Varicose veins (varicose veins) are a disease accompanied by an increase in length, the formation of serpentine pathological curvature of the veins, irreversible dilation of the vesicles of their lumen and valvular insufficiency. The organs of the lower pelvis are involved in the varicose process. The mechanisms of disease development are different. Doctors include the perineal area, external and internal genitalia as atypical locations.
General information about the pathology
The process of blood flow through the veins takes place in such a way that under physiological conditions conditions are created for the development of stagnation and bleeding.
Varicose veins of the vulva (VV) - vasodilation of the external genitalia. The disease occurs in women who suffer from varicose veins of the pelvis and legs, as well as in pregnant women. In 30% of cases, varicose veins of the pelvis include the perineum and vulva.
The beginning of the treatment of the disease is delayed due to the localization of the intimate place. Women are shy. In some cases, patients do not experience pain or discomfort. But varicose veins during pregnancy, and not only when carrying a fetus, have complications: clogged veins (thromboembolism), sexual sensitivity disorders, pain in the perineum, psycho-emotional problems and family conflicts.
The mechanisms of pelvic obstruction have not been fully elucidated. The cause of the primary form of the disease is called malfunction of the valves of the gonadal (ovarian) veins. This provokes backflow of blood and increases the pressure in the venous nodes of the lower pelvis. Valve failure can be acquired or congenital. It gets worse with age or pregnancy.
The secondary form of VVV of the pelvic organs is associated with gynecological pathologies: endometriosis, tumors of the pelvic organs.
Diagnosis of the disease is difficult due to the fact that there are no specific symptoms of its course. It is based on the results of ultrasound (ultrasound).
To distinguish between primary and secondary forms of pathology, the Valsalva test is used during the sonographic examination. In the secondary cause of varicose veins of the pelvis, it is negative.
Varicose veins of the labia with VBT
A doctor's examination is needed to diagnose varicose veins. The symptoms of the disease are as follows:
- varicose veins of the genitals;
- pain in the external genitalia;
- feeling of heaviness and burning in the perineum;
- swelling of the perineum by the end of the day.
Chronic pelvic pain occurs less frequently (in 30% of cases).
Once the diagnosis is made, a study is performed to determine the degree of complexity of the pathological process and to prescribe adequate treatment. A number of events are taking place:
- examination of the veins of the perineum and legs by ultrasound angioscanning - USAS;
- conducting ultrasound examination of the pelvic vessels, including vaginal, uterine, parametric, ovarian, iliac, inferior vena cava and renal veins;
- according to the indications, multislice computed tomography (MSCT), selective ovaricography and pelvic phlebography (SOFT) are performed.
Doctors call a characteristic feature of varicose veins of the labia with VBT that the disease is constantly progressing and is combined with the transformation of the intrapelvic veins.
Treatment of varicose veins of the vulva with varicose veins of the lower pelvis
IV treatment is prescribed based on symptoms and diagnostic results.
Non-steroidal anti-inflammatory drugs and phlebotropic drugs are prescribed for complex treatment of systemic chronic venous pathology.
Prescribe pharmacotherapy with antiplatelet agents, intra-pelvic blockade with antihypoxants, physiotherapy with ultrasound, therapeutic exercises. Antioxidants and enterobiotics are added to the therapy.
According to the indications, phlebosclerotic treatment is performed - sclerotherapy. The vessel is "sealed" with drugs and a laser. It stops working. The procedure does not use special methods of anesthesia. It is performed on an outpatient basis and has a cosmetic effect.
In pelvic multiple veins, dilation and reverse blood flow through the gonadal (ovarian) veins, surgery to remove the veins is indicated. In varicose enlargement of the labia minora is removed.
Varicose veins of the vulva during pregnancy
Pregnancy is the first most common risk factor leading to VVV. Significant and prolonged increase in the concentration of progesterone in the early stages of pregnancy reduces venous tone and worsens blood flow disorders. Also, VBT, involving the perineum and vulva, is associated with compression of the great veins of the retroperitoneal region (iliac veins and inferior vena cava) by the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Often varicose veins of the vulva appear bilaterally. Signs of disease:
- pronounced enlargement of the veins of the vulva for a period of 18-24 weeks during the first pregnancy, from 12 weeks in re-pregnancy;
- groin discomfort;
- pulling, painful, dull pain in the pelvic area;
- pain during intercourse;
- itching of the vulva;
- swelling of the genitals and perineum.
The signs of the pathology progress with the course of pregnancy. In addition to increasing the size of varicose veins, its thickening is determined by the third trimester. A characteristic symptom of IV is its combination with inguinal varicose veins during pregnancy or varicose veins of the legs.
Instrumental examination for varicose veins in pregnant women is limited to ultrasound and ultrasound of the legs, as painful changes in the venous bed undergo involution in the postpartum period.
In most cases (about 80%), from the first days of birth, the symptoms of varicose veins during pregnancy begin to decrease and are reduced to a minimum of 2-8 months after the birth of the baby. There is no complete return of the diameter of the vessels to their original values.
In 4-8% of women IV does not disappear after birth and the disease progresses.
An interesting feature is the relationship between the end of the feeding period or the reduction in the volume of breastfeeding on the rate of disappearance of varicose veins in the groin in women. The shortened period of breastfeeding is accompanied by a reduction and disappearance of varicose veins and vice versa. This proves that varicose veins of the perineum during pregnancy are associated with changes in hormone levels.
Treatment of varicose veins of the perineum during pregnancy
The basis of varicose vein therapy during pregnancy is phlebotropic treatment. In the majority of fertile women IV begins in the II and III trimesters. Diosmin preparations may be used during this period. The severity of the symptoms of the pathology is reduced by the micronized purified flavonoid fraction. Itching is relieved by zinc paste and H1-histamine receptor blockers.
Low-molecular-weight heparin in a prophylactic dose prevents venous thrombosis and pulmonary embolism (blockage of blood vessels).
As an option for compression treatment, it is prescribed to wear tight elastic underwear with the help of latex or gauze pillows. Relieves puffiness of the labia and the feeling of heaviness. Special compression jersey for women with varicose veins of the vulva helps a lot.
If a complication, such as local thrombophlebitis, develops, surgical treatment is required.
When a conglomeration of genital varicose veins is found, the question of how to give birth arises. In varicose veins of the vulva, natural childbirth is permissible. On the contrary, the risks of surgery during a cesarean section are higher than the onset of bleeding from painful vessels during childbirth. This rarely happens. But varicose veins of the vagina are often performed by caesarean section.
Prevention of varicose veins of the labia
The main factor in the formation of varicose veins in the groin is the carrying of the fetus. It is difficult to name any preventive methods, given the fact that during pregnancy there are a number of limitations to many therapeutic measures. Some tips to follow:
- exclusion of physical and static stress;
- follow a diet;
- performs therapeutic exercises in which the movements accelerate the flow of blood from the legs and lower pelvic organs;
- in case of venous dysfunction, the presence of varicose veins before pregnancy, it is necessary to take phlebotropic drugs, wear compression underwear.
An effective method of prevention is considered surgery of the ovarian veins, surgery for other pathologies associated with varicose veins. This reduces the phenomenon of pelvic venous congestion, reduces the risk of varicose veins of the labia.
Varicose veins of the vulva are a common disease in women with varicose veins of the pelvis, legs or during pregnancy.
In order to improve the quality of treatment of patients with chronic venous diseases, it is important to detect the disease, to distinguish between methods of diagnosis and treatment of this condition.