Varicose veins (varicose veins) is a disease accompanied by an increase in length, the formation of serpentine pathological tortuosity of the veins, irreversible saccular enlargements of their lumen and valvular insufficiency. The organs of the lower pelvis are involved in the varicose process. The mechanisms of development of the disease are different. Doctors include the perineal region, external and internal genitalia as atypical locations.
General information on pathology
The process of blood flow through the veins proceeds in such a way that, under physiological conditions, prerequisites are created for the development of stagnation and the outflow of blood.
Varicose veins of the vulva (VV): vasodilation of the external genitalia. The disease manifests itself in women suffering from varicose veins of the pelvis and legs, as well as in pregnant women. In 30% of cases, pelvic varicose veins affect the perineum and vulva.
The start of treatment of the disease is delayed due to the location in an intimate place. Women are shy. In some cases, patients do not experience pain or discomfort. But varicose veins of the lips during pregnancy and not only when the fetus progresses with complications: obstruction of the veins by a thrombus (thromboembolism), disorders of sexual sensitivity, pain in the perineum, psycho-emotional problems and family conflicts.
The mechanisms of development of congestion of the vessels of the pelvis are not fully described. The cause of the primary form of the disease is called gonadal (ovarian) vein valve malfunction. This causes a backflow of blood and increases pressure in the venous nodes in the lower pelvis. Valve insufficiency can be acquired or congenital. It gets worse with age or with pregnancy.
The secondary form of VVV of the pelvic organs is associated with gynecological pathologies - endometriosis, tumors of the pelvic organs.
Diagnosis of the disease is difficult because there are no symptoms specific to its course. It is based on the results of ultrasound (ultrasound).
To distinguish between primary and secondary forms of pathology, the Valsalva test is used during ultrasound examination. With a secondary cause of pelvic varicose veins, it is negative.
Varicose veins of the lips with VBT
To establish a diagnosis of varicose veins of the lips, a medical examination is required. Symptoms of the disease are as follows:
- varicose veins on the genitals;
- pain in the external genital area;
- a feeling of heaviness and burning in the perineum;
- swelling of the perineum at the end of the day.
Chronic pelvic pain occurs less frequently (in 30% of cases).
Once the diagnosis is established, a study is carried out to identify the degree of complexity of the pathological process and prescribe the appropriate treatment. Several events are taking place:
- Examination of the veins of the perineum and legs by ultrasound angiography - USAS;
- perform ultrasound of the pelvic vessels, including vaginal, uterine, parametric, ovarian, iliac, inferior cava, and renal veins;
- According to indications, multispiral computed tomography (MCCT), selective ovariocography and pelvic venography (SOFT) are performed.
Doctors call a characteristic property of varicose veins on the lips with VBT that the disease is constantly progressing and is combined with the transformation of the intrapelvic veins.
Treatment of varicose veins of the vulva with varicose veins of the lower pelvis.
Intravenous treatment is prescribed based on symptoms and diagnostic results.
In complex drug therapy for the treatment of systemic chronic venous pathology, non-steroidal anti-inflammatory drugs and phlebotropic drugs are prescribed.
Prescribe drug therapy with antiplatelet drugs, intrapelvic blockade with antihypoxatives, physiotherapy with ultrasound, therapeutic exercises. Antioxidants and enterobiotics are added to the therapy.
According to the indications, a phlebosclerosing treatment is carried out - sclerotherapy. The glass is "sealed" with drugs and a laser. It stops working. The procedure does not use special methods of anesthesia. It is done on an outpatient basis and produces a cosmetic effect.
With a plethora of pelvic veins, expansion and backflow of blood through the gonadal (ovarian) veins, a surgical operation to remove the veins is indicated. In the case of varicose enlargement of the labia minora, it is removed.
Varicose veins of the vulva during pregnancy.
Pregnancy is the most common first risk factor for VVV. A significant and sustained increase in progesterone concentration already in the early stages of pregnancy reduces venous tone and aggravates impaired blood flow. Furthermore, VBT, which involves the perineum and vulva, is associated with compression of the large veins of the retroperitoneal region (iliac veins and inferior vena cava) by the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Varicose veins of the vulva often present bilaterally. Signs of illness:
- a pronounced increase in the veins of the vulva in a period of 18-24 weeks during the first pregnancy, starting at 12 weeks with a repeat pregnancy;
- discomfort in the groin;
- dull, aching, drawing pain in pelvic region;
- pain during intercourse;
- itching of the vulva;
- swelling of the genitals and perineum.
Signs of pathology progress with the course of pregnancy. In addition to increasing the size of varicose veins, their compaction is determined by the third trimester. A characteristic symptom of the intravenous route is its combination with inguinal varicose veins during pregnancy or varicose veins in the legs.
Instrumental examination of varicose veins of the lips in pregnant women is limited to their ultrasound, as well as ultrasound of the legs, because painful changes in the venous bed undergo involution in the postpartum period.
In most cases (about 80%), from the first days of delivery, the symptoms of varicose veins during pregnancy begin to decrease and are minimized 2-8 months after the baby is born. There is not a complete return of the diameter of the vessels to their original values.
In 4-8% of women, the IV does not go away after delivery and the disease progresses.
An interesting feature is the relationship between the end of the feeding period or a reduction in the volume of breastfeeding on the rate of disappearance of varicose veins in the groin in women. A shortened lactation period is accompanied by a decrease and disappearance of the dilated veins and vice versa. This shows that varicose veins of the perineum during pregnancy are associated with a change in hormone levels.
Treatment of varicose veins of the perineum during pregnancy.
The basis of therapy for varicose veins during pregