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 learned about only at the end of the twentieth century, when the ultrasound diagnostic method became widespread. This is one of the most common causes of chronic abdominal pain. Varicose veins of the pelvic veins, moreover, 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 overstretched. The liquid part of the blood leaks through the walls, which leads to tissue swelling.

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 returns 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 valves that are underdeveloped or absent 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. Mutations in them lead to weakness of the venous wall 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%. Moreover, 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 in an expanded state throughout pregnancy and for another month after childbirth.

In addition to uterine compression, other risk factors include:

endometriosis;
prolonged sitting or standing position (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 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 itself as visually noticeable dilated vessels of the vulva and perineum. In addition, in some women, the veins of the buttocks, pubis and groin become enlarged. By the end of the day, the labia may swell.
Pain syndrome.With dilated varicose vessels of the small pelvis, this becomes the main reason to see a doctor and undergo treatment. Features of the pain: constant, aching, localized in the lower abdomen (associated with the uterus) and radiates to the thighs and perineum. 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 may increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
Dysfunction of the pelvic organs.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 the venous bed of the pelvic organs with blood. Pain may persist from half an hour to 1 day after contact. The third most common group of symptoms is dysuria. Usually there is an increase in urination, less often - urinary incontinence.
Psycho-emotional disorders.They arise due to prolonged pain and decreased quality of sexual life. Mostly depression develops.

The peculiarity of varicose veins is that the severity of symptoms does not have a 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 in 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 vessels.

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

X-ray with contrast – pelvic phlebography and selective oophorography.
CT and MR 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 therapy is the main method if there are no indications for surgery to remove the pelvic veins. In addition, it complements surgery. Varicose veins are not a local disease, but a systemic one. Veins can dilate, if they are not already dilated, in other places, most often in the legs. The use of drugs and procedures can increase the tone of the venous wall and slow down the progression of varicose veins.

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

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

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

Compression therapy is most 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 are used, squeezing the lower part of the limbs, then when varicose veins of the small pelvis, on the contrary, compression is needed in the upper part. Compression shorts are used that compress the upper third of the thigh, pelvic area and anterior abdominal wall. Note that the effectiveness of this method has not been confirmed, and it does not provide long-term results: it can be used exclusively for symptomatic purposes.

Surgical treatment of dilated pelvic veins

Invasive procedures and surgeries 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.

Interventions on the vessels of the perineum

Miniphlebectomy is used to remove veins in the perineum and buttocks. This is a minimally invasive intervention that involves removing veins through minimal incisions. It has obvious advantages: quick 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. Veins have to be removed through longer incisions. In case of varicose veins of the labia minora, their resection followed by plastic surgery may be required.

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 together, become invisible, and blood flow 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, during treatment the doctor must eliminate pelvic-subcutaneous venous reflux.

Interventions on 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 relapse within 5 years of observation does not exceed 3%.

You can do without surgery. Embolization is used for treatment. Sclerosing (gluing) drugs or a coil are introduced through the blood vessels into the ovarian vein, which causes the formation of blood clots, eliminates the dilation and closes the vein completely. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical vein removal, the advantage is minimal invasiveness, 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 needed are uncommon.

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

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 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. Interventions are performed by experienced doctors using the latest 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, sedentary lifestyle;
"aorto-mesenteric tweezers" syndrome;
history of pregnancy and childbirth;
genetic predisposition;
congenital anatomical features of the renal veins;
endometriosis;
pelvic area injuries, 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 experience 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. 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 return blood to the heart against gravity become weakened and do not close properly. This allows blood to flow backwards through the ovarian vein, which increases venous pressure and causes varicose veins. The outflow of blood is disrupted by a similar mechanism, as with 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 overcrowded venous system leads to stretching of the venous wall and secondary dilatation of the pelvic vessels, so the disease continuously progresses.

