Varicose veins of the pelvis: treatment

causes of pelvic varicose veins

This disease is poorly understood, although several thousand observations have been described with diagnosis and subsequent treatment.

The great variety and non-specificity of the clinical picture of varicose veins of the pelvis lead to gross errors in the diagnosis, which in the future affects the consequences.

Features of varicose veins of the pelvis

The pelvic veins are several times longer than the arteries, which leads to their greater capacity. This is due to the phylogeny of the vascular system of the pelvic region. The pelvic veins are highly adaptable and potentially prone to remodeling, which contributes to the formation of a tightly intertwined network.

The speed and direction of blood flow are regulated by valves that are controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous network.

When the valves stop performing their functions, blood stagnation develops, this leads to vascular pathology and the formation of varicose veins. The uniqueness of the pelvic veins lies in the fact that the wide ligaments of the uterus, which keep the lumen of the vessel wide, can narrow it, causing pathology.

Causes

Pathological pelvic venous dilatation may be due to the following reasons:

  • Blood tract disorders;
  • deletion of the venous trunk;
  • Compression of concomitant trunks by altered uterine position, eg in retroflexion;
  • ovarian valve vein insufficiency (congenital or acquired);
  • Obstructive postphlebitis syndrome;
  • Connective tissue pathology;
  • Arteriovenous angiodysplasia;
  • Prolonged sitting, hard physical labor;
  • Varicose veins of the lower extremities;
  • Pregnancy (3 or more) and childbirth (2 or more);
  • Diseases of the female genital area (chronic salpingo-oophoritis, ovarian tumors, uterine fibroids and genital endometriosis);
  • Adhesion of the pelvic organs;
  • Obesity.

Classification by degree of disease

The following degrees differ in the size of the varicose vein:

  • up to 0, 5 cm, "corkscrew" stroke of the vessels;
  • 0, 6-1 cm;
  • more than 1 cm.

Variants of the course of the disease

  • varicose veins of the perineum and vestibule of the vagina;
  • pelvic venous congestion syndrome;

Symptoms

  1. The most common - frequent pain in the lower abdomen, perineum after prolonged static and dynamic overexertion. The pain intensifies in the second phase of the cycle, after hypothermia, fatigue, stress, exacerbations of various diseases.
  2. Feeling out of place, pain during and after sex.
  3. Dysmenorrhea - menstrual disorders, including pain.
  4. Secretion, more than normal, of the glands of the genital tract.
  5. Blood stagnation leads to infertility, miscarriage, abortion.
  6. Impaired urination due to varicose veins of the bladder.

Diagnostics

Diagnosis of the disease only by complaints is successful in only 10% of cases.

Palpation of the inner walls of the pelvis allows you to feel the elongated seals and venous nodes. When viewed in the mirror, cyanosis of the vaginal mucosa is seen.

diagnostic options for pelvic varicose veins

The chosen procedure is ultrasound examination with color Doppler mapping, which allows to detect not only varicose ovarian veins, but also venous thrombosis, post-thrombophlebitis occlusions. Ultrasound shows curvature, "worm-like" structures without signal reflection, located on the lateral surface of the uterus.

The Doppler effect is based on the "hue" in blue and red, venous and arterial blood flow, respectively.

The device for ultrasound examination with the help of a special program detects the movement of blood from the sensor and in the other direction, calculates the speed of blood flow and the type of vessel.

But the exact definition of a vein or artery remains with the doctor. The Doppler method works in almost all cases, the exceptions to the rules are dictated by our body, because the blood that flows from the heart is not always arterial and vice versa.

In this way, the ultrasound doctor sees this arterial or venous vessel, its size, the speed of blood flow in it and many indicators that are not necessary for the average person, but play an important role in the diagnosis. Transabdominal and transvaginal sensors are used for this.

In 5. 7% of cases the disease is recognized by chance during screening. Usually the diameter of the ovarian vein is 0. 4 cm.

CT and MRI are very accurate. With these methods it is possible to detect the accumulation of varicose veins in the ligaments of the uterus, ovaries and around these organs. It is possible to determine concomitant pathology.

