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What will the enlarged pelvic veins show in women?

From the article you will learn the features of varicose veins of the pelvis in women - this is a deformity of the veins of the pelvic region with impaired blood flow to the internal and external genitalia.

varicose veins of the small pelvis

general information

In the literature, small pelvic varicose veins are also referred to as "pelvic congestion syndrome", "varicocele in women", "chronic pelvic pain syndrome". The prevalence of varicose veins in the pelvis increases with age: from 19. 4% in girls under 17 to 80% in menopausal women. Most often, pelvic vein pathology is diagnosed in the reproductive period in patients aged 25-45 years.

In the vast majority of cases (80%), varicose transformation affects the ovarian veins and is extremely rare (1%) observed in the wide ligament veins of the uterus. According to modern medical approaches, the treatment of VVMT should be performed not so much from the point of view of gynecology, but, first of all, from the point of view of phlebology.

Causes of pathology

Under the varicose veins of the pelvic organs in women, doctors understand a change in the structure of the vascular walls characteristic of other types of disease - weakening followed by stretching and the formation of "pockets" within which blood stagnates. Cases when only the vessels of the pelvic organs are affected are extremely rare. In about 80% of patients, along with this form, signs of inguinal vein varices, vessels of the lower extremities are observed.

The incidence of varicose veins of the pelvis is more pronounced in women. This is due to anatomical and physiological features, suggesting a tendency to weaken the venous walls:

  • hormonal fluctuations, including those related to the menstrual cycle and pregnancy;
  • increased pressure in the pelvis, which is typical of pregnancy;
  • periods of most active venous filling, including cyclical periods of menstruation, during pregnancy, as well as during sex.

All these phenomena belong to the category of factors that provoke varicose veins. And they are found exclusively in women. The largest number of patients have experienced small pelvic varicose veins during pregnancy, as there is a simultaneous stratification of provocative factors. According to statistics, in men, varicose veins of the small pelvis are 7 times less common than in the fairer sex. They have a variety of different provocative factors:

  • hypodynamics - long-term maintenance of low physical activity;
  • increased physical activity, especially weight lifting;
  • obesity;
  • lack of sufficient fiber in the diet;
  • inflammatory processes in the organs of the genitourinary system;
  • sexual dysfunction or outright refusal to have sex.

A genetic predisposition can also lead to pathology of the plexuses located within the small pelvis. According to statistics, varicose veins of the perineum and pelvic organs are most often diagnosed in women whose relatives suffered from this disease. The first changes in them can be noticed in adolescence during puberty.

The greatest risk of developing veins with inguinal varicose veins in women with the involvement of pelvic vessels is observed in patients with venous pathology in other parts of the body. In this case, it is a question of congenital weakness of the veins.

Etiopathogenesis

Proctologists believe that the following main reasons always contribute to the occurrence of VVP: valvular insufficiency, venous obstruction and hormonal changes.

Pelvic venous congestion syndrome can develop due to the congenital absence or insufficiency of venous valves, which was discovered by anatomical studies in the last century and modern data confirm this.

It was also found that in 50% of patients the varicose veins are genetic in nature. FOXC2 was one of the first genes identified to play a key role in the development of VVP. Currently, the link between disease development and gene mutations (TIE2, NOTCH3), thrombomodulin level, and type 2 transformative growth factor has been established. These factors contribute to a change in the structure of the valve itself or the venous wall - all of which leads toin valve structure failure; enlargement of the vein, which causes a change in valve function; to progressive reflux and eventually to varicose veins.

An important role in the development of the disease can play dysplasia of connective tissue, the morphological basis of which is a decrease in the content of different types of collagen or a violation of the ratio between them, which leads to a decrease in the strength of the veins. .

The incidence of VVP is directly proportional to the amount of hormonal changes, which are particularly pronounced during pregnancy. In pregnant women, the capacity of the pelvic veins increases by 60% due to the mechanical compression of the pelvic vessels by the pregnant uterus and the vasodilating effect of progesterone. This venous dilatation continues for one month after birth and can cause venous valve failure. In addition, during pregnancy, the mass of the uterus increases, changes in its position occur, which causes the ovarian veins to dilate, followed by venous congestion.

Risk factors also include endometriosis and other inflammatory diseases of the female reproductive system, estrogen therapy, unfavorable working conditions for pregnant women, which include hard physical work and prolonged forced position (sitting or standing) duringworking day.

The formation of varicose veins in the small pelvis is also facilitated by the anatomical features of the exit from the small pelvic veins. The diameter of the ovarian veins is usually 3-4 mm. The long, thin ovarian vein on the left flows into the left renal vein, and on the right into the inferior vena cava. Normally, the left renal vein is located in front of the aorta and behind the superior mesenteric artery. The physiological angle between the aorta and the upper mesenteric artery is approximately 90 °.

