Treatment of varicose veins of the small pelvis in women.

12 December 2023

Varicose veins of the pelvis are a relatively new disease, which 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. Varicose veins of the pelvic veins additionally cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.

What are varicose veins of the pelvis?

The essence of the pathology is that the veins dilate, fill with blood and are overstretched. The liquid part of the blood leaks through the walls, causing tissue inflammation.

Causes of dilated pelvic veins.

Three main mechanisms of varicose veins of the small pelvis have been established:

insufficiency of the valves of the pelvic veins: they must allow blood to pass only to the heart, but if the valve apparatus fails, part of the blood returns;
obstruction of pelvic vessels (blockage, obstruction);
Hormonal changes in a woman's body that increase the permeability of the venous wall.

Some women have underdeveloped or absent valves from birth. An important role of heredity in the development of varicose veins of the small pelvis has been established. 50% of women have a burdened family history: cases of varicose veins of the pelvic organs among close relatives. Some genes responsible for the development of uterine varicose veins have already been identified: FOXC2, TIE2, NOTCH3. Mutations in them cause weakness of the venous wall or valve insufficiency.

Pregnancy can be a trigger for the development of varicose veins of the small pelvis. A pregnant woman's hormonal levels change and the amount of blood circulating through the body increases by 30%. Additionally, the capacity of the pelvic veins increases by 60% due to mechanical compression of the veins by the enlarged uterus and increased progesterone production. The vessels remain expanded during pregnancy and for an additional month after childbirth.

In addition to uterine compression, other risk factors include:

endometriosis;
prolonged sitting or standing position (leads to stagnation of blood in the pelvic organs);
congenital structural features of blood vessels.

In 3% of women, the direct cause of the disease is May-Turner syndrome. This is the 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 syndrome.It manifests itself as visually noticeable dilated vessels of the vulva and perineum. Additionally, in some women, the veins in the buttocks, pubis, and groin become larger. At the end of the day, lips may swell.
Pain syndrome.With dilated varicose vessels of the small pelvis, this becomes the main reason for consulting a doctor and undergoing treatment. Pain characteristics: constant, painful, localized in the lower abdomen (associated with the uterus) and radiating to the thighs and perineum. The pain intensifies with physical activity and prolonged static position of the body. They decrease after resting in a horizontal position. Pain may increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
Dysfunction of the pelvic organs.Very often, due to varicose veins of the pelvis, the menstrual cycle is disturbed. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with the overflow of blood from the venous bed of the pelvic organs. Pain may persist from half an hour to 1 day after contact. The third most common group of symptoms is dysuria. Usually there is increased urination, less often - urinary incontinence.
Psychoemotional disorders.They arise due to prolonged pain and decreased quality of sexual life. Mainly depression develops.

The peculiarity of varicose veins is that the severity of the symptoms does not have a direct correlation with the diameter of the dilated vessels. That is, in severe forms of pathology, symptoms may be absent, and vice versa: they can be very pronounced even at the initial stage.

Diagnosis of varicose veins.

The main diagnostic method is ultrasound. It is performed transabdominally (through the abdomen) and transvaginally (through the vagina). Different methods allow you to see different glasses.

The effectiveness of varicose vein diagnosis increases with modern ultrasound options: color mapping and Power Doppler.

Contrast radiography: pelvic phlebography and selective oophorography.
CT and MR venography are more informative diagnostic methods than conventional radiographs. Additionally, they are less invasive: contrast can be injected into the cubital vein and MRI is informative even without the use of contrast.
Radionuclide techniques.

Conservative treatment of varicose veins.

Conservative therapy is the main method if there are no indications for surgery to remove the pelvic veins. In addition, it complements surgery. Varicose veins are not a local disease, but a systemic one. Veins may dilate, if they are not already dilated, in other places, most often in the legs. The use of drugs and procedures can increase the tone of the venous wall and slow the progression of varicose veins.

medicines for varicose veins of the small pelvis;
compression shirt;
herbs (most medicines for varicose veins of the small pelvis are created on a herbal basis);
physiotherapy;
physiotherapy.

