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. It is one of the most common causes of chronic abdominal pain. Varicose veins of the pelvic veins also lead to dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.

What are pelvic varicose veins?

The essence of the pathology is that the veins expand, fill with blood and stretch excessively. The liquid part of the blood flows through the walls, leading to 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 only allow blood to pass to the heart, but if the valve apparatus fails, some of the blood returns;
obstruction of the pelvic vessels (blockage, obstruction);
hormonal changes in a woman's body that increase the permeability of the vein wall.

Some women have underdeveloped or absent valves from birth. An important role of heredity in the development of varicose veins of the small pelvis has been established. 50% of women have a strong family history: cases of varicose veins of the pelvic organs among relatives. Certain genes responsible for the development of uterine varicose veins have already been identified: FOXC2, TIE2, NOTCH3. Their mutations lead to vein wall weakness or valve failure.

Pregnancy can be a trigger for the development of varicose veins of the small pelvis. A pregnant woman's hormonal 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 production of progesterone. The vessels remain dilated throughout pregnancy and for another month after delivery.

In addition to uterine compression, other risk factors include:

endometriosis;
prolonged sitting or standing (leads to stagnation of blood 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 a compression of the left common iliac vein by the right common iliac artery.

Symptoms of enlarged pelvic veins

Varicose veins of the pelvis are accompanied by the following syndromes:

Varicose syndrome.It manifests itself as visually visible dilated vessels of the vulva and perineum. Additionally, in some women, the veins in the buttocks, pubis and groin become enlarged. At the end of the day, the lips may swell.
Pain syndrome.With dilated varicose veins of the small pelvis, this becomes the main reason to consult a doctor and undergo treatment. Pain characteristics: 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 rest in a horizontal position. It is possible that pain increases during the second phase of the menstrual cycle, associated with hormonal changes.
Pelvic organ dysfunction.Most often, due to varicose veins of the pelvis, the menstrual cycle is disrupted. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with overflow of blood from the venous bed of the pelvic organs. The pain may persist for half an hour to 1 day after contact. The third most common group of symptoms is dysuria. There is usually increased urination, less often - urinary incontinence.
Psycho-emotional disorders.They occur due to prolonged pain and a decrease in the quality of sexual life. Depression mainly develops.

The peculiarity of varicose veins is that the severity of the symptoms has no direct correlation with the diameter of the dilated vessels. That is, symptoms may be absent in severe forms of pathology, and vice versa: they can be very pronounced even at the initial stage.

Diagnosis of varicose veins

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

The effectiveness of varicose vein diagnosis is increased by modern ultrasound options: color mapping and powerful Doppler.

X-ray with contrast – pelvic phlebography and selective oophorography.
CT and MRI venography are more informative diagnostic methods than conventional x-rays. In addition, they are less invasive: contrast 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 treatment is the main method if there is no surgical indication for removing the pelvic veins. Additionally, she completes the surgery. Varicose veins are not a local disease, but systemic. The veins can dilate, 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 vein wall and slow down the progression of varicose veins.

medicines for varicose veins of the small pelvis;
compression shirt;
herbs (most medicines for varicose veins of the small pelvis are created on the basis of plants);
physiotherapy;
physiotherapy.

The main method of treating varicose veins is medication. All other methods are only auxiliary.

The drugs are good mainly because they affect the veins throughout the body, not just the pelvis. They increase their 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 treatment, nonsteroidal anti-inflammatory drugs are prescribed - they reduce pain. Many patients require antidepressants.

Compression therapy is most often used for varicose veins of 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 are used, tightening the lower part of the limbs, then in case of varicose veins of the small pelvis, on the contrary, compression is necessary in the upper part. Compression shorts are used to compress the upper third of the thigh, pelvic region and anterior abdominal wall. Note that the effectiveness of this method has not been confirmed, and that it does not give long-term results: it can be used exclusively 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 carried out on different vessels of the pelvis, depending on the characteristics of the disease.