This normal anatomical position prevents compression of the left renal vein. On average, the angle between the aorta and the superior mesenteric artery in adults is 51 ± 25 °, in children - 45, 8 ± 18, 2 ° in boys and 45, 3 ± 21, 6 ° in girls. In the case of an angle decrease from 39, 3 ± 4, 3 ° to 14, 5 °, aorto-mesenteric compression, or arrhythmia syndrome, occurs. This is the so-called former, or true, nut syndrome, which has the greatest clinical significance. Posterior arrhythmia syndrome occurs rarely in patients with a retroaortic or annular arrangement of the left distal renal vein. Obstruction of the proximal venous bed causes an increase in pressure in the renal vein, which leads to the formation of renovarian reflux in the left ovarian vein with the development of chronic pelvic venous insufficiency.

May-Turner syndrome - compression of the left common iliac vein by the right common iliac artery - also serves as one of the etiological factors of varicose veins in the pelvis. Occurs in no more than 3% of cases, most often found in women. Currently, due to the introduction of radiation and endovascular imaging methods, this pathology is being discovered more and more often.

Distribution

Varicose veins are divided into the following forms:

  • The main type of varicose veins: an increase in pelvic blood vessels. The reason is valvular insufficiency of 2 types: acquired or congenital.
  • The secondary form of pelvic vein thickening is diagnosed exclusively in the presence of pathologies in the gynecological aspect (endometriosis, neoplasia, polycystic).

Varicose veins of the pelvis develop gradually. In medical practice, there are several key stages in the development of the disease. They will vary depending on the presence of complications and the spread of the disease:

  • First step. Changes in the structure of ovarian vein valves can occur for hereditary or acquired reasons. The disease is characterized by an increase in the diameter of the veins up to 5 mm. The left ovary has a pronounced enlargement in the outer parts.
  • The second degree. This degree is characterized by the spread of pathology and damage to the left ovary. The veins in the uterus and right ovary can also dilate. The diameter of the expansion reaches 10 mm.
  • Third degree. The diameter of the veins increases up to 1 cm The dilation of the veins is observed in the right and left ovary equally. This stage is due to pathological phenomena of gynecological nature.

It is also possible to classify the disease depending on the main cause of its development. There is a primary degree, in which the enlargement is caused by impaired functioning of the venous valves and a secondary degree, which is a consequence of chronic female diseases, inflammatory processes or complications of oncological nature. The degree of the disease can vary according to the anatomical feature, which indicates the location of the vascular disorder:

  • Abundance within the caste.
  • Vulvar and perineal.
  • Combined forms.

Symptoms and clinical manifestations

In women, pelvic varices are associated with severe but not specific symptoms. Often, the manifestations of this disease are considered as signs of gynecological disorders. The main clinical symptoms of varicose veins in the groin in women with the involvement of pelvic vessels are:

pain in the lower abdomen with varicose veins of the small pelvis
  • Non-menstrual pain in the lower abdomen. Their intensity depends on the stage of venous damage and the extent of the process. For the first degree of varicose veins of the small pelvis, it is characteristic periodic pain, mild, extending to the lower back. In later stages it is felt in the abdomen, perineum and lower back and is long and intense.
  • Abundant mucosal discharge. The so-called leucorrhoea has no unpleasant odor, does not change color, which would indicate an infection. The discharge volume increases in the second phase of the cycle.
  • Increased symptoms of premenstrual syndrome and dysmenorrhea. Even before the onset of menstruation, the pain in women increases, until the appearance of difficulties in walking. During menstrual bleeding, it can become unbearable, spreading to the entire pelvic region, perineum, lower back and even the thighs.
  • Another characteristic sign of varicose veins in the groin in women is discomfort during sexual intercourse. It is felt in the vulva and vagina and is characterized as dull pain. It can be noticed at the end of sexual intercourse. In addition, the disease is accompanied by increased anxiety, irritability and mood swings.
  • As with varicose veins of the pelvis in men, in the female part of patients with such a diagnosis, interest in sex gradually disappears. The cause of the dysfunction is both constant anxiety and decreased production of sex hormones. In some cases, infertility can occur.

Instrumental diagnostics

Diagnosis and treatment of varicose veins is performed by a phlebologist, a vascular surgeon. Currently, the number of VVP detection cases has increased due to new technologies. Patients with CPP are examined in several stages.