Because the cause of pelvic pain is often undiagnosed, no treatment is offered, although treatment does exist. If you have pelvic pain that may get worse during the day when you are upright, you may want to seek a second opinion from an endovascular surgeon to help 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 surgical intervention is necessary, the use of minimally invasive techniques is preferable.

Sometimes the pathology in question may be the cause of the inability to get pregnant or provoke problems during pregnancy. Regardless of what stage of life you have encountered reproductive health problems, experienced gynecologists and obstetricians-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 into the lumen of the vein, which prevent improper blood flow, leading to varicose veins of the pelvis

No stitches required. 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
Bursting 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 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 menstruation
varicose veins of the external genitalia
pain during sexual intercourse

Varicose veins of the pelvis have symptomatic and asymptomatic forms (that is, 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 scant. During examination, expansion of the superficial veins in the area of the perineum and buttocks is rarely noted. Disorders of urination 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 abdomen during sexual intercourse.

Chronic pelvic pain:

nagging and dull pain in the lower abdomen;
pain in the sacrum and coccyx area;
pain in the lower back and groin;
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 groin areas, on the back of the thigh, buttocks).

Enlarged vein on the inner thigh.

Varicose veins of the pelvis and its treatment

Painful varicose veins of the small pelvis are more often detected in the fairer sex. The disease is quite common, but diagnosing the disease is a complex process. 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) is 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 algia syndrome.

Women of reproductive age usually suffer 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 dilation of the vessels through which blood flows from the genitals. With this disease, the veins expand to more than ten millimeters in diameter, which causes compression of the nerve endings and pain. Vienna

Why do varicose veins of the pelvis occur?

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 drugs that contain estrogens;
congenital anomalies of the vascular wall;
lack of orgasm or frequent protection by 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 themselves 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. At 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. At the third stage, veins with a diameter of 10-13 mm are identified, located below 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 package depends on the degree of development of varicose veins. Doctors are adherents of conservative and gentle treatment: to obtain maximum effect through minimal intervention in the body. And, when the disease can be dealt with without surgery, medications, injections and vitamins are prescribed to reduce pain and other manifestations of symptoms of pelvic varicose veins. Also to normalize blood flow and eliminate risk factors for blockage of blood vessels. Doctors accurately calculate the dosage of medications for each case to help the body cope with the disease almost independently.

Strict adherence to normal working conditions is prescribed, with the exception of heavy physical exertion and prolonged stay in one 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 level of fiber and the consumption of vegetables, fruits, and vegetable oils in moderation. 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 stopping smoking and taking hormonal contraceptives in order 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 and deep inhalation and exhalation using the abdominal muscles. Water procedures. Various unloading exercises.

We strongly recommend 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 treatment complex includes wearing compression hosiery: tights or shorts of a certain compression class, suitable for a specific case. Wearing compression hosiery improves blood flow from the lower extremities, including the venous plexuses of the perineum and buttocks. On average, wearing 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 full information.

When a patient complains of frequent unbearable pain in the pelvic area, the phlebologist prescribes non-steroidal anti-inflammatory drugs and painkillers. Use must be in compliance with the 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 is performed under anesthesia. Many patients worry about pain during and after operations and are surprised that they are completely absent. Therefore, do not be afraid, painlessness has been proven by many years of experience of doctors. You will be able to return home the day after surgery.

In the absence of timely and proper treatment, the patient feels a deterioration in symptoms and quality of life. For women: inability to become 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 very next day after surgery you will be able to walk independently.

Measures to prevent varicose veins of the small pelvis

Prevention aims to eliminate disease risk and symptoms. Here are a few 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 have a sitting or standing job, try to take breaks every 30 minutes to move around a bit. For example, take a walk, put on the kettle, take things to the shelf.
It is advisable for women 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 drinking regime. An adult needs 30 ml per 1 kg per day.
Eat right. Eat more vegetables and fruits. Eat less fast food, fatty, floury and spicy.
Consult a phlebologist and perform a set of exercises at home.