Interventions on the vessels of the perineum

Miniphlebectomy is used to remove veins from the perineum and buttocks. This is a minimally invasive procedure that involves removing 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 of 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: scleroobliteration of the vulvar and perineal veins. Doctors inject liquid or foam sclerosants into the veins. As a result, these veins stick to each other, become invisible, and the blood passing through them stops.

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

Interventions on the gonadal vessels

The goal of treating varicose veins is to eliminate retrograde (backward) blood flow in the ovarian vessels. As a result, blood supply to the pelvic venous plexus 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 carried out through minimal incisions. The surgical method is also very effective. Chronic pelvic pain after vein removal disappears in 100% of patients within 1 to 2 months after surgery. The risk of relapse within 5 years of observation does not exceed 3%.

You can do without surgery. Embolization is used for treatment. Sclerosing (sticky) drugs or an IUD are introduced through the blood vessels into the ovarian vein, which causes blood clots to form, eliminates dilation and completely closes 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 its minimally invasive nature, which is why endovascular procedures are among the standard approaches to treating pelvic varicose veins in women.

Interventions on the renal and iliac vessels

Have limited use. Clinical situations where these types of interventions are necessary are rare.

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

Operations on the left iliac vein are performed for May-Turner syndrome. Doctors perform intravascular stenting of the left common iliac vein (installation of a frame inside the vein). This is a rare operation carried out only in specialized centers.

Where to go

To treat varicose veins, contact the SOYUZ clinic. We perform minimally invasive procedures and surgeries. The procedures are carried out by experienced doctors using the most recent equipment. All women experience pelvic pain after surgery.

Causes of pelvic varicose veins

The most common risk factors for varicose veins are:

sedentary and sedentary lifestyle;
"aortomesenteric tweezers" syndrome;
history of pregnancy and childbirth;
genetic predisposition;
congenital anatomical features of the renal veins;
endometriosis;
injuries to the pelvic region, etc.

Treatment of varicose veins of the small pelvis in women

Causes of pelvic varicose veins

According to international studies, almost a third of women suffer from chronic pelvic pain. The causes of chronic pelvic pain are varied, 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 move blood back to the heart against gravity become weakened and don't close properly. This allows blood to flow backward into the ovarian vein, increasing venous pressure and causing varicose veins. The flow of blood is disrupted by a mechanism similar to that of varicose veins of 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 overloaded venous system leads to stretching of the vein wall and secondary dilation of the pelvic vessels, so that the disease continually progresses.

As the cause of pelvic pain is often undiagnosed, no treatment is offered, although there is treatment. If you experience pelvic pain that may worsen throughout the day when you are standing, you may want to seek a second opinion from an endovascular surgeon to help you find the cause of the problem. Pelvic varicose veins can be effectively treated by endovascular surgical methods. Gynecology does not offer effective treatments for this disease.

Treatment of varicose veins of the small pelvis in clinic

As part of conservative treatment, anticoagulants, vetotonics and vitamins are prescribed. Efforts are aimed at reducing blood cholesterol levels and correcting women's lifestyles. 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. Whatever stage of your life you encountered reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you cope with them. The clinic creates the most favorable conditions and prescribes effective treatment so that women and their families are healthy.

With the help of special instruments, special spirals are installed in the lumen of the vein, which prevent poor blood circulation, leading to varicose veins of the pelvis.

No points required. The duration of the intervention varies from 30 minutes to several hours depending on the complexity of the pathology.

Symptoms of pelvic varicose veins include:

Discomfort in the pelvis
Heaviness in the pelvis
Bursting pain in the pelvis

These symptoms may intensify with prolonged standing or 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 required.

These factors are:

Physical exercise
Prolonged standing and sitting
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 periods
varicose veins of the external genitalia
pain during sex

Varicose veins of the pelvis have symptomatic and asymptomatic forms (that is, they can occur without symptoms). The asymptomatic form generally does not require any treatment

Symptoms of pelvic varicose veins in men and women

Visual symptoms are rare. During examination, expansion of the superficial veins in the perineum and buttocks is rarely noted. Urination problems due to congestion of the venous plexus of the bladder.