  • The first stage is a routine examination by a gynecologist: taking the anamnesis, manual examination, ultrasound examination of the pelvic organs (to exclude another pathology). Based on the results, an examination is also prescribed by a proctologist, urologist, neurologist, and other related specialists.
  • If the diagnosis is unclear but there is a suspicion of VVPT, ultrasound angiography (USAS) of the pelvic veins is performed in the second stage. This is a non-invasive, highly informative method of screening diagnosis, which is used in all women with suspected VVPT. If previously it was believed that it was sufficient to examine only the pelvic organs (examination of the veins was considered difficult to access and optional), then at the current stage, ultrasonography of the pelvic veins is a mandatory examination procedure. With the help of this method, it is possible to determine the presence of varicose veins of the pelvis by measuring the diameters, the speed of blood flow in the veins and in advance to find out what is the main pathogenetic mechanism - ovarian failure or venous obstruction. Also, this method is used for dynamic evaluation of conservative and surgical treatment of VVPT.
  • The research is performed transvaginally and transabdominally. Parameter veins, groin-like plexuses, and uterine veins are visualized transvaginally. According to various authors, the diameter of the vessels of the named localizations ranges from 2, 0 to 5, 0 mm (on average 3, 9 ± 0, 5 mm), d. m. th. not more than 5 mm, and the average diameter of the arched veins is 1. 1 ± 0. 4 mm. Veins larger than 5 mm in diameter are considered dilated. The inferior vena cava, iliac veins, left renal vein, and ovarian veins are examined transabdominally to rule out thrombotic masses and extravasal compression. The length of the left renal vein is 6 to 10 mm, and its average width is 4 to 5 mm. Normally, the left renal vein at the point where it passes over the aorta is somewhat flattened, but a decrease in its transverse diameter of 2-2, 5 times occurs without a significant acceleration of blood flow, which ensures a normal exit withoutincreased pressure in the pretenosis. area. In the case of venous stenosis against the background of pathological compression, there is a significant decrease in its diameter - by 3, 5-4 times and an acceleration of blood flow - over 100 cm / s. The sensitivity and specificity of this method is 78 and 100%, respectively.
  • Examination of the ovarian veins is included in the mandatory examination of the pelvic veins. They are located along the anterior abdominal wall, along the rectus abdominis muscle, slightly to the side of the iliac veins and arteries. A sign of ovarian vein failure in USAS is considered to be more than 5 mm in diameter with the presence of retrograde blood flow. For a thorough examination, prevention of recurrences, and appropriate treatment tactics, ultrasonography of the veins of the lower extremities, perineum, vulva, inner thigh, and gluteal region should be performed.
  • The development of medical technology has led to the use of new diagnostic methods. In the third stage, after ultrasound verification of the diagnosis, radiation diagnostic methods are used to confirm it.
  • Pelvic phlebography with selective bilateral radiopaque ovarianography is one of the invasive diagnostic methods with radiation performed only in hospital conditions. This method has long been considered the diagnostic "gold standard" for assessing dilatation and detecting valvular insufficiency in pelvic veins. The essence of the method is the introduction of a contrast agent under the control of an X-ray installation through a catheter installed in one of the main veins (jugular, brachial or femoral) in the iliac, renal and ovarian veins. Thus, it is possible to identify the anatomical variants of the structure of the ovarian veins, to determine the diameters of the gonadal and pelvic veins.
  • The retrograde contrast of the gonadal veins at the height of the Valsalva test serves as a pathognomonic angiographic sign of their valvular insufficiency by visualizing a sharp dilation and tortuosity, respectively. This is the most accurate method for detecting May-Turner syndrome, post-thrombophlebitic changes in the iliac and inferior vena cava.
  • When the left renal vein is compressed, perirenal venous collaterals with retrograde blood flow to the gonadal veins are defined, contrast stagnation in the renal vein. The method measures the pressure gradient between the left and lower renal kava vein. Normally, it is 1 mm Hg. Art. ; gradient equal to 2 mm Hg. Art. , may suggest slight compression; with a gradient>3 mm Hg. Art. can be diagnosed with aorto-mesenteric compression syndrome with hypertension in the left renal vein, and gradient>5 mm Hg. Art. considered a hemodynamically significant stenosis of the left renal vein. Determining the pressure gradient is an important element of the diagnosis, as depending on its values, substantially different surgical interventions are planned in the small pelvic veins, which is very important in modern conditions. Currently, this study (with a normal pressure gradient) can be used for therapeutic purposes - for ovarian vein embolization.
  • The other irradiation method is computed tomography emitting pelvic veins with erythrocytes labeled in vitro. Characterized by deposition of labeled erythrocytes in the pelvic veins and visualization of the gonadal veins, allows the identification of small pelvic varicose plexuses and enlarged ovarian veins in different positions, the degree of pelvic venous congestion, pelvic blood flow and venous refluxin the saphenous veins of the legs and perineum. Normally, the ovarian veins do not contrast, the accumulation of radiopharmaceuticals in the venous plexuses is not observed. For an objective assessment of the degree of small pelvic venous congestion, the pelvic venous congestion coefficient is calculated. But this method also has disadvantages: invasiveness, relatively low spatial resolution, the inability to accurately determine the diameter of the veins, therefore, is not currently used as often in clinics.
  • Laparoscopic video examination is a valuable tool in assessing the undiagnosed. In combination with other methods, it can help determine the causes of pain and prescribe appropriate treatment. With varicose veins of the small pelvis in the ovarian region, along the round and wide ligaments of the uterus, the veins can be visualized in the form of cyanotic vessels, enlarged by a thinned and stretched wall. The use of this method is significantly limited by the following factors: the presence of retroperitoneal adipose tissue, the possibility of evaluating varicose veins only in a limited area, and the inability to determine reflux through the veins. Currently, the use of this method is diagnostically justified in cases of suspected multifocal pain. Laparoscopy allows visualization of the causes of CPP, for example, foci of endometriosis or adhesions, in 66% of cases.

