This disease is poorly understood, although several thousand observations with diagnosis and follow-up have been described.
The variety of diversity and non-specification of the clinical picture of small pelvic varicose veins lead to major errors in the diagnosis, which in the future affect the consequences.
Characteristics 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 densely intertwined network.
The speed and direction of blood flow are regulated by valves, which are controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous network.
When the valves stop working, blood stagnation develops, which leads to vascular pathology and the formation of varicose veins. The uniqueness of 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 of occurrence
Pathological enlargement of the pelvic veins may be due to the following reasons:
- Disruption of the outflow tract;
- Extermination of the vein trunk;
- Compression of collateral trunks from a changed position of the uterus, for example, in retroflection;
- ovarian valve insufficiency (congenital or acquired);
- Obstructive postphlebitic syndrome;
- Connective tissue pathology;
- arteriovenous angiodysplasia;
- Sitting long, hard physical work;
- Varicose veins of the lower extremities;
- Pregnancy (3 or more) and childbirth (2 or more);
- Diseases of the female genital area (chronic salpino-oophoritis, ovarian tumors, uterine fibroids and genital endometriosis);
- Pelvic organ attachment;
- Mbipesha.
Classification according to the degree of the disease
From the size of the varicose vein, the following scales are distinguished:
- up to 0, 5 cm, "cork stopper" course of ships;
- 0, 6-1 cm;
- more than 1 cm.
Variants of the disease course
- varicose veins of the perineum and vaginal vestibule;
- small pelvic venous congestion syndrome;
Symptoms
- Most common - frequent pain in the lower abdomen, perineum after long static and dynamic stress. The pain intensifies in the second phase of the cycle, after hypothermia, fatigue, stress, exacerbations of various diseases.
- Feeling "out of place", pain during and after sex.
- Dismenorrea - menstrual irregularities, including pain.
- More than normal secretion of genital tract glands.
- Blood clots lead to infertility, miscarriage, miscarriage.
- Violation of urination due to dilation of bladder veins.
Diagnosis
Diagnosis of the disease by complaints alone is successful in only 10% of cases.
Palpation of the inner walls of the pelvis makes it possible to feel the elongated seals and venous nodes. When viewed in mirrors, cyanosis of the vaginal mucosa is visible.
The procedure of choice is a Doppler color map ultrasound examination, which allows to detect not only varicose veins of the ovaries, but also venous thrombosis, post-thrombophlebitic occlusions. Ultrasound shows tortuosity, "worms", structures without signal reflection, located on the lateral surface of the uterus.
The Doppler effect is based on "color" in blue and red, venous and arterial blood flow respectively.
Ultrasound examination device 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 the 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, as the blood flowing from the heart is not always arterial and vice versa.
Thus, the ultrasound diagnostician sees this arterial or venous vessel, its size, the speed of blood flow in it, and many indicators that are not needed by an ordinary person, but play an important role in settingof a diagnosis. For this, transabdominal and transvaginal sensors are used.
In 5. 7% of cases, the disease is recognized by chance at screening. Normally 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 the accompanying pathology.
A very reliable method is phlebographic search.
Contrast is performed at the height of the Valsalva test, against blood flow. This allows you to see exactly the valve failure.
Left retinal angiography, renal phlebography, superselective fleboovarioscopy, and phlebovariography on both sides are also used. These methods make it possible to determine the hemodynamic and anatomical changes in the renal veins and the places where the gonadal veins flow into them.
Superselective phleboovarioscopy is performed by catheterization of the gonadal veins through the femoral or subclavian contralateral 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 extraorganic veins of the uterus to the internal iliac vein. The plexus of veins through which outflow can occur includes the sacral and bladder plexuses.
In left-sided fleboovarography, there are 3 stages of venous stasis in the uviform plexus of the left ovary:
- There is no exit from the left ovarian plexus, or it follows an additional short path.
- There is an extra long way.
- Two additional exit paths are visible, or one additional and auxiliary.
In stages 2 and 3, varicose veins of the uviform plexus of the right ovary are formed.
Laparoscopy is used for differential diagnosis. Pathologically twisted veins are located in the ovarian region, in the direction of round and wide ligaments. They look like large cyanotic conglomerates with a thin, tense wall.
The complexity of the diagnosis lies in the fact that the disease often hides behind the signs of an inflammatory process, varies in clinical manifestations, disguised as endometriosis, prolapse of internal organs, postoperative neuropathy and many extragenital diseases.
Treatment
The main goal of treatment is to remove the reflux into the veins. In the initial stages of the disease, conservative treatment is used. In the later stages of the disease, surgery is the treatment of choice.
Conservative treatment
Consists of normalizing venous tone, improving hemodynamics and trophic processes.
Symptomatic treatment for 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 vascular wall tone and increases blood flow. With this disease, it is better to consult a gynecologist for some medication.
Physiotherapy is an important method.
Surgical Treatment
- Varicose vein resection.
- Shutimi gonado-kaval.
- Scleotherapy in laparoscopy.
- Closure of the ovarian vein using X-ray endovascular methods.
Folk remedies
Since the main factor in the onset of the disease is the weakness of the valve apparatus, then all the folk remedies used for varicose veins of the lower extremities are also used for this pathology.
The most used are: common hazelnut, dandelion, nettle, horse chestnut, dandelion root, kombucha, willow, oak, rye, string, pollen and many more plants.
The following is effective: bath treatment with oak, chestnut, willow, chamomile, pharmacy, cayenne herb, St. John's wort, tel.
Prevention
- The first thing you should do if you have any of the complaints, predictions, or conditions listed above is to contact your gynecologist.
- it is necessary to normalize the work regime and rest, try not to stay in a vertical position for a long time, physical overload.
- Do exercises to prevent "pedal", "birch", "scissors foot"
- Eat a diet: eat foods rich in vitamins E, P, C, try to eat only white meat, less fatty, replace it with fruits, vegetables and whole grains.
- Drink plenty of fluids, but not less than 1. 5 liters per day.
- Get rid of excess weight, bad habits.
- Consult your doctor about wearing compression garments, this will improve blood flow from the lower extremities, thus reducing blood clots in the pelvis.
- Avoid baths, saunas, steam rooms, hot baths.
In order not to get sick with such a difficult disease to diagnose, you should follow the preventive recommendations listed above. Treat your health as the most precious thing in life.
For the slightest suspicious symptoms that you can not get rid of within a few days, you should see your doctor. He must offer you highly qualified help and save you from suffering.