Varicose veins of small pelvis

Varicose veins pelvic – ectasia of the vessels from the venous system of the pelvis, which leads to disruption of bleeding from internal and external sexual organs. Shows a visible extension of all the veins, accompanied by local edema, a feeling of weight and severe pain, bleeding. Feature of pelvic pain, dysmenorrhoea, dyspareunia and other symptoms. Varicose veins of the pelvis is diagnosed by gynecological examination and ultrasound, venography, CT, laparoscopy. Syndrome treatment may be conservative (pills, physical therapy) or surgical (embolization of specific veins, phlebectomy, etc).

General information

varicose veins of small pelvis

Varicose veins of the pelvis – disease of the pelvic veins associated with a breach of its architectonics and the stagnation of venous blood in the pelvis. In the literature, varicose veins of the pelvis is also indicated by the terms "syndrome of the pelvic venous plethora", "varicocele in women", "chronic pelvic pain syndrome". The prevalence of varicose veins of the pelvis increases with age: from 19.4% in girls under the age of 17 years, that 80% of women in perimenopause. The most often pathology of the pelvic veins is diagnosed during their reproductive period, in patients in the age group of 25-45 years. In most cases (80%) of varicose transformation of the influence of the ovarian vein is extremely rare (1%) is observed in the veins of the broad ligaments of the uterus. In accordance with modern medical approaches to the treatment of varicose veins is to be done, not so much with regard to obstetrics, but primarily from the perspective of phlebology.

Causes of varicose veins of the small pelvis

On the basis of varicose veins of the pelvis, is considered a connective tissue dysplasia, which occurs in 35% of healthy people. This condition is congenital and is characterized by reduction in content of certain types of collagen that contribute to the reduction of the strength of the connective tissue, including the component of the vessel wall. The extreme manifestation of this pathology may be underdevelopment or absence of the morphological component of the vascular wall. Systemic lesions of connective tissue due to the frequent combination of varicose veins of small pelvis varicosis veins of the lower extremities and hemorrhoids. In addition to the connective tissue, some of the "debilitating" effect on the tone of the venous system of small pelvis in women who have sexual hormones (mainly progesterone), and thrombosis of the pelvic veins.

Factors that increase the risk for varicose veins of the pelvis, are heavy physical exertion; work, coupled with the prolonged forced presence in the standing or sitting, pregnancy and childbirth, the pelvis, the lack of orgasm in women. Gynecological diseases, the most important influence on the development of varicose veins are endometriosis, prolapse of the uterus, tumors of the uterus and ovaries, and varicose veins of the uterus, etc., has Not ruled out starting the role of hormonal contraceptives and hormone replacement therapy.

Classification of varicose veins of the small pelvis

Varicose veins of the pelvis can manifest itself in two forms: varicose veins of vulva and perineum syndrome, and venous plethora. More than half of the cases, both these forms of cause and support for each other. Insulated, strong and perineal varicose veins often occurs due to reflux of blood through a special vessel with a lesion of the external sexual veins and the tributaries of the great saphenous vein. Found in 30% of pregnant women, after childbirth is saved between 2-10% of women. The main precipitating factor for varicose veins of perineum and vulva is the pressure of the growing uterus on the iliac and inferior caval veins. A prerequisite for varicose veins of the pelvis perform the reflux vein into the ovarian vein.

Be awarded 3 degrees of severity of varicose veins of small pelvis taking into account the diameter and localization of venous disease:

  • 1 rate – blood vessels have a diameter of 0.5 cm and wrinkled, of course; the injury can affect any of the venous plexuses of small pelvis;
  • Level 2 – blood vessels have a diameter of 0.6-1 cm; injuries, which can carry a total of the character or affect the ovarian plexus, or other veins or arcuate veins of the myometrium;
  • Class 3 – the blood vessels have a diameter of more than 1 cm with varicose veins coupled type, or a type of trunk.

