Varicose veins of the pelvis are a relatively new disease that doctors learned about only at the end of the 20th 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 varicose veins in the pelvis?
The essence of the pathology is that the veins expand, fill with blood and become overstretched. The liquid part of the blood leaks through the walls, causing tissue swelling.
Causes of enlarged pelvic veins
Three main mechanisms for pelvic varicose veins have been identified:
- Insufficiency of the valves of the pelvic veins - they should allow blood flow only to the heart, but when the valve apparatus fails, some of the blood returns;
- Blockage of the pelvic vessels (blockage, obstruction);
- hormonal changes in a woman's body that increase the permeability of the vein wall.
In some women, the heart valves are underdeveloped or missing from birth. It has been found that heredity plays a significant role in the development of varicose veins of the pelvis. 50% of women have a burdensome family history: cases of varicose veins of the pelvic organs in 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 in the 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 the mechanical compression of the veins by the enlarged uterus and the increased production of progesterone. The vessels remain in a dilated state throughout pregnancy and for a 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);
- innate structural features of blood vessels.
In 3% of women, May-Turner syndrome is the direct cause of the disease. This is compression of the left common iliac vein by the right common iliac artery.
Symptoms of dilated pelvic veins
Varicose veins of the pelvis are accompanied by the following syndromes:
- Varicose vein syndrome.It is manifested by visually striking dilated vessels in the vulva and perineum. In addition, some women experience enlargement of the veins in the buttocks, pubic bone and groin. At the end of the day, the labia may swell.
- pain syndrome.With enlarged varicose veins of the pelvis, this is the main reason for a visit to the doctor and treatment. Characteristics of pain: constant, aching, localized in the lower abdomen (in connection with the uterus) and radiating to the thighs and perineum. The pain increases with physical activity and prolonged static posture. They decrease after resting in a horizontal position. It is possible that pain increases in the second phase of the menstrual cycle, which is associated with hormonal changes.
- Dysfunction of the pelvic organs.Most often, disruption of the menstrual cycle occurs due to varicose veins in the pelvis. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with overfilling of the venous bed of the pelvic organs with blood. The pain may last half an hour to a day after contact. The third most common symptom group is dysuria. There is usually an increase in urination, less often urinary incontinence.
- Psycho-emotional disorders.They arise from persistent pain and a reduced quality of sexual life. Most often depression develops.
The peculiarity of varicose veins is that the severity of the symptoms is not directly related to the diameter of the dilated vessels. That is, in severe forms of pathology, symptoms may be absent and vice versa: they may be very pronounced even in the initial stages.
Diagnosis of varicose veins
The main diagnostic method is ultrasound. It is performed transabdominally (through the stomach) and transvaginally (through the vagina). Different methods allow you to see different vessels.
The effectiveness of diagnosing varicose veins is increased by modern ultrasound options: color mapping and power Doppler.
- X-ray with contrast agent – pelvic phlebography and selective oophorography.
- CT and MR venography are more meaningful diagnostic methods than traditional X-rays. In addition, they are less invasive: contrast medium can be injected into the cubital vein and MRI is informative even without contrast medium.
- Radionuclide techniques.
Conservative treatment of varicose veins
If there is no indication for surgical removal of the pelvic veins, conservative therapy is the treatment of choice. In addition, it complements the operation. Varicose veins are not a local disease, but a systemic disease. Veins, if not already dilated, can also dilate in other places, most commonly in the legs. The use of medications and procedures can increase the tone of the vein wall and slow the progression of varicose veins.
- Medicines for varicose veins of the pelvis;
- compression jersey;
- herbs (most drugs for varicose veins of the pelvis are made on a plant basis);
- Physical therapy;
- Physical therapy.
The leading treatment method for varicose veins is taking medication. All other methods are just helper methods.
The drugs are good primarily because they affect the veins of the entire body, and not just the pelvis. They increase their tone and reduce the permeability of the vessel wall. Diosmin preparations are most often used for varicose veins. Depending on the indication, hormonal agents are included in the treatment regimen. Non-steroidal anti-inflammatory drugs are prescribed for symptomatic therapy - they relieve pain. Many patients require antidepressants.
Compression therapy is most commonly used for varicose veins in the legs. When the pelvic veins are affected, it is rarely used. If compression stockings or stockings that compress the lower part of the limbs are used when the leg veins are affected, on the other hand, when varicose veins of the pelvis are affected, compression is required 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 varicose veins in the pelvic area and reduce the risk of complications. Depending on the clinical picture, they are carried out on different vessels in the pelvis.
Interventions on the vessels of the perineum
Miniphlebectomy removes veins in the perineum and buttocks. This is a minimally invasive procedure in which veins are removed through minimal incisions. It has obvious advantages: quick recovery, minimal risk of complications, good aesthetic result.
However, a miniphlebectomy is not always possible. It is not suitable for eliminating varicose veins on the labia majora and minora. Veins must be removed through longer incisions. If there are varicose veins of the labia minora, their resection followed by plastic surgery may be necessary.
