This disease is hardly known, although several thousand observations with diagnosis and subsequent treatment have been described.
The great variety and non-specificity of the clinical picture of the varicose veins of the pelvis leads to serious errors in the diagnosis, which will affect the consequences in the future.
Features of the varicose veins of the pelvis
The veins of the pelvis are many times longer than the arteries, which leads to a greater capacity. This is due to the phylogenesis of the vasculature of the pelvic region. The pelvic veins are very adaptable and can be easily remodeled, which helps to create a tightly woven network.
The speed and direction of blood flow are regulated by valves that are controlled by complex humoral mechanisms. The valves equalize the pressure in different parts of the venous network.
When the valves no longer perform their functions, blood stagnation develops, which leads to vascular pathology and the formation of varicose veins. The uniqueness of the pelvic veins lies in the fact that the wide ligaments of the uterus, which hold the lumen of the vessel wide, can narrow it, causing pathology.
Causes of occurrence
The pathological enlargement of the pelvic veins can have the following reasons:
- disruption of blood flow;
- obliteration of the venous trunk;
- Compression of collateral trunks due to a changed position of the uterus, for example during retroflexion;
- ovarian venous valve insufficiency (congenital or acquired);
- Obstructive postphlebitic syndrome;
- connective tissue pathology;
- arteriovenous angiodysplasia;
- Sitting for long periods, hard physical work;
- varicose veins of the lower extremities;
- pregnancy (3 or more) and childbirth (2 or more);
- Diseases of the female genital area (chronic salpingo-oophoritis, ovarian tumors, uterine fibroids and genital endometriosis);
- adhesion of the pelvic organs;
- obesity.
Classification according to degree of illness
The size of the enlarged vein distinguishes the following degrees:
- up to 0. 5 cm, "corkscrew" course of the vessels;
- 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;
- syndrome of venous congestion of the small pelvis;
Symptoms
- The most common - frequent pain in the lower abdomen, perineum after a long static and dynamic load. The pain intensifies in the second phase of the cycle after hypothermia, fatigue, stress and various diseases exacerbated.
- Feeling "out of place", pain during and after sex.
- Dysmenorrhea - menstrual disorders, including pain syndrome.
- More than normal secretion from the glands of the genital tract.
- Stagnation of blood leads to infertility, miscarriages, abortion.
- Violation of urination due to the expansion of the bladder veins.
Diagnosis
Diagnosis of the disease based solely on symptoms is only successful in 10% of cases.
By palpating the inner walls of the pelvis, the elongated seals and venous nodes can be felt. Cyanosis of the vaginal mucosa is visible in the mirrors.
The procedure of choice is an ultrasound examination with color Doppler mapping, with which not only varicose veins of the ovaries, but also venous thromboses and post-thrombophlebitic occlusions can be detected. Ultrasound reveals tortuosity, "worm-like", structures with no signal reflection, localized on the lateral surface of the uterus.
The Doppler effect is based on the blue and red coloring of the venous and arterial blood flow.
The device for ultrasound examination with the help of a special program detects the movement of the blood from the sensor and calculates the blood flow speed and the vessel type in the other direction.
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 made by our body, since the blood that flows from the heart is not always arterial and vice versa.
The ultrasound diagnostic doctor sees this arterial or venous vessel, its size, blood flow rate and many indicators that are not needed by a normal person, but play an important role in the diagnosis. For this purpose, transabdominal and transvaginal sensors are used.
In 5. 7% of cases, the disease is detected by chance during screening. Usually the ovarian vein is 0. 4 cm in diameter.
CT and MRI are very accurate. Using 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 an accompanying pathology.
A very reliable method is phlebographic research.
The contrast is carried out at the level of the Valsalva test against blood flow. This way you can see exactly the valve fault.
Left back genorenoscopy, renal phlebography, superselective phleboovarioscopy, and phleboovariography on both sides are also used. These methods make it possible to determine hemodynamic and anatomical changes in the renal veins and the places where the gonadal veins flow into them.
The superselective phleboovarioscopy is performed by catheterizing the gonadal veins through the contralateral femoral or subclavian vein followed by an injection of contrast medium.
Most of the blood from the varicose veins of the uvarian plexus is drained through the ovarian vein. In the case of high blood pressure, however, it occurs via the extraorgan uterine veins into the internal iliac vein. The venous plexus, through which drainage can occur, includes the sacral plexus and the bladder.
In the left-sided phleboovaricography, three stages of venous stasis in the uviform plexus of the left ovary are distinguished:
- There is no drainage from the left ovary plexus or it follows an additional short path.
- There is an additional long path.
- Two additional drainage paths are visible or one additional and additional.
In 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 area in the direction of the round and wide ligaments. They look like large cyanotic conglomerates with a thin and tense wall.
The complexity of the diagnosis lies in the fact that the disease is often hidden behind signs of the inflammatory process, differs in clinical manifestations, disguises itself as endometriosis, prolapse of internal organs, postoperative neuropathies and many extragenital diseases.
Treatment
The main goal of treatment is to eliminate reflux in the veins. In the initial stages of the disease, conservative treatment is used. In the later stages of the disease, surgery is the treatment of choice.
Conservative treatment
It consists in normalizing venous tone, improving hemodynamics and trophic processes.
Symptomatic treatment of individual symptoms. Nonsteroidal anti-inflammatory agent for pain, bleeding - hemostatic therapy.
The main drugs in conservative treatment are venotonic drugs and platelet aggregation inhibitors.
Phlebotonics - improve the tone of the vascular wall and increase blood flow. With this disease, it is better to consult a gynecologist about certain drugs.
Physiotherapy is an important method.
Surgical treatment
- Resection of varicose veins.
- Gonado caval shunting.
- Sclerosis in laparoscopy.
- Closure of the ovarian vein using endovascular x-ray methods.
Folk Remedies
Since the main factor behind the onset of the disease is the weakness of the valve apparatus, all folk remedies that are used for varicose veins of the lower extremities are also used for this pathology.
The most commonly used are: hazel, hops, nettles, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, string, pollen and many other plants.
Is effective: Treatment with baths with oak, chestnut, willow, chamomile, pharmacy, dried herbs, St. John's wort, string.
Prevention
- If you have complaints, predictors or illnesses, first contact your gynecologist.
- It is necessary to normalize the work regime and rest. Try not to stay in an upright position for a long time, physical overload.
- Do "Pedal", "Birch", "Scissor Legs" preventative exercises
- Stick to a diet: eat foods high in vitamins E, P, and C, try to eat only white meats and less fatty meats, and replace them with fruits, vegetables, and grains.
- Drink plenty of fluids, but not less than 1. 5 liters per day.
- Get rid of excess weight and bad habits.
- Ask your doctor about wearing compression clothing. This improves blood flow from the lower extremities and reduces congestion in the pelvis.
- Avoid baths, saunas, steam rooms and 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 eliminate within a few days, you should consult your doctor. He must give you highly qualified help and save you from suffering.