Varicose veins of the pelvis – ectasia of the vessels of the venous system of the pelvis, which leads to disruption of bleeding internal and external genitalia. Occurs in view of the extension of all the veins, accompanied by local swelling, feeling of heaviness and severe pain, bleeding. Feature pelvic pain, menstrual pain, pain during intercourse and other symptoms. Varicose veins of the pelvis is diagnosed by gynecological examination and ultrasound, venography, CT scan, laparoscopy. Syndrome treatment can be conservative (pills, physical therapy) or surgical (embolization particularly veins, phlebectomy, etc.).
Varicose veins of the pelvis – disease of the pelvic veins associated with the violation of their architecture and the stagnation of venous blood in the pelvis. In the literature, varicose veins of the pelvis is also marked with the terms "syndrome of pelvic venous plethora", "varicocele in women", "chronic pelvic pain syndrome". The prevalence of varicose veins of the pelvis increases with age: 19.4% of girls under the age of 17-years, 80% of women during perimenopause. Most often, the 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 veins change affects the ovarian vein is extremely rare (1%) is observed in the veins of the broad ligament of the uterus. According to the modern medical approaches to the treatment of varicose veins should be performed, not so much from the point of view of a gynecologist, but primarily from the point of view, phlebology.
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 a decrease in the content of some of the collagen reduction in the strength of connective tissue, including part of the vessel wall. The extreme manifestation of this pathology may be underdevelopment or absence of the morphological part of the vessel wall. Systemic lesions of the connective tissue often due to a combination of varicose veins of small pelvis varicost the veins of the lower extremities and hemorrhoids. In addition, the connective tissue, a certain "debilitating" effect on the tone of the venous system of small pelvis in women is the sex hormones (mainly progesterone), and thrombosis of the pelvic veins.
Factors that increase the risk of varicose veins in the pelvis, are heavy physical exertion; work, coupled with the long-term to the presence of standing or sitting, pregnancy and childbirth, the pelvis, the lack of orgasm in women. Gynecological diseases the most significant impact 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. it is not excluded from the role of hormonal contraception and hormone replacement therapy.
Varicose veins of the pelvis can occur in two forms: varicose veins of vulva and perineum syndrome, and venous plethora. More than half of the cases, both these forms of reason and to support each other. Isolated strong and perineal varicose veins often occur as a result of reflux of blood through a special vessel, which is damage to the external sexual veins and tributaries of the great saphenous vein. Found in 30% of pregnant women, after childbirth is saved from 2-10% of women. The most important precipitating factor for varicose veins of perineum and vulva is the pressure of the growing uterus on the iliac and inferior caval veins. The condition of varicose veins in the pelvis to perform venous reflux in the ovarian veins.
Divided into 3 degrees of severity of varicose veins of small pelvis taking into account the diameter and localization of venous disease:
On the basis of the clinical picture of the various varicose veins are visible because of expansion of venous vessels in this area. Subjective complaints may include sensations, itching, discomfort, heaviness and severe pain in the region of outer genitals. When research may reveal swelling of the labia. Can be related to spontaneous or post-traumatic bleeding, often provoked by sexual intercourse or childbirth. Because of the thinning of the venous wall, and the high pressure in the varicose veins to stop this bleeding is associated with certain difficulties. Another complication of varicose veins, this localization may become an acute thrombophlebitis of the veins of the perineum. In this situation, you can experience severe pain, redness and swelling of the skin of the perineum. Varicose veins become tight and painful to the touch. Develop a hyperthermic syndrome, increased body temperature to 37,5-38,0 °C.
Another form of varicose veins in the pelvic syndrome venous plethora – can provide a diverse clinical picture, often taken for inflammatory gynecological diseases, colitis, cystitis, sciatica, etc. The most constant symptom is pain in the lower abdomen, in different volume and nature and radiant. Most patients describe the feeling as aching, radiating to the lumbar region, the groin or crotch. Almost half of the women with varicose veins of the pelvis implies a 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. Eye syndrome venous plethora of the pelvis is typically the presence of a pronounced premenstrual syndrome, dyspareunia, dysuric disorders.
The diagnosis of varicose veins of the pelvis consists of the standard pelvic exam, ultrasound scanning of the OMT and the veins of the lower extremities, pelvic venous x-rays, a CT scan of the pelvis, laparoscopy. In patients with suspected varices should consult a gynecologist.
During the inspection of the external genitalia found dilated superficial veins of the vulva and the perineum; when vaginal study determined the cyanosis of the vaginal walls, pain on palpation of the abdomen. Strengthen varicose veins with the help of sonography of the pelvic organs, the most informative is ultrasound combined with TA+TV-connection. The study not only provides an opportunity to identify organic pathology, but also the use of ultrasound to detect groupings of varicose veins change in blood flow, pathological venous reflux. According to the ultrasound of the blood vessels is determined by the reduction of the peak blood flow velocity in the uterine and internal iliac veins. Evaluation of the venous condition of the patient is recommended to do ultrasound imaging of the veins of the lower extremities.
The study of the localization and prevalence of varicose veins in the pelvis, the condition of the valve system and venous anastomoses, and detection of blood clots using special venography. Syndrome venous plethora may be showing a selection procedure, involving the injection of contrast directly into the ovarian vein. Isolated varicose veins to use contrasting veins of the perineum. Currently, the transformation becomes x-ray, CT scan of the small pelvic organs, are of equal diagnostic importance. As part of the differential diagnosis, as well as the lack of informativeness of these methods, resort to diagnostic laparoscopy.
During pregnancy is possible only for the symptomatic treatment of varicose veins of the pelvis. Recommend wearing support stockings, medication on the recommendation of the vascular surgeon. II-III trimester of pregnancy can be treatment of varicose veins of the perineum. If in the context of varicose veins is a high risk of bleeding during spontaneous labor, the choice is made in favor of operative delivery.
Conservative tactics can be effective varicose veins 1-2 degrees. Of course, the reception of special preparations, anti-inflammatory drugs, physical therapy, thermal contrast shower, normalization of work conditions and physical activity selection of compression hosiery and other measures can slow the progression of varicose veins and significantly improve your health. When the occurrence of uterine bleeding is configured with special care. In some cases, the patient may require the help of a therapist.
Strong pain syndrome and varicose veins of small pelvis 3 degrees are an indication for surgical treatment pathology. Modern methods of minimally invasive surgery include embolization of the ovarian veins, which is carried out under special supervision. During the surgery under local anesthesia lumen of the vessel material has been introduced or installed in a special twist, resulting in destruction/occlusion of the gonadal vein. A possible option could be the resection of the veins, which have special use rights or endoscopic surgery. If the cause of varicose veins disease of the uterus, is made of plastic its ligamentous apparatus.
Isolated varicose veins can be performed phlebectomy branch. The operation is often supplemented by resection of the small or large labia. In case of a combination of varicose veins of perineum and lower extremities have shown a special procedure.
Preventive measures aimed at reducing the risk of onset and progression of varicose veins in the pelvis, are reduced mainly to the normalization of a way of life. In this row the leading role belongs to the exception of long-term static and strenuous exercise, correction of the diet (the inclusion of a large number of fruits and vegetables), avoiding alcohol and Smoking. At the first signs of varicose veins and recommended therapeutic breathing exercises, wearing compression stockings, preventive courses of conservative treatment. In this case, it is possible to achieve long-term remission and improve patient quality of life.