Minimally invasive procedures are also used: scleroobliteration of the vulva and perineal veins. Doctors inject liquid or foaming sclerosing agents into the veins. This causes these veins to stick together, become invisible and the blood flow through them stops.
These vasodilation treatment methods are very effective: 95% of patients are satisfied with the result. The disadvantage is the high relapse rate - up to 60% within 7 years of observation after sclerotherapy, up to 40% within 7 years after surgical removal of enlarged veins. To reduce the risk of relapse, the doctor must eliminate pelvic subcutaneous venous reflux during treatment.
Interventions on gonadal vessels
The goal of treating varicose veins is to prevent retrograde (backward) blood flow in the ovarian vessels. This causes the blood supply to the pelvic venous plexuses to decrease. 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 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 resolves in 100% of patients within 1-2 months after surgery. The risk of relapse within 5 years of observation is no more than 3%.
You can do without surgery. Embolization is used for treatment. Through the blood vessels, sclerosing (adhesive) drugs or a coil are introduced into the ovarian vein, which leads to the formation of blood clots, cancels the dilation and completely closes the vein. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical vein removal, their advantage is minimal invasiveness, which is why endovascular procedures are one of the standard approaches to treating pelvic varicose veins in women.
Interventions on the renal and pelvic vessels
Only available for limited use. Clinical situations requiring such interventions are rare.
In women, operations on the left renal vein are performed when there is compression, which leads to an increase in pressure in the renal vein. The doctor relocates the vein and creates a new anastomosis (connection) between the left kidney and the inferior vena cava. He also performs an ovarian vein resection.
In May-Turner syndrome, operations are performed on the left iliac vein. Doctors perform intravascular stenting of the left common iliac vein (installation of a frame in the vein). This is a rare operation that is only performed in specialized centers.
Where
For the treatment of varicose veins, contact the SOYUZ clinic. We carry out minimally invasive procedures and operations. The procedures are carried out by experienced doctors using the most modern equipment. All women experience pelvic pain after surgery.
Causes of varicose veins in the pelvis
The most common risk factors for varicose veins are:
- sedentary, sedentary lifestyle;
- "Aorto-mesenteric forceps" syndrome;
- pregnancy and birth history;
- genetic predisposition;
- congenital anatomical features of the renal veins;
- endometriosis;
- Injuries to the pelvic area, etc.
Treatment of varicose veins of the pelvis in women
Varicose veins of the pelvis are a relatively new disease that doctors learned about only at the end of the 20th 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 in the pelvis
According to international studies, almost a third of all women suffer from chronic pelvic pain. The causes of chronic abdominal pain are varied, but are often associated with the presence of ovarian disease or varicose veins of the pelvis. The symptoms of venous congestion in the pelvis are similar to the symptoms of varicose veins in the legs.
In both cases, the venous valves that return blood to the heart against gravity are weakened and do not close properly. This allows blood to flow back through the ovarian vein, increasing venous pressure and causing varicose veins. The outflow of blood is disrupted by a mechanism similar to that of varicose veins in the legs. Due to the insufficiency of the venous valves, the dilated ovarian vein is unable to regulate the return flow of venous blood. An overcrowded venous system leads to stretching of the venous wall and secondary dilatation of the pelvic vessels, so that the disease progresses continuously.
Because the cause of pelvic pain is often undiagnosed, no treatment is offered, although treatment is available. If you have pelvic pain that may get worse 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. Pelvic varicose veins can be effectively treated using endovascular surgery methods. Gynecology does not offer effective treatment options for this condition.
Treatment of varicose veins of the 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 preferable.
Sometimes the pathology in question can be the cause of the inability to become pregnant or provoke problems during pregnancy. No matter what stage of life you are facing with reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you deal with these problems. 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 circulation, which leads to varicose veins in the pelvis
No stitches required. The duration of the procedure varies between 30 minutes and several hours, depending on the complexity of the disease.
Symptoms of pelvic varicose veins include:
- Pelvic discomfort
- Feeling of heaviness in the pelvis
- Bursting pain in the pelvis
These symptoms can worsen with prolonged standing and sitting, during menstruation and during sexual intercourse. Causing discomfort and suffering to women.
The cause of pelvic varicose veins (PVVV) is weak connective tissue. However, the presence of provoking factors is necessary for the development of the disease.
These factors are:
- Physical movement
- Prolonged standing and sitting
- Pregnancy and birth
- Pelvic trauma
- Tumors of the uterus and ovaries
- Endometriosis
- Indications for embolization are:
- Varicose veins of the pelvis with chronic pelvic pain syndrome
- painful menstruation
- Varicose veins of the external genitalia
- Pain during sexual intercourse
Pelvic varicose veins 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 minor. During examination, dilatation of the superficial veins in the area of the perineum and buttocks is rarely detected. Difficulty urinating due to congestion in 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 varying degrees of pain in the lower abdomen during sexual intercourse.
Chronic pelvic pain:
- excruciating and dull pain in the lower abdomen;
- pain in the sacrum and coccyx area;
- pain in the lower back and groin;
- frequent urination;
- urinary incontinence;
- false urge to empty the bladder.