The main method of therapy for varicose veins is taking medications. All other methods are only auxiliary.

The drugs are good mainly because they affect the veins of the entire body, and not just the pelvis. They increase its tone and reduce the permeability of the vessel wall. Most often, diosmin preparations are used for varicose veins. According to indications, the treatment regimen includes hormonal agents. For symptomatic therapy, non-steroidal anti-inflammatory drugs are prescribed, which reduce pain. Many patients need antidepressants.

Compression therapy is most commonly used for varicose veins in the legs. When the pelvic veins are affected, it is rarely used. If, when the veins in the legs are affected, compression stockings or stockings that squeeze the lower part of the extremities are used, then with varicose veins of the small pelvis, on the contrary, compression is needed in the upper part . Compression shorts are used that compress the upper third of the thigh, the pelvic area and the anterior abdominal wall. Please 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 dilated pelvic veins.

Invasive procedures and surgeries help eliminate the manifestations of pelvic varicose veins and reduce the risk of complications. They are performed in different vessels of the pelvis, depending on the characteristics of the disease.

Interventions on the vessels of the perineum.

Miniphlebectomy is used to remove veins in the perineum and buttocks. It is a minimally invasive intervention that consists of removing veins through minimal incisions. It has obvious advantages: quick recovery, minimal risk of complications, good aesthetic result.

But miniphlebectomy is not always possible. It is not suitable for removing varicose veins of the labia majora and minora. The veins must be removed using longer incisions. In case of varicose veins of the labia minora, resection followed by plastic surgery may be necessary.

Minimally invasive procedures are also used: scleroobliteration of the vulvar and perineal veins. Doctors inject liquid or foam sclerosants into veins. As a result, these veins stick together, become invisible, and the blood stops.

These treatment methods for dilating blood vessels 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 dilated veins. To reduce the risk of relapse, during treatment the doctor must exclude pelvic-subcutaneous venous reflux.

Interventions on gonadal vessels

The goal of varicose vein treatment is to eliminate retrograde (backward) blood flow in the ovarian vessels. As a result, blood supply to the pelvic venous plexuses decreases. These interventions are considered the most effective.

The operation to eliminate varicose veins is technically simple and non-traumatic. Trauma is further reduced when an endoscopic technique is used; In this case, the operation is performed through minimal incisions. The surgical method is also very effective. Chronic pelvic pain after vein removal disappears in 100% of patients between 1 and 2 months after surgery. The risk of relapse within 5 years after observation does not exceed 3%.

You can do without surgery. Embolization is used for treatment. Sclerosing drugs (glues) or a coil are introduced through the blood vessels into the ovarian vein, causing blood clots to form, eliminating dilation, and closing the vein completely. According to several authors, the effectiveness of the method is 65-95%. Although less effective than surgical vein removal, the advantage is that it is minimally invasive, which is why endovascular procedures are among the standard methods for treating pelvic varicose veins in women.

Interventions on the renal and iliac vessels.

Have limited use. Clinical situations in which these types of interventions are needed are rare.

Operations on the left renal vein in women are performed in case of compression, which leads to increased pressure in it. The doctor moves the vein and creates a new anastomosis (connection) between the left renal vein and the inferior vena cava. He also performs ovarian vein resection.

Operations on the left iliac vein are performed for May-Turner syndrome. Doctors place an intravascular stent in the left common iliac vein (installation of a frame inside the vein). This is a rare operation that is performed only in specialized centers.

Where to go

To treat varicose veins, contact the SOYUZ clinic. We perform minimally invasive procedures and surgeries. The interventions are carried out by experienced doctors using the latest equipment. All women experience pelvic pain after surgery.

Causes of varicose veins of the pelvis.

