This disease is poorly understood, although several thousand observations with subsequent diagnosis and treatment have been described.
The multitude of diversity and non-specificity of the clinical picture of small pelvic varicose veins leads to serious errors on the part of the diagnosis, which in the future will affect the consequences.
Characteristics of varicose veins of the small pelvis
The pelvic veins are several times longer than the arteries, which leads to their greater capacity. This is due to the phylogeny of the vascular system of the pelvic region. Pelvic veins are highly adaptable and potentially prone to remodeling, contributing to the formation of a densely woven network.
The speed and direction of blood flow are regulated by valves, which are controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous network.
When valves fail to perform their functions, stagnation of the blood develops, leading 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 and cause pathology.
Causes of occurrence
Pathological pelvic venous dilation may be due to the following reasons:
- Interruption of the blood outflow tract;
- Obliteration of the trunk of the vein;
- Compression of collateral trunks by an altered position of the uterus, for example, in retroflexion;
- ovarian vein valve insufficiency (congenital or acquired);
- postphlebitic obstructive syndrome;
- Connective tissue pathology;
- arteriovenous angiodysplasia;
- Prolonged sitting, intense physical work;
- Varicose veins of the lower extremities;
- Pregnancy (3 or more) and delivery (2 or more);
- Diseases of the female genital area (chronic salpingophoritis, ovarian tumors, uterine fibroids and genital endometriosis);
- Attachment of the pelvic organs;
- Obesity.
Classification by degree of disease
By the size of the dilated vein, the following grades are distinguished:
- up to 0. 5 cm, "corkscrew" glasses course;
- 0. 6-1 cm;
- more than 1 cm.
Variants of the disease course
- varicose veins of the perineum and the vestibule of the vagina;
- small pelvic venous congestion syndrome;
Symptoms
- The most common: frequent pains in the lower abdomen, perineum after prolonged static and dynamic overexertion. 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.
- Secretion, more than normal, from the glands of the genital tract.
- Blood stagnation leads to infertility, miscarriage and abortion.
- Violation of urination due to expansion of the veins of the bladder.
Diagnosis
Diagnosis of the disease only by complaints is successful only in 10% of cases.
Palpation of the internal walls of the pelvis allows palpation of the oblong glands and the venous ganglia. When looking in mirrors, cyanosis of the vaginal mucosa is visible.
The procedure of choice is an ultrasound examination with color Doppler mapping, which allows detecting not only varicose ovarian veins, but also venous thrombosis, post-thrombophlebitic occlusions. Ultrasound shows tortuous, "worm-like" structures, without 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 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 vein or artery is left to the doctor. The Doppler method works in almost all cases, exceptions to the rules are dictated by our body, since the blood that flows from the heart is not always arterial and vice versa.
Therefore, the ultrasound diagnostic doctor sees this arterial or venous vessel, its size, the rate of blood flow in it, and many indicators that are not necessary for an ordinary person, but play an important role in thediagnosis. For this, transabdominal and transvaginal sensors are used.
In 5. 7% of cases, the disease is recognized by chance on detection. Normally, the diameter of the ovarian vein is 0. 4 cm.
CT and MRI are very accurate. With these methods, it is possible to detect accumulations of varicose veins in the ligaments of the uterus, the 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 valve failure.
Left retannorenoscopy, renal venography, superselective veno-ovarioscopy, and veno-ovariangraphy are also used on both sides. These methods allow the determination of hemodynamic and anatomical changes in the renal veins and the places where the gonadal veins flow into them.
Superselective phleboovarioscopy is performed by catheterization of the gonadal veins through the contralateral femoral or subclavian vein, followed by contrast injection.
Most of the blood from the varicose veins of the uvine plexus is poured through the ovarian vein. But in conditions of hypertension, it occurs through the extraorganic uterine veins into the internal iliac vein. The plexus of veins, through which outflow can occur, includes the sacral and bladder plexus.
On left-sided phlebovaricography, there are 3 stages of venous stasis in the uviform plexus of the left ovary:
- There is no outflow from the left ovary plexus or it follows an additional short path.
- There is an additional long path.
- You see two additional outflow paths, or an additional and auxiliary one.
In stages 2 and 3, varicose veins form the uviform plexus of the right ovary.
Laparoscopy is used for differential diagnosis. Pathologically tortuous veins are found 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 often hides behind the signs of an 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 of normalizing venous tone, improving hemodynamics and trophic processes.
Symptomatic treatment for individual symptoms. Non-steroidal anti-inflammatory for pain, for bleeding - hemostatic therapy.
The main drugs in conservative treatment are venotonic drugs and antiplatelet drugs.
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-Knight Detour.
- Laparoscopic sclerosis.
- Ovarian vein occlusion by endovascular X-ray methods.
Folk remedies
Since the main factor in the appearance of the disease is the weakness of the valve apparatus, all the home remedies that are used for varicose veins of the lower extremities are also used for this pathology.
The most used are: hazelnut, hops, nettle, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, thread, pollen and many other plants.
The following is effective: treatment with baths with oak, chestnut, willow, chamomile, pharmacy, cayenne herbs, St. John's wort, thread.
Prevention
- The first thing to do if you have complaints, predictors, or diseases listed above is to contact your gynecologist.
- It is necessary to normalize the regime of work and rest, try not to stay in an upright position for a long time, physical overexertion.
- Do "pedal", "standing birch", "scissor legs" prevention exercises
- Follow a diet: eat foods rich in vitamins E, P, C, try to eat only white meat, less fat, 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, bad habits.
- Consult your doctor about the use of compression garments, as it will improve blood flow from the lower extremities, 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 should follow the preventive recommendations listed above. Treat your health as the most precious thing in life.
For the slightest suspicious symptoms that you can't get rid of in a few days, you should see your doctor. He must provide you with highly qualified assistance and save you from suffering.