Phlebographic examination is a very reliable method.

Contrast is performed at the height of the Valsalva test, relative to blood flow. This allows you to see exactly the damage to the valve.

Left radioscopy, renal phlebography, superselective phlebovarioscopy and phleboubiography on both sides are also used. These methods make it possible to determine hemodynamic and anatomical changes in the renal veins and the places where the veins of the gonads flow into them.

Superselective phlebovarioscopy is performed by catheterization of the veins of the gonads through the contralateral femoral or subclavian vein, followed by contrast injection.

Most of the blood from the varicose veins of the ovarian plexus is pumped through the ovarian vein. But in conditions of hypertension, this occurs through the extraorganic uterine veins in the internal iliac vein. The plexus of the veins, through which leakage can occur, includes the sacral and urinary bladder.

In left-sided phleboovaricography there are 3 stages of venous stasis in the uviform plexus of the left ovary:

  1. There is no leakage from the plexus of the left ovary, or it follows an additional short path.
  2. There's an extra long way to go.
  3. You see two additional outbound paths or one additional and auxiliary.

In stages 2 and 3, varicose veins form on the uviform plexus of the right ovary.

Laparoscopy is used for differential diagnosis. The pathologically curved veins are located in the area of ​​the ovaries, in the direction of the round and wide ligaments. They look like large cyanotic conglomerates with a thin and tense wall.

The complexity of the diagnosis lies in the fact that the disease often lies behind signs of inflammation, differs in clinical manifestations, masked as endometriosis, prolapse of internal organs, postoperative neuropathy and many extragenital diseases.

Treatment

The main goal of treatment is to eliminate the reflux in the veins. In the early stages of the disease, conservative treatment is used. In the later stages of the disease, surgery is the treatment of choice.

Conservative treatment

treatment of varicose veins of the pelvis with drugs

It consists in normalizing venous tone, improving hemodynamics and trophic processes.

Symptomatic treatment of individual symptoms. Non-steroidal anti-inflammatory drugs for pain, bleeding - hemostatic therapy.

The main drugs in conservative treatment are venotonic drugs and antiplatelet agents.

Phlebotonics - improves the tone of the vessel wall and increases blood flow. With this disease it is better to consult a gynecologist for some medications.

Physiotherapy is an important method.

Surgical treatment

  1. Resection of varicose veins.
  2. Gonado-kavalen maneuver.
  3. Sclerotherapy in laparoscopy.
  4. Occlusion of ovarian veins using X-ray endovascular methods.

Folk remedies

Since the main factor at the beginning of the disease is the weakness of the valvular apparatus, all folk remedies used for varicose veins of the lower extremities are also used for this pathology.

The most commonly used are: hazel, hops, nettle, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, string, pollen and many other plants.

It is effective: treatment with baths with oak, chestnut, willow, chamomile, pharmacy, dried herbs, St. John's wort, string.

Prevention

  1. The first thing to do if you have any of the complaints, predictors, or conditions listed above is to contact your gynecologist.
  2. It is necessary to normalize the mode of work and rest, try not to stand for a long time in an upright position, physical strain.
  3. Do prevention exercises "pedal", "birch stand", "scissor legs"
  4. Stick to a diet: eat foods high in vitamins E, P, C, try to eat only white meat, less fatty meat, replace it with fruits, vegetables, cereals.
  5. Drink plenty of fluids, but not less than 1, 5 liters per day.
  6. Get rid of excess weight, bad habits.
  7. Consult your doctor about wearing compression garments, this will improve blood flow from the lower extremities, thus reducing congestion in the pelvis.
  8. Avoid baths, saunas, steam baths, hot baths.

In order not to get so difficult to diagnose the disease, you should follow the preventive recommendations listed above. Treat your health as the most valuable thing in life.

For the slightest suspicious symptoms that you cannot get rid of within a few days, you should see your doctor. He must provide you with highly qualified help and save you from suffering.

06.11.2020