The illness 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. Both men and women may complain of pain of varying intensity in the lower abdomen during sexual intercourse.

Chronic pelvic pain:

throbbing, dull pain in the lower abdomen;
pain in the sacrum and coccyx region;
pain in the lower back and groin;
frequent urination;
urinary incontinence;
false desire to empty the bladder.

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

Enlarged vein on the inside of the thigh.

Pelvic varicose veins and their treatment

Painful varicose veins of the small pelvis are more often detected in women. The disease is quite common, but its diagnosis is a complex process. More and more women walk around with abdominal pain all their lives and deal with 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 (found in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.

Women of childbearing age usually suffer and it is very important to treat the disease on time.

What are pelvic varicose veins

Varicose veins of the small pelvis are a dilation of the vessels through which blood from the genitals circulates. In 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 appear?

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

compression of blood vessels by the growing uterus during pregnancy;
lifting weights and other physical activities;
sedentary work, sedentary lifestyle;
gynecological diseases: ovarian inflammation, endometriosis;
unstable menstrual cycle;
hormonal imbalances and treatment with estrogen-containing medications;
congenital anomalies of the vascular wall;
lack of orgasm or frequent protection through 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 seen in the right ovary and uterus. At 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, at the third stage, the diameter of the veins of the left and right ovaries is almost the same.

Treatment of varicose veins

The treatment program depends on the degree of development of varicose veins. Doctors adhere to conservative and gentle treatment: to achieve maximum effect through 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 accurately calculate the dosage of drugs for each case in order to help the body cope with the disease almost independently.

Strict compliance with normal working conditions is prescribed, with the exception of intense physical exertion 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 is prescribed with an increase in the rate of fiber and moderate consumption of vegetables, fruits and vegetable oils. 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 organs and the 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. Because these 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 not recommended to self-medicate without consulting a phlebologist. Each patient needs an individual selection of a treatment program, including a specific set of physical exercises.

The therapeutic complex includes wearing compression stockings: tights or shorts of a certain compression class, suitable for a specific case. Wearing compression stockings improves blood circulation in the lower limbs, particularly in the venous plexus of the perineum and buttocks. On average, wearing is prescribed for up to 14 days: several hours per day. You will learn how to choose the size, compression class and manufacturer in 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 region, the phlebologist prescribes nonsteroidal anti-inflammatory drugs and painkillers. Use should be in accordance with doctor's recommendations.

If conservative treatment does not bring results or the disease is at an advanced stage, then the phlebologist prescribes sclerotherapy or phlebectomy (surgical intervention) to remove the affected veins. The procedure is absolutely painless and takes place under anesthesia. Many patients worry about pain during and after surgery and are surprised that it is completely absent. Therefore, do not be afraid, painlessness has been proven by many years of experience of doctors. You will be able to go home the day after the operation.

In the absence of timely and appropriate treatment, the patient experiences a deterioration in symptoms and quality of life. For women: inability to become pregnant and give birth alone. For men: heaviness and inability to lead an active life.

With conservative treatment, the patient's recovery occurs gradually, directly during treatment. After the operation, the patient recovers easily and quickly. The day after the operation, 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: walks, exercises. Moving your muscles keeps blood flowing through your veins, which is why it's important to move.
If you work sitting or standing, try to take breaks every 30 minutes to move around a little. For example, take a walk, turn on the kettle, bring the items to the shelf.
Women are advised to avoid intense and excessive sports activities: swinging, lifting heavy weights and running incredible distances. Such fillers are unnatural for the female body.
Stick to your drinking regime. An adult needs 30 ml per 1 kg per day.
Eat well. Eat more vegetables and fruits. Eat less fast, fatty, floury and spicy food.
Consult a phlebologist and perform a set of exercises at home.