This disease is poorly understood, although several thousand observations with subsequent diagnosis and treatment have been described.
The great diversity and non-specificity of the clinical picture of varicose veins of the small pelvis leads to serious errors of diagnosis, which in the future will 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 phylogenesis of the vascular system of the pelvic region. Pelvic veins are highly adaptable and potentially subject to remodeling, which contributes to the formation of a densely interwoven network.
The speed and direction of blood flow are controlled by valves that are controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous network.
When the valves stop performing their functions, blood stagnation occurs, 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 keep the lumen of the vessel wide, can narrow it, causing pathology.
Causes of the occurrence
Pathological pelvic venous dilation may be due to the following reasons:
- Interruption of the blood outlet;
- Obliteration of the vein trunk;
- Compression of the collateral trunks by an altered position of the uterus, for example, in retroflection;
- insufficiency of the ovarian vein valve (congenital or acquired);
- Post-phlebitis obstructive syndrome;
- Connective tissue pathology;
- Arteriovenous angiodysplasia;
- Prolonged session, heavy 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 Organs pelvic organs;
- Obesity.
Classification by degree of disease
By the size of the dilated vein, the following degrees are distinguished:
- up to 0. 5 cm, pot course in "corkscrew"; <0. 6x1. 6 cm;
- more than 1 cm.
Variants of the course of the disease
- varicose veins of the perineum and the vestibule of the vagina;
- syndrome of small pelvis venous congestion;
Symptoms
- The most common - frequent pain in the lower abdomen, perineum after long static and dynamic effort. The pain intensifies in the second phase of the cycle, after hypothermia, tiredness, stress, exacerbations of various diseases.
- Feeling "out of place", pain during and after sex.
- Dysmenorrhea - menstrual irregularities, including pain.
- Secretion, more than normal, of glands in the genital tract.
- Stagnation of blood leads to infertility, miscarriage.
- Violation of urination due to the expansion of bladder veins.
Diagnosis
The diagnosis of the disease only by complaints is successful in only 10% of cases.
Palpation of the inner walls of the pelvis makes it possible to feel the oblong seals and venous nodules. When seen in the mirrors, cyanosis of the vaginal mucosa is visible.
The procedure of choice is an ultrasound exam with color Doppler mapping, which allows not only to detect varicose ovarian veins, but also venous thrombosis, post-thrombophlebitic occlusions. Ultrasonography shows tortuous, "wormlike" structures, with no signal reflection, located on the lateral surface of the uterus.
The Doppler effect is based on the blue and red shade of the venous and arterial blood flow, respectively.
The device for ultrasound examination 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, the exceptions to the rules are dictated by our body, since the blood that leaves the heart is not always arterial and vice versa.
Thus, the diagnostic ultrasound doctor sees this arterial or venous vessel, its size, blood flow rate in it and many indicators that are not necessary for an ordinary person, but play an important role in the diagnosis. For this, transabdominal and transvaginal sensors are used.
In 5, 7% of cases, the disease is recognized at random during screening. Usually, the diameter of the ovarian vein is 0. 4 cm.
CT and MRI are highly accurate. 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 the concomitant pathology.
A very reliable method is phlebographic research.
The contrast is performed at the height of the Valsalva test, against blood flow. This allows you to see exactly the failure of the valve.
Left rectenorenoscopy, renal phlebography, superselective phleboovarioscopy and phleboovariography on both sides are also used. These methods allow to determine the hemodynamic and anatomical changes of the renal veins and the places where the gonadal veins flow.
Superselective phleboovarioscopy is performed by catheterization of the gonadal veins through the contralateral or subclavian femoral vein, followed by contrast injection.
Most of the blood from the varicose veins of the uvar plexus is discharged into the ovarian vein. But in conditions of hypertension, it occurs through extra-organic uterine veins in the internal iliac vein. The plexus of the veins through which flow can occur includes the sacral and bladder plexus.
In phleboovaricography on the left side, three stages of venous stasis in the uviform plexus of the left ovary are distinguished:
- There is no exit from the plexus of the left ovary or it follows an additional short path.
- There is an additional long path.
- Two additional output stream paths are visible, or an additional and auxiliary one.
In stages 2 and 3, varicose veins in 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 wide ligaments. They look like large cyanotic conglomerates with a thin, tense wall.
The complexity of the diagnosis lies in the fact that the disease often hides behind signs of the inflammatory process, differs in clinical manifestations, is disguised in endometriosis, prolapse of internal organs, postoperative neuropathies and many extragenital diseases.
Treatment
The main purpose of treatment is to remove reflux in the veins. In the early stages of the disease, conservative treatment is used. In the most advanced stages of the disease, surgery is the treatment of choice.
Conservative treatment
It consists of the normalization of venous tone, improving hemodynamics and trophic processes.
Symptomatic treatment for individual symptoms. Nonsteroidal anti-inflammatory for pain, for bleeding - hemostatic therapy.
The main drugs for conservative treatment are venotonic and antiplatelet drugs.
Phlebotonics - improve the tone of the vascular wall and increase blood flow. With this disease, it is best to consult a gynecologist about certain medications.
Physiotherapy is an important method.
Surgical Treatment
- Resection of varicose veins.
- Gonad-caval maneuver.
- Sclerotherapy in laparoscopy.
- Occlusion of the ovarian vein using endovascular X-ray methods.
Folk remedies
As the main factor in the appearance of the disease is the weakness of the valve system, all folk remedies that are used for varicose veins of the lower extremities are also used for this pathology.
The most commonly used are: common hazelnut, hops, nettle, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, string, pollen and many other plants.
The following is effective: treatment with oak, chestnut, willow, chamomile, pharmacy, cayenne herbs, St. John's wort, string.
Prevention
- The first thing to do if you have complaints, predictors or illnesses listed above is to contact your gynecologist.
- It is necessary to normalize the work and rest regime, try not to stand for a long time, excessive physical effort.
- Do prevention exercises "pedal", "birch", "scissor legs"
- Follow a diet: eat foods rich in vitamins E, P, C, try to eat only white meat, less fatty meat, substitute fruits, vegetables, cereals.
- Drink lots of fluids, but not less than 1. 5 liters a day.
- Get rid of excess weight and bad habits.
- Consult your doctor about wearing compression garments, as this will improve blood flow from the lower extremities, thus reducing congestion in the pelvis.
- Avoid baths, saunas, steam rooms, hot baths.
In order not to fall ill with a disease so difficult to diagnose, you need to follow the preventive recommendations listed above. Treat your health as the most precious thing in life.
For the smallest suspicious symptoms that you can't get rid of in a few days, you should see your doctor. He must provide highly qualified assistance and save you from suffering.