The most common risk factors for varicose veins are:

sedentary and sedentary lifestyle;
"aortomesenteric clamps" syndrome;
pregnancy and childbirth history;
genetic predisposition;
congenital anatomical features of the renal veins;
endometriosis;
injuries to the pelvic area, etc.

Treatment of varicose veins of the small pelvis in women.

Causes of varicose veins of the pelvis.

According to international studies, almost a third of all women experience chronic pelvic pain. The causes of chronic pelvic pain are varied, but are usually associated with the presence of ovarian pathology or varicose veins of the small pelvis. The symptoms of venous stagnation in the pelvis are similar to the symptoms of varicose veins in the legs.

In both cases, the venous valves that help return blood to the heart against gravity become weak and do not close properly. This allows blood to flow backward through the ovarian vein, which increases venous pressure and causes varicose veins. Blood outflow is affected by a mechanism similar to that of varicose veins in the legs. The dilated ovarian vein does not have the ability to regulate the reverse flow of venous blood due to insufficiency of the venous valves. An overcrowded venous system causes stretching of the venous wall and secondary dilation of the pelvic vessels, so the disease continually progresses.

Because the cause of pelvic pain is often undiagnosed, no treatment is offered, although it is available. If you have pelvic pain that may worsen during the day when you are standing, you may want to seek a second opinion from an endovascular surgeon to help find the cause of the problem. Pelvic varicose veins can be treated effectively using endovascular surgery methods. Gynecology does not offer effective treatments for this disease.

Treatment of varicose veins of the small 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 get pregnant or cause problems during pregnancy. Regardless of the stage of life at which she has had reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help her deal with them. The clinic creates the most favorable conditions and prescribes effective treatments 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 inadequate blood flow and provoke varicose veins in the pelvis.

No points required. The duration of the procedure varies from 30 minutes to several hours depending on the complexity of the condition.

Symptoms of pelvic varicose veins include:

Discomfort in the pelvis.
Heaviness in the pelvis
Stabbing pain in the pelvis.

These symptoms may intensify with prolonged standing and sitting, during menstrual periods, and during sexual intercourse. Causing discomfort and suffering to women.

The cause of the development of pelvic varicose veins (PVVV) is weak connective tissue. But for the development of the disease, the presence of provoking factors is required.

These factors are:

Physical exercise
Standing and sitting for a long time
Pregnancy and childbirth
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

Varicose veins of the pelvis 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 few. During the examination, expansion of the superficial veins in the area of the perineum and buttocks is rarely observed. Urination disorders due to congestion of 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 may complain of pain of varying intensity in the lower abdomen during sexual intercourse.

Chronic pelvic pain:

dull, annoying pain in the lower abdomen;
pain in the area of the sacrum and coccyx;
pain in the lower back and groin;
frequent urination;
urinary incontinence;
False need to empty the bladder.

Dilated veins in the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin, on the back of the thigh, buttocks).

Enlarged vein on the inner thigh.

Varicose veins of the pelvis and its treatment.

Painful varicose veins of the small pelvis are most often detected in the fair sex. The disease is quite common, but diagnosing it is a complex process. More and more women walk with abdominal pain all their lives and treat an imaginary pathological process, without even thinking that they have varicose veins of the small pelvis.

What are pelvic varicose veins?

Pelvic varicose veins (PVVV) are a disease that affects the elasticity of blood vessels. In medicine, the disease is called in different ways: varicocele (occurring in both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.

Women of reproductive age often suffer from it and it is very important to treat the disease in a timely manner.

What are pelvic varicose veins?

Varicose veins of the small pelvis are the dilation of the vessels through which blood flows from the genitals. In this disease, the veins expand to more than ten millimeters in diameter, causing compression of the nerve endings and pain. Vienna

Why do varicose veins appear in the pelvis?

The causes of varicose veins of the small pelvis in women are considered to be:

compression of blood vessels by the growing uterus during pregnancy;
lifting weights and other physical activities;
sedentary work, sedentary lifestyle;
gynecological diseases: inflammation of the ovaries, endometriosis;
unstable menstrual cycle;
hormonal imbalances and treatment with estrogen-containing medications;
congenital anomalies of the vascular wall;
lack of orgasm or frequent protection through interrupted sexual relations.