Enlarged veins on the external genitals (in the perineum, in the lower abdomen, above the pubic bone, in the groin, on the back of the thigh, on the buttocks).
Enlarged vein on the inside of the thigh.
Varicose veins of the pelvis and their treatment
Painful varicose veins of the pelvis are more often found in the fairer sex. The disease is quite common, but diagnosing the disease is a complex process. More and more women suffer from abdominal pain all their lives, treating an imaginary pathological process, without even thinking that they have varicose veins in the pelvis.
What are pelvic varicose veins?
Pelvic varicose veins (PVVV) is a condition that affects the elasticity of blood vessels. In medicine, the disease is called differently: varicocele (in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic algia syndrome.
As a rule, women of childbearing age suffer and it is very important to treat the disease in a timely manner.
What are varicose veins in the pelvis?
Varicose veins of the pelvis are an expansion of the vessels through which blood flows from the genitals. In this disease, the veins expand to a diameter of more than ten millimeters, causing compression of the nerve endings and pain. Vienna
Why do varicose veins develop in the pelvic area?
The following are the causes of varicose veins of the pelvis in women:
- Compression of blood vessels by the growing uterus during pregnancy;
- weight lifting and other physical activities;
- sedentary activity, sedentary lifestyle;
- gynecological diseases: ovarian inflammation, endometriosis;
- unstable menstrual cycle;
- hormonal imbalances and treatment with estrogen-containing drugs;
- congenital anomalies of the vascular wall;
- Lack of orgasm or frequent protection through interrupted intercourse.
Types of varicose veins of the pelvis
Phlebologists distinguish two types of varicose veins of the small pelvis:
- primary, caused by congenital or acquired dyspareunia
- Advanced pelvic varicose veins can present 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 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) cover 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 below the lower edge of the left ovary and with pronounced varicose veins of the right ovary, uterus and small pelvis. In addition, in the third stage, the diameter of the veins of the left and right ovaries is almost the same.
Treatment of varicose veins
The treatment package depends on the degree of development of the varicose veins. Doctors are supporters of conservative and gentle treatment: achieving maximum effect through minimal intervention in the body. And if the disease can be treated without surgery, medications, injections and vitamins are prescribed to relieve pain and other symptoms of pelvic varicose veins. Also used to normalize blood flow and eliminate risk factors for blockage of blood vessels. Doctors accurately calculate the dosage of medication for each case in order to help the body cope with the disease almost independently.
Strict observance of normal working conditions is required, 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 normalizes.
It is recommended to correct the type of diet; a diet with an increase in fiber content and moderate consumption of vegetables, fruits and vegetable oils is prescribed. 80% of fatty and spicy foods are excluded from the diet and alcohol is completely avoided. Weight correction is recommended for overweight people to reduce intra-abdominal pressure on the organs and 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. BecauseThese 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 proceduresVarious 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 specific compression class suitable for a specific case. Wearing compression stockings improves blood circulation in the lower extremities, including the venous plexuses of the perineum and buttocks. On average, it is required to be worn for up to 14 days, i. e. several hours a day. You can find out how to choose size, compression class and manufacturer in the article Compression stockings or in a consultation with a phlebologist.
If a patient complains of frequent unbearable pain in the pelvic area, the phlebologist prescribes non-steroidal anti-inflammatory drugs and painkillers. The application must comply with the doctor's recommendations.
If conservative treatment does not bring results or the disease is in an advanced stage, the phlebologist prescribes sclerotherapy or phlebectomy (surgical procedure) to remove the affected veins. The procedure is absolutely painless and is carried out under anesthesia. Many patients worry about pain during and after surgery and are surprised that it doesn't occur at all. Therefore, do not be afraid, the lack of pain is proven by the many years of experience of doctors. You can return home the day after surgery.
Without timely and appropriate treatment, the patient experiences a worsening of symptoms and quality of life. For women: Inability to become pregnant and give birth independently. In men: feeling of heaviness and inability to lead an active lifestyle.
With conservative treatment, the patient's recovery occurs gradually right during the treatment. After the operation, the patient recovers quickly and easily. You will be able to walk independently the next day after the operation.
Measures to prevent varicose veins of the pelvis
Prevention aims to eliminate disease risks and symptoms. Here are a few simple steps to help you:
- Moderate physical activity: walks, exercises. Moving your muscles keeps blood flowing through your veins, which is why it's important to exercise.
- If you have a sitting or standing job, try to take a break every 30 minutes to move around a bit. For example, take a walk, put the kettle on, and put things on the shelf.
- For women, it is advisable to avoid strenuous and excessive sports activities: swinging, lifting heavy weights and overcoming incredible distances. Such stress is unnatural for the female body.
- Stick to your drinking regime. An adult needs 30 ml per 1 kg per day.
- Eat properly. Eat more vegetables and fruits. Eat less fast food, fatty, floury and spicy.
- Consult a phlebologist and perform a series of exercises at home.