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 became aware of 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. Furthermore, varicose veins of the pelvic veins 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 become excessively stretched. The liquid part of the blood leaks through the walls, causing swelling of the tissues.

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 should allow blood to pass only towards the heart, but if the valve apparatus fails, part of the blood flows back;
obstruction of the 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. A significant 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. Their mutations lead to weakness of the vein wall or valve failure.

Pregnancy can be a trigger for the development of varicose veins of the small pelvis. A pregnant woman's hormone levels change and the amount of blood circulating in 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 in an expanded state during pregnancy and for another month after giving birth.

In addition to uterine compression, other risk factors include:

endometriosis;
prolonged sitting or standing position (leads to blood stagnation 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 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 as visually noticeable dilated vessels of the vulva and perineum. Additionally, in some women, the veins in the buttocks, pubic area, and groin become enlarged. By the end of the day, your 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. Characteristics of pain: constant, aching, 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. It is possible that pain increases in the second phase of the menstrual cycle, which is associated with hormonal changes.
Pelvic organ dysfunction.Very often, due to varicose veins of the pelvis, the menstrual cycle is interrupted. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with blood overflow of 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.
Psycho-emotional disorders.They arise due to prolonged pain and reduced quality of sexual life. Mostly 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 the symptoms may be absent and vice versa: they can be very pronounced even in the initial phase.

Diagnosis of varicose veins

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

The effectiveness of diagnosing varicose veins is increased by modern ultrasound options: color mapping and power Doppler.

Contrast radiography – pelvic venography and selective oophorography.
CT and MR venography are more informative diagnostic methods than conventional X-rays. Furthermore, they are less invasive: the contrast medium 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 is no indication for surgery to remove the pelvic veins. Furthermore, it integrates surgery. Varicose veins are not a local disease, but a systemic one. Veins may become dilated, if they are not already, in other places, most often in the legs. The use of medications and procedures can increase the tone of the venous wall and slow the progression of varicose veins.

drugs for varicose veins of the small pelvis;
compression shirt;
herbs (most drugs for varicose veins of the small pelvis are created on a plant basis);
Physiotherapy;
Physiotherapy.

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

The drugs are good mainly because they affect the veins of the whole body and not just the pelvis. They increase the tone and reduce the permeability of the vascular wall. Most often, diosmin preparations are used for varicose veins. According to indications, hormonal agents are included in the treatment regimen. For symptomatic therapy, nonsteroidal anti-inflammatory drugs that reduce pain are prescribed. Many patients require antidepressants.

Compression therapy is often used for varicose veins in the legs. When the pelvic veins are affected, it is rarely used. If, when the veins of the legs are affected, compression stockings or stockings that compress the lower part of the limbs are used, then with varicose veins of the small pelvis, on the contrary, compression in the upper part is necessary. 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 only be used for symptomatic purposes.

Surgical treatment of dilated pelvic veins

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

Operations on the vessels of the perineum

Miniphlebectomy is used to remove the veins of the perineum and buttocks. This is a minimally invasive procedure that involves the removal of veins through minimal incisions. It has obvious advantages: rapid recovery, minimal risk of complications, good aesthetic result.

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

Minimally invasive procedures are also used: sclerobliteration of the vulvar and perineal veins. Doctors inject liquid or foam sclerosants into the veins. As a result, these veins merge, become invisible, and blood flow through them stops.

These methods of treatment for dilation of blood vessels are very effective: 95% of patients are satisfied with the result. The disadvantage is the high rate of recurrence: 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 recurrence, the doctor must eliminate pelvic-subcutaneous venous reflux during treatment.

Operations on the gonadal vessels

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

The operation to remove varicose veins is technically simple and not very traumatic. Trauma is further reduced when using an endoscopic technique: 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 within 1-2 months after surgery. The risk of recurrence within 5 years of observation does not exceed 3%.

You can do without surgery. Embolization is used for treatment. Sclerosing (gluing) drugs or a spiral are introduced through the blood vessels into the ovarian vein, causing the formation of blood clots, eliminating dilation and completely closing the vein. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical removal of veins, the advantage is minimal invasiveness, which is why endovascular procedures are among the standard approaches for treating pelvic varicose veins in women.

Operations on the renal and iliac vessels

They have limited use. Clinical situations in which these types of interventions are necessary are rare.

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

Operations on the left iliac vein are performed for May-Turner syndrome. Doctors perform an intravascular stenting of the left common iliac vein (installation of a structure 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 operations are performed by expert doctors using the most modern 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;
"aorto-mesenteric tweezers" syndrome;
history of pregnancy and childbirth;
genetic predisposition;
congenital anatomical features of the renal veins;
endometriosis;
injuries of 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 suffer from chronic pelvic pain. The causes of chronic pelvic pain are various, but are often 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 bring blood back to the heart against gravity become weakened and do not close properly. This allows blood to flow backwards through the ovarian vein, increasing venous pressure and causing varicose veins. The outflow of blood is interrupted 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 leads to stretching of the venous wall and secondary dilation of the pelvic vessels, so the disease continually progresses.

Because the cause of pelvic pain often goes undiagnosed, no treatment is offered, although therapy exists. If you have pelvic pain that may get worse during the day when you are standing, you may want to get a second opinion from an endovascular surgeon to help you find the cause of the problem. Pelvic varicose veins can be effectively treated 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 surgery 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 in which you have experienced reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you deal with them. The clinic creates the most favorable conditions and prescribes effective treatments for women and their families to be healthy.

With the help of special instruments, special coils are installed in the lumen of the vein that prevent inadequate blood flow, which leads to varicose veins of the pelvis

No stitches are needed. 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
Shooting pain in the pelvis

These symptoms may intensify with prolonged standing and sitting, during menstrual periods and 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 necessary.

These factors are:

Physical exercise
Standing and sitting for prolonged periods
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 (i. e. 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 superficial veins in the area of the perineum and buttocks is rarely noted. Micturition 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 part of the abdomen during sexual intercourse.

Chronic pelvic pain:

dull, nagging pain in the lower abdomen;
pain in the area of the sacrum and coccyx;
lower back and groin pain;
frequent urination;
urinary incontinence;
false urge to empty the bladder.

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

Enlarged vein on the inside of the thigh.

Varicose veins of the pelvis and its treatment

Painful varicose veins of the small pelvis are detected more often in the fair sex. The disease is quite common, but diagnosing the disease is a complex process. More and more women walk around 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 differently: varicocele (present in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.

Women of reproductive age usually 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. With this disease, the veins expand to more than ten millimeters in diameter, causing compression of the nerve endings and pain. Vienna

Why do pelvic varicose veins form?

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

compression of blood vessels by the growing uterus during pregnancy;
weight lifting and other physical activities;
sedentary work, sedentary lifestyle;
gynecological diseases: ovarian inflammation, endometriosis;
unstable menstrual cycle;
hormonal imbalances and treatment with drugs that contain estrogen;
congenital anomalies of the vascular wall;
lack of orgasm or frequent protection from interrupted sexual intercourse.

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. In 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. Moreover, 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 adhere to conservative and gentle treatment: achieving maximum effect with 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 blockage of blood vessels. Doctors carefully calculate the dosage of drugs for each case to help the body cope with the disease almost independently.

Strict compliance with normal working conditions is required, 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 increased level of fiber and moderate consumption of vegetables, fruits and vegetable oils 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 on the perineal area is recommended. Breathing exercises: slow, deep inhalation and exhalation using the abdominal muscles. Water procedures. Various unloading exercises.

It is strongly recommended not to self-medicate without consulting a phlebologist. Each patient requires an individual selection of a treatment package, including a specific set of physical exercises.

The therapeutic complex involves the use of compression stockings: tights 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. You will learn how to choose the size, compression class and manufacturer from the article Compression stockings or during a consultation a phlebologist will give you all the information.

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

If conservative treatment does not bring 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 surgery and are surprised that it is completely absent. Therefore, do not be afraid, the absence of pain has been proven by many years of experience of doctors. You will be able to go home the day after surgery.

In the absence of timely and adequate treatment, the patient experiences a worsening of 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: walking, exercises. Moving your muscles causes blood to circulate in your veins, which is why it's important to move.
If you work sitting or standing, try taking breaks every 30 minutes to move around a bit. For example, go for a walk, put the kettle on, take things to the shelf.
Women are advised to avoid strenuous and excessive sports activities: swinging, lifting heavy weights and overcoming incredible distances. Such loads are unnatural for the female body.
Stick to your diet. An adult needs 30 ml per 1 kg per day.
Eat well. Eat more fruits and vegetables. Eat less fast, fatty, floury and spicy food.
Consult a phlebologist and perform a set of exercises at home.