Symptoms of varicose veins of the small pelvis

On the basis of the clinical picture of different of varicose veins is visible to the eyes of the extension of venous vessels in this area. Subjective complaints may include a feeling of itching, discomfort, heaviness and severe pain in the region of the external genitals. In the review it is possible to discover the swelling of the labia. You can join in spontaneous or posttraumatic bleeding, often provoked by sexual intercourse or childbirth. Due to the thinning of the venous wall and the high pressure in the varicose veins it stops bleeding, which is associated with certain difficulties. The other complication varicose veins of this localization can become acute thrombophlebitis of the veins of the perineum. In this case, there may be severe pain, redness and swelling of the skin of the perineum. The varicose veins become tight and painful to the touch. Developing a hyperthermic syndrome increased body temperature to 37,5-to 38.0 °C.

causes of varicose veins of the small pelvis

Another form of varicose veins of the pelvic syndrome venous plethora – can give a polymorphic clinical picture, is often taken for inflammatory gynecological diseases, colitis, cystitis, sciatica, etc., the Most constant symptom is pain in the lower part of the abdomen, with varying degrees of intensity and character, and irradiation. Most patients describe the feeling as painful, radiate to the lumbar region, the groin or crotch. Almost half of women with varicose veins of the pelvis mark strengthening of pain in the second phase of the menstrual cycle. It often happens, that the pain provoked by intercourse, prolonged sitting or standing, physical activity. By syndrome of venous plethora of the pelvis is usually the presence of a pronounced premenstrual syndrome, dyspareunia, dysuric disorders.

The diagnosis of varicose veins of the small pelvis

The diagnosis of varicose veins of the pelvis consists of the standard pelvic examination, ultrasound scanning of the OMT programme and the veins of the lower extremities, pelvic venography, CT scan of the pelvis, laparoscopy. In the treatment of patients with suspected varices must include a gynecologist.

During examination of the external genitalia found dilated superficial veins in the vulva and the perineum; when vaginal study determined cyanosis of the vaginal wall, pain on palpation of the abdomen. For confirmation of varicose veins allows sonography of the pelvic organs, the most informative is ultrasound in combination of THIS+TV access. The study not only provides the opportunity for the identification of organic pathology, but also with the ultrasonic detection of conglomerates of varicose veins with altered blood flow, pathological venous reflux. According to the ultrasound of the veins is determined to reduce the maximum speed of blood flow in the uterine and internal iliac out. Assessment of the venous condition of the patient, it is recommended to perform imaging, an ultrasound of the veins of the lower extremities.

To study the localization and prevalence of varicose veins of the pelvis, the condition of the valve system and venous anastomoses, and detection of blood clots with special venography. The syndrome of venous plethora of shows, a selective process, which involves the injection of contrast directly into the ovarian vein. With isolated varicose veins uses contrasting veins of the perineum. The current change comes an x-ray CT of the small pelvis organs, are nothing less diagnostic importance. In the context of the differential diagnosis, as well as the lack of informativeness of these methods, resort to diagnostic laparoscopy.

Treatment of varicose veins of the small pelvis

During pregnancy is possible only symptomatic therapy of varicose veins in the pelvis. Recommended wearing compression socks, medication on the recommendation of the vascular surgeon. In II-III trimester, the treatment of varicose veins of the perineum. If in connection with varicose veins there is a high risk for bleeding during spontaneous labour, the choice in favor of operational delivery.

Conservative tactics may be effective in varicose veins 1-2 degrees. Of course the reception of special preparations, nonsteroidal anti-inflammatory drugs, exercise therapy, thermal contrast shower, the normalization of work conditions and physical activity, the selection of compression hosiery and other measures, which may help slow the progression of varicose veins and significantly improve health. Upon the occurrence of dysfunctional bleeding from the uterus, which is assigned to a particular therapy. In some cases, the patient may requires the assistance of a therapist.

Strong pain syndrome and varicose veins of the small pelvis 3 degrees are the indication for surgical treatment of pathology. Modern methods of minimally invasive surgery include embolization of the ovarian veins, which is carried out in the context of a specific control. During the surgery under local anesthesia in the lumen of the vessel material is introduced or installed a special spiral, arising from the game end/occlusion of the gonadal vein. A possible alternative may be resection of the veins with special access or their endoscopic clipping. If the cause for varicose veins is a disease of the uterus, is made of plastic its ligamentous apparatus.

With isolated varicose veins can be performed phlebectomy in the crotch. The operation is often supplemented by a resection of the small or large labia. In the case of a combination of varicose veins of the perineum and lower extremities have shown a special procedure.

The prevention of varicose veins of the small pelvis

the prevention of varicose veins of the small pelvis

Preventive measures to reduce the risk of occurrence and progression of varicose veins of the pelvis, are reduced mainly to the normalization of life. In this row the leading role belongs to the exception of long-term static and strenuous exercise, correction of the diet (inclusion of a large number of fruits and vegetables), avoiding alcohol and Smoking. At the first signs of varicose veins and the recommended therapeutic breathing exercises, wearing compression hosiery, prevention programs conservative therapy. In this case, it is possible to achieve long-term remission and improve the quality of life of patients.