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What will the dilated veins of the small pelvis tell in women?

From the article you will learn the characteristics of small pelvic varicose veins in women - this is a deformation of the veins of the pelvic area with impaired blood flow in the internal and external genital organs.

small pelvic varicose veins

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 small pelvis increases with age: from 19. 4% in girls under 17 to 80% in perimenopausal women. Often, pelvic vein pathology is diagnosed in the reproductive period in patients in the age group of 25-45 years.

In most cases (80%), varicose transformation affects the ovarian veins and very rarely (1%) is observed in the extensive ligament veins of the uterus. According to modern medical approaches, VVMT treatment should be performed not from a gynecological point of view, but, first of all, from a phlebology point of view.

Triggering pathology

Under the varicose veins of the pelvic organs in women, doctors understand the changes in the structure of the vascular wall characteristic of other types of disease - weakening followed by stretching and the formation of "pockets" in them of stagnant blood. Cases when only the pelvic organ ducts are affected are very rare. In about 80% of patients, along with this form, there are signs of varicose veins in the inguinal veins, vessels in the lower part of the leg.

The incidence of varicose veins in the small pelvis is most pronounced in women. This is due to anatomical and physiological features, showing a tendency to weaken the venous wall:

  • hormonal fluctuations, including those related to the menstrual cycle and pregnancy;
  • increased pressure in the small pelvis, which is typical for pregnancy;
  • periods of more active venous filling with blood, including periods of the menstrual cycle, during pregnancy, as well as during sexual intercourse.

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 are confronted with small pelvic varicose veins during pregnancy, because there is a simultaneous layer of provoking factors. According to statistics, among men, varicose veins in the small pelvis are 7 times less common than among the fairer sex. They have a more diverse set of provocative factors:

  • hypodynamia - long -term maintenance of low physical activity;
  • increased physical activity, especially heavy dragging;
  • obesiti;
  • lack of adequate fiber in the diet;
  • inflammatory processes in the organs of the genitourinary system;
  • sexual dysfunction or obvious reluctance to have sex.

Genetic predisposition can also lead to pathology of the plexus located in the small pelvis. According to statistics, varicose veins of the perineum and pelvic organs are most often diagnosed in women whose relatives suffer from the disease. The first changes in them can be observed in adolescence during puberty.

The greatest risk of developing inguinal varicose veins in women with pelvic canal involvement is observed in patients with venous pathology in other parts of the body. In this case, we are talking about congenital weakness of the veins.

Etiopathogenesis

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

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

It was also found that in 50% of patients, varicose veins are genetic in nature. FOXC2 is one of the first genes identified to play an important role in the development of VVP. Currently, the relationship between disease progression and gene mutations (TIE2, NOTCH3), thrombomodulin levels and type 2 β altering growth factor has been determined. These factors contribute to changes in the structure of the valve itself or the venous wall - all of which lead to failure of the valve structure; vein enlargement, which causes changes in valve function; to progressive reflux and eventually to varicose veins.

An important role in the development of the disease can be played by dysplasia of connective tissue, the basis of which morphology is a decrease in the content of various types of collagen or a violation of the ratio between them, which leads to a decrease in the strength of 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 is increased by 60% due to the mechanical compression of the pelvic canal by the pregnant uterus and the vasodilating effects of progesterone. This venous dilation persists for a month after delivery and can lead to venous valve failure. In addition, during pregnancy, the mass of the uterus increases, a change in its position occurs, which causes stretching of the ovarian veins, followed by venous congestion.

Risk factors also include endometriosis and other inflammatory diseases of the female reproductive system, estrogen therapy, poor working conditions for pregnant women, which include difficult physical labor and prolonged forced standing (sitting or standing) during the working day.

The formation of varicose veins in the small pelvis is also facilitated by the anatomical features of the outflow from the small pelvic veins. The diameter of the ovarian vein 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. Typically, 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 superior 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 males and 45. 3 ± 21. 6 ° in females. In the case of a decrease in angle from 39. 3 ± 4. 3 ° to 14. 5 °, aorto-mesenteric compression, or bean-breaking syndrome, occurs. This is the so -called anterior syndrome, or true, nutcracker, which has the greatest clinical significance. Posterior nut rupture syndrome occurs in a rare condition in patients with a retroaortic or annulus arrangement in the distal left renal vein. Proximal venous bed obstruction causes an increase in pressure in the renal veins, which leads to the formation of renoovarian reflux in the left ovarian vein with the development of chronic pelvic venous insufficiency.

May -Turner syndrome - compression of the left prevalent iliac vein by the right prevalent iliac artery - also serves as one of the etiological factors of varicose veins in the pelvis. It occurs in no more than 3% of cases, it is found more often in women. Currently, due to the introduction of radiation and endovascular imaging methods into practice, this pathology is detected more and more frequently.

Welding

Varicose veins are divided into the following forms:

  • The main types of varicose veins: increase in pelvic blood vessels. The reason is the lack of valves of 2 types: acquired or congenital.
  • Secondary forms of pelvic vein thickening are diagnosed exclusively in the presence of gynecological pathology (endometriosis, neoplasms, polycystic).

Pelvic varicose veins develop gradually. In medical practice, there are several key stages in the development of this disease. They will differ depending on the presence of complications and the spread of the disease:

  • First degree. Changes in the structure of the ovarian venous valve can occur for hereditary or acquired reasons. The disease is characterized by an increase in vein diameter up to 5 mm. The left ovary has a significant expansion on the outside.
  • 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 expand. The diameter of the expansion reaches 10 mm.
  • third degree. Vein diameter increased up to 1 cm Vein expansion was observed in the right and left ovaries equally. This stage is due to pathological phenomena of a gynecological nature.

It is also possible to classify the disease depending on the main cause of its development. There is a primary stage, where the expansion is due to impaired venous valve function, and a secondary stage, which is a consequence of chronic gynecological diseases, inflammatory processes or complications of an oncological nature. The stage of the disease can vary according to anatomical features, which indicate the location of the vascular disorder:

  • Intra-caste mostly.
  • Vulvar and perineum.
  • Combined form.

Symptoms and clinical manifestations

In women, pelvic varicose veins are accompanied by severe, but not specific, symptoms. Often, the manifestations of this disease are considered a sign of gynecological disorders. The main clinical symptoms of varicose veins in the groin in women with pelvic canal involvement are:

pain in the lower abdomen with small pelvic varicose veins
  • 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 stage of small pelvic varicose veins, periodic, mild pain, extending to the lower back, is characteristic. At a later stage, it is felt in the abdomen, perineum and lower back, and is long and intense.
  • Excessive mucus discharge. The so -called leucorrhoea has no unpleasant odor, does not change color, which would indicate an infection. The volume of emissions 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, resulting in difficulty walking. During menstrual bleeding, it can become unbearable, spreading to the entire pelvic area, perineum, lower back, and even to 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 a dull ache. It can be observed at the end of intercourse. In addition, the disease is accompanied by increased anxiety, irritability, and mood swings.
  • Like small pelvic varicose veins in men, in the female part of patients with such a diagnosis, interest in sex gradually disappears. The cause of dysfunction is constant discomfort and a decrease in the production of sex hormones. In some cases, infertility may occur.

Instrumental diagnostics

Diagnosis and treatment of varicose veins is performed by a phlebologist, 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 anamnesis, manual examination, ultrasound examination of the pelvic organs (to exclude other pathologies). Based on the results, additional examinations are prescribed by proctologists, urologists, neurologists and other relevant specialists.
  • If the diagnosis is unclear, but there is a suspicion of VVPT, in the second stage, pelvic vein angioscanning ultrasound (USAS) is performed. This is a non -invasive and highly informative diagnostic screening method, used on all women with suspected VVPT. If previously it was believed that it was sufficient to examine only the pelvic organs (vein examination was considered difficult to access and optional), then at the present stage, pelvic vein ultrasonography is a mandatory examination procedure. With the help of this method, it is possible to establish the presence of small pelvic varicose veins by measuring the diameter, velocity of blood flow in the veins, and early to find out what are the leading pathogenetic mechanisms - ovarian vein failure or venous obstruction. Also, this method is used for the dynamic evaluation of conservative treatment and VVPT surgery.
  • Research was conducted transvaginally and transabdominally. Parametrial veins, groin -like plexuses, and uterine veins were visualized transvaginally. According to different authors, the diameter of the named localization vessels ranged from 2. 0 to 5. 0 mm (on average 3. 9 ± 0. 5 mm), i. e. not more than 5 mm, and the mean diameter of the arcata vein is 1. 1 ± 0. 4 mm. Veins larger than 5 mm in diameter are considered dilated. The inferior vena cava, iliac vein, left renal vein and ovarian vein were examined transabdominally to exclude thrombotic mass and extravasal compression. The length of the left renal vein is 6 to 10 mm, and its average width is 4 to 5 mm. Typically, the left renal vein where it passes through the aorta is relatively flat, but its transverse diameter decreases by 2-2. 5 times occurred without significant acceleration of blood flow, which ensures normal outflow without increasing the pressure in the prethenotic. 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 the acceleration of blood flow - over 100 cm / s. The sensitivity and specificity of these methods were 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 lateral to the iliac veins and arteries. Signs of ovarian venous failure in the USAS are considered to be more than 5 mm in diameter in the presence of retrograde blood flow. For full examination, relapse prevention and proper treatment tactics, venous ultrasonography of the lower leg, perineum, vulva, inner thigh and gluteal area must be performed.
  • The development of medical technology has led to the use of new diagnostic methods. In the third stage, after ultrasound confirmation of the diagnosis, radiation diagnostic methods are used to confirm it.
  • Pelvic phlebography with selective bilateral radiopaque ovaryography is one of the invasive diagnostic methods of radiation performed only in a hospital setting. This method has long been considered the diagnostic "gold standard" for assessing dilatation and detecting valve insufficiency in the pelvic veins. The essence of this method is the introduction of a contrast agent under the control of X-ray installation through a catheter inserted in one of the major veins (jugular, brachial or femoral) to the iliac, renal and ovarian veins. Therefore, it is possible to identify anatomical variants of the structure of the ovarian veins, to determine the diameter of the gonadal and pelvic veins.
  • Retrograde differentiation of gonadal veins at Valsalva test height serves as a pathognomonic angiographic marker for their valve insufficiency with visualization of sharp expansion and twisting, 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, the collateral of the perirenal vein with retrograde blood flow into the gonadal vein, contrast stagnation in the renal vein is determined. This method measures the pressure gradient between the left renal and the inferior vena cava. Typically, it is 1 mm Hg. Art. ; the gradient is equal to 2 mm Hg. Art. , may suggest mild 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 significant hemodynamic stenosis of the left renal vein. Determination of the pressure gradient is an important element in the diagnosis, because, depending on its value, essentially different surgical interventions on the small pelvic veins are planned, which are very important in modern conditions. Currently, this study (with a normal pressure gradient) can be used for therapeutic purposes - for ovarian vein embolization.
  • The next radiation method is computed tomography of pelvic vein discharge with in vitro labeled erythrocytes. It is characterized by the deposition of labeled erythrocytes in the pelvic vein and visualization of the gonadal veins, allows to identify small pelvic varicose plexus and dilated ovarian veins in various positions, degree of pelvic venous congestion, blood reflux from pelvic vein into saphenous vein of legs and perineum. Usually, the ovarian veins are not differentiated, radiopharmaceutical accumulation in the venous plexus is not observed. For objective assessment of the degree of small pelvic venous congestion, the coefficient of pelvic venous congestion was calculated. But this method also has drawbacks: invasive, relatively low spatial resolution, the impossibility of accurately determining the diameter of the vein, therefore, at present it is not so often used in the clinic.
  • Video laparoscopic examination is a valuable tool in assessing the undiagnosed. In combination with other methods, it can help determine the cause of pain and prescribe the right treatment. With small pelvic varicose veins in the ovarian area, along the round ligaments and width of the uterus, the veins can be visualized in the form of cyanotic vessels, dilated with thin and tense walls. The use of this method is severely limited by the following factors: the presence of retroperitoneal fatty tissue, the possibility of assessing varicose veins only in a limited area, and the impossibility to determine reflux through the veins. Currently, the use of this method is allowed diagnostically in cases of suspected multifocal pain. Laparoscopy makes it possible to visualize the cause of CPP, for example, focal endometriosis or adhesions, in 66% of cases.

Therapeutic properties

For the full treatment of small pelvic varicose veins, a woman must follow all the recommendations of the doctor, as well as change her lifestyle. First of all, you need to pay attention to the load, if they are too high, they must be reduced, if the patient leads an inactive lifestyle, need to play sports, walk more often, etc.

Patients with varicose veins are strongly advised to adjust their diet, taking possible snacks (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 prophylaxis for disease progression and for medical purposes, doctors prescribe the use of compression underwear for patients with varicose veins.

Medications

ERCT therapy implies several important things:

  • get rid of venous blood backflow;
  • relieve symptoms of the disease;
  • vascular tone stabilization;
  • increase blood circulation in tissues.

Preparations for varicose veins should be taken in the course. The rest of the medications, which play the role of painkillers, are allowed to be taken exclusively during a painful attack. For effective therapy, doctors often prescribe the following medications:

  • phleboprotectors;
  • enzyme supplies;
  • drugs that relieve the inflammatory process with varicose veins;
  • pills to improve blood circulation.

Surgical treatment

It should be acknowledged that conservative treatment methods give really visible results especially in the early stages of varicose veins. At the same time, the problem can be solved fundamentally and the disease can be completely eliminated only with surgery. In modern medicine, there are many variations of varicose vein surgical treatment, consider the most common and effective types of surgery:

  • vein embolization in the ovaries;
  • sclerotherapy;
  • uterine ligament plastic;
  • removal of enlarged veins through laparoscopy;
  • clamping of the veins in the small pelvis with special medical clips (clips);
  • crossectomy - vein ligation (prescribed if, in addition to the pelvic organs, the vessels of the lower leg are affected).

During pregnancy, only symptomatic therapy of small pelvic varicose veins is possible. We recommend wearing compression tights, taking phlebotonics on the recommendation of a vascular surgeon. In the II-III trimesters, perineum varicose vein phlebosclerosis can occur. If, due to varicose veins, there is a high risk of bleeding during spontaneous delivery, the choice is made in favor of surgical delivery.

Physiotherapy

The system of physical activity for the treatment of varicose veins in women consists of training:

  • "Bicycle". We lie on our backs, throw our hands behind our heads or place them along our bodies. Lifting our legs, we made circular movements with them, as if we were pedaling a bicycle.
  • "Birch". We sit facing up to any hard and comfortable surface. Lift your legs and start them slowly behind your head. Support the lumbar region with your hands and place your elbows on the floor, slowly straighten your legs, lift the body upwards.
  • "Scissors". The starting position is at the back. Raise the covered leg slightly above floor level. We spread the lower limb to the side, turn it over and repeat.

Possible complications

Why are varicose veins in the small pelvis dangerous? The consequences of the following diseases are often recorded:

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

Prophylaxis

In order for varicose veins in the small pelvis disappear as quickly as possible and in the future there is no recurrence of pathology of the pelvic organs, it is desirable to adhere to simple rules of prevention:

  • do gymnastic exercises every day;
  • prevent constipation;
  • observe a dietary regimen, in which plant fiber must be present;
  • do not stay in one position for long periods of time;
  • perineum contrast bath;
  • so that varicose veins do not appear, it is better to wear very comfortable shoes and clothes.

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