This disease is poorly understood, although several thousand cases with diagnosis and subsequent treatment have been described.
The multitude of diversity and non-specificity of the clinical picture of varicose veins of the small pelvis leads to gross errors on the part of the diagnosis, which in the future affect the consequences.
Characteristics of varicose veins of the small pelvis
The veins in the pelvis are several times longer than the arteries, which leads to their greater capacity. This is due to the phylogeny of the vascular system in the pelvic region. Pelvic veins are highly adaptable and potentially prone to remodeling, which contributes to the formation of a densely interwoven network.
The speed and direction of blood flow is regulated by valves, which are controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous system.
When the valves stop working, blood stagnation develops, which leads to vascular pathology and the formation of varicose veins. The uniqueness of pelvic veins is that the large ligaments of the uterus, which keep the lumen of the vessel wide, can narrow it, causing pathology.
Causes of occurrence
Pathologic pelvic venous dilation may be due to the following reasons:
- Disturbance of the blood outlet;
- Obliteration of the venous trunk;
- Compression of the collateral trunks by a modification of the position of the uterus, for example in retroflexion;
- ovarian venous valve insufficiency (congenital or acquired);
- postphlebitic obstructive syndrome;
- Pathology of connective tissue;
- arteriovenous angiodysplasia;
- Prolonged sitting, heavy physical labor;
- Varicose veins of the lower limbs;
- Pregnancy (3 or more) and childbirth (2 or more);
- Diseases of the female genital area (chronic salpingo-ovariosis, ovarian tumors, uterine fibroids and genital endometriosis);
- Adhesion of the pelvic organs;
Classification by degree of disease
By the size of the dilated vein, the following degrees can be distinguished:
- up to 0. 5 cm, "corkscrew" course of ships;
- 0. 6-1 cm;
- more than 1 cm.
Variants of the course of the disease
- varicose veins of the perineum and vestibule of the vagina;
- venous congestion syndrome of the small pelvis;
- The most common - frequent pain in the lower abdomen, perineum after a long static and dynamic overload. 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.
- Dysmenorrhea - menstrual irregularities, including pain syndrome.
- Secretion, more than normal, from the glands of the genital tract.
- Stagnation of blood leads to infertility, miscarriage, abortion.
- Violation of urination due to the expansion of the veins in the bladder.
Diagnosis of the disease only through complaints is only successful in 10% of cases.
Palpation of the internal walls of the pelvis, allows you to feel the oblong seals and venous nodes. Seen in mirrors, cyanosis of the vaginal lining is visible.
The procedure of choice is ultrasound examination with color Doppler mapping, which can detect not only ovarian varices, but also venous thrombosis, post-thrombophlebic occlusions. Ultrasound shows tortuous, "worm-shaped" structures with no signal reflection located on the lateral surface of the uterus.
The Doppler effect is based on the blue and red tint of venous and arterial blood flow, respectively.
The ultrasound examination machine with the help of a special program recognizes 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 a vein or artery remains with the doctor. The Doppler method works in almost all cases, exceptions to the rules are dictated by our body, because the blood flowing from the heart is not always arterial and vice versa.
So, the doctor of ultrasound diagnosis sees this arterial or venous vessel, its size, blood flow and many indicators that are not needed by an ordinary person, but play an important role in diagnosis. For this, transabdominal and transvaginal sensors are used.
In 5. 7% of cases, the disease is recognized by chance during screening. Normally, the diameter of the ovarian vein is 0. 4 cm.
CT and MRI are very precise. With these methods, it is possible to detect accumulations of varicose veins in the ligaments of the uterus, ovaries and around these organs. It is possible to determine a concomitant pathology.
A very reliable method is phlebographic research.
The contrast is performed at the height of the Valsalva test, against the flow of blood. This allows you to see exactly the failure of the valve.
Left rethngenorenoscopy, renal venography, superselective phleboovarioscopy and phleboovariography of both sides are also used. These methods make it possible to determine the hemodynamic and anatomical changes of the renal veins and the places where the gonadal veins enter them.
Superselective phlebovarioscopy is performed by catheterization of the gonadal veins through the contralateral femoral or subclavian vein, followed by contrast injection.
Most of the blood from varicose veins in the uvinus plexus is discharged into the ovarian vein. But in the conditions of hypertension, it occurs through the extraorganic uterine veins in the internal iliac vein. The plexus of the veins, through which discharge can occur, includes the sacral and bladder plexus.
In left phlebovaricography, 3 stages of venous stasis can be distinguished in the uviform plexus of the left ovary:
- There is no exit from the left ovarian plexus, or it takes a short additional path.
- There is a long way more.
- Two additional output paths are visible, or one additional and auxiliary.
At 2 and 3 stages varicose veins of the uviform plexus of the right ovary are formed.
Laparoscopy is used for differential diagnosis. Pathologically tortuous veins are located in the ovarian region, in the direction of the round and broad ligaments. They look like large cyanotic conglomerates with a thin, taut wall.
The complexity of the diagnosis lies in the fact that the disease is often hidden behind signs of an inflammatory process, differs in clinical manifestations, disguised as endometriosis, prolapse of internal organs, postoperative neuropathies and many extragenital diseases.
The main goal of treatment is to eliminate reflux in the veins. In the early stages of the disease, conservative therapy is used. In the later stages of the disease, surgery is the treatment of choice.
It consists in normalizing venous tone, improving hemodynamics and trophic processes.
Symptomatic treatment of individual symptoms. Nonsteroidal anti-inflammatory drug for pain, for bleeding - hemostatic therapy.
The main drugs in conservative treatment are venotonic drugs and antiplatelet drugs.
Phlebotonic - improves the tone of the vascular wall and increases blood flow. With this disease, it is better to consult a gynecologist about certain medications.
Physiotherapy is an important method.
- Resection of varicose veins.
- Gonado-caval maneuver.
- Laparoscopic sclerotherapy.
- Occlusion of the ovarian vein using radiographic endovascular methods
Since the main factor in the onset of the disease is the weakness of the valve apparatus, all folk remedies used for varicose veins of the lower extremities are also used for this pathology.
The most commonly used are: common hazel, hops, nettles, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, string, pollen and many other plants.
Effective is: treatment with oak baths, chestnut, willow, chamomile, pharmacy, dried herbs, St. John's wort, string.
- The first thing to do if you have any complaints, predictors, or any of the conditions listed above is to contact your gynecologist.
- It is necessary to normalize the regime of work and rest, try not to stand in an upright position for a long time, physical overload.
- Do "pedal", "stand-birch", "scissor legs" prevention exercises
- Stick to a diet: eat foods rich in vitamins E, P, C, try to eat only white meat, less fat, replace it with fruits, vegetables and 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, it will improve blood outflow from the lower limbs, thus reducing congestion in the small pelvis.
- Avoid baths, saunas, steam rooms, hot baths.
In order not to get sick with such a difficult to diagnose disease, you need to follow the preventive recommendations listed above. Treat your health as the most precious thing in life.
For the slightest suspicious symptoms that you cannot get rid of in a few days, consult your doctor. He must provide you with highly qualified assistance and prevent you from suffering.