Characteristics of therapy

For complete treatment of varicose veins of the pelvis, a woman should follow all the recommendations of the doctor, as well as change her lifestyle. First of all, you should pay attention to the loads, if they are too high, they should be reduced, if the patient leads a very sedentary lifestyle, it is necessary to play sports, take walks more often, etc.

Patients with varicose veins are strongly advised to adjust their diet, to consume as few unwanted foods (fried, smoked, sweet in large quantities, salty, etc. ), alcohol, caffeine. It is better to give preference to vegetables and fruits, dairy products, cereals.

Also, as a prophylaxis for disease progression and for medical purposes, doctors recommend wearing compression underwear for patients with varicose veins.

medicaments

ERCT therapy includes several important points:

  • elimination of reverse venous blood flow;
  • relief of disease symptoms;
  • stabilization of vascular tone;
  • improved blood circulation to tissues.

Preparations for varicose veins should be taken in courses. The rest of the drugs, which play the role of sedatives, are allowed to be taken exclusively during a painful attack. For effective therapy, the doctor often prescribes the following medications:

  • phleboprotectors;
  • enzymatic preparations;
  • medicines that relieve inflammatory processes with varicose veins;
  • pills to improve blood circulation.

Surgical treatment

It is worth acknowledging that conservative methods of treatment give really visible results mainly in the initial stages of varicose veins. At the same time, the problem can be solved radically and the disease can be completely eliminated only with surgery. In modern medicine, there are many variations of surgical treatment of varicose veins, consider the most common and effective types of surgeries:

  • embolization of veins in the ovaries;
  • sclerotherapy;
  • uterine ligament plastics;
  • removal of varicose veins through laparoscopy;
  • tightening of veins in the small pelvis with special medical clamps (incisions);
  • crossectomy - ligation of the veins (described if, in addition to the pelvic organs, the vessels of the lower extremities are affected).

During pregnancy, only symptomatic therapy of varicose veins of the pelvis is possible. We recommend wearing compression stockings, taking phlebotonics on the recommendation of a vascular surgeon. Phlebosclerosis of the perineum varices can be performed in the II-III trimester. If due to varicose veins there is a high risk of bleeding during spontaneous delivery, the choice is made in favor of operative delivery.

Physiotherapy

The system of physical activity for the treatment of varicose veins in a woman consists of exercises:

  • "Bicycle". We lie on our backs, throw our hands behind our heads or place them along our body. Raising our legs, we make circular motions with them, as if we were cycling.
  • "Tekpërnë". We sit face up on any solid and comfortable surface. Lift your legs up and start gently behind your head. Supporting the lumbar region with your hands and placing your elbows on the floor, slowly straighten your legs, raising your body up.
  • "Scissors. "The starting position is on the back. Raise your closed legs slightly above floor level. We stretch the lower limbs sideways, turn them back and repeat.

Possible complications

Why are small pelvic varicose veins dangerous? The following consequences of the disease are often recorded:

  • inflammation of the uterus, its appendages;
  • uterine bleeding;
  • abnormalities in bladder function;
  • formation of venous thrombosis (a small percentage).

Prophylaxis

In order for varicose veins in the small pelvis to disappear as quickly as possible and in the future to have no recurrence of pelvic organ pathology, it is worth adhering to simple preventive rules:

  • perform gymnastic exercises every day;
  • constipation prevention;
  • adhere to a diet regimen in which plant fiber should be present;
  • do not stay in one position for a long time;
  • take a perineum contrast bath;
  • in order not to show varicose veins, it is better to wear extremely comfortable shoes and clothes.

Preventive measures aimed at reducing the risk of the appearance and progression of varicose veins in the pelvis are mainly reduced to the normalization of lifestyle.