury and spicy food.
- Consult a phlebologist and do a set of exercises at home.