Types of varicose veins of the small pelvis.

Phlebologists distinguish two types of varicose veins of the small pelvis:

primary, caused by congenital or acquired dyspareunia
Advanced varicose veins of the small pelvis can manifest 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 small 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) occupy the entire left ovary and are also observed in the right ovary and uterus. At the third stage, veins with a diameter of 10-13 mm are identified, located under the lower edge of the left ovary 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 varicose veins. Doctors are in favor of conservative and gentle treatment: obtaining the maximum effect through minimal intervention in the body. And, when the disease can be treated without surgery, medications, injections and vitamins are prescribed to reduce pain and other manifestations of pelvic varicose vein symptoms. Also to normalize blood flow and eliminate risk factors for blood vessel obstruction. Doctors accurately calculate the dosage of medications for each case to help the body cope with the disease almost independently.

Strict compliance with normal working conditions is prescribed, with the exception of intense physical effort and prolonged stay in the same position. Rest. This improves the patient's quality of life: physical and social activity increases and the psychological state returns to normal.

It is recommended to correct the nature of the diet, a diet with an increase in the level of fiber and the consumption of vegetables, fruits and vegetable oils in moderation is prescribed. 80% of fatty and spicy foods are excluded from the diet, and alcohol is completely excluded. For overweight people, weight correction is recommended 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 walls of blood vessels and reduce their elasticity.

A contrast shower in the perineal area is recommended. Breathing exercises: slow, deep inhalation and exhalation using the abdominal muscles. Water procedures. Various download exercises.

We strongly recommend not self-medicating without consulting a phlebologist. Each patient requires an individual selection of a treatment package, which includes a specific set of physical exercises.

The treatment complex includes the use of compression stockings - stockings or shorts of a certain compression class, suitable for a specific case. Wearing compression stockings improves blood flow from the lower extremities, including the venous plexuses of the perineum and buttocks. On average, use is prescribed for up to 14 days: several hours a day. How to choose the size, compression class and manufacturer, you will learn in the article Compression stockings or during a consultation, a phlebologist will provide you with complete information.

When a patient complains of frequent unbearable pain in the pelvic area, the phlebologist prescribes analgesics and non-steroidal anti-inflammatory drugs. Use should comply with doctor's recommendations.

If conservative treatment does not give results or the disease is in an advanced stage, the phlebologist prescribes sclerotherapy or phlebectomy (surgical intervention) to remove the affected veins. The procedure is absolutely painless and is performed under anesthesia. Many patients worry about pain during and after operations and are surprised that they are completely absent. Therefore, do not be afraid, the painless experience of doctors has shown that it is painless. You will be able to return home the day after surgery.

In the absence of timely and adequate treatment, the patient experiences a deterioration in symptoms and quality of life. For women: inability to get pregnant and give birth on their own. For men: heaviness and inability to lead an active lifestyle.

With conservative treatment, the patient's recovery occurs gradually, directly during treatment. After the operation, the patient recovers easily and quickly. The day after surgery you will be able to walk independently.

Measures to prevent varicose veins of the small pelvis.

Prevention aims to eliminate the risk and symptoms of the disease. Here are some simple steps to help you:

Moderate physical activity: walks, exercises. Moving your muscles keeps blood flowing through your veins, so moving is important.
If you work sitting or standing, try to take breaks every 30 minutes to move around a bit. For example, going for a walk, boiling, taking things to the shelf.
It is advisable for women to avoid strenuous and excessive sports activities: swinging, lifting weights and overcoming incredible distances. These loads are not natural for the female body.
Follow your drinking regimen. An adult needs 30 ml per 1 kg per day.
Eat well. Eat more vegetables and fruits. Eat less fast, fatty, floury and spicy food.
Consult a phlebologist and do a series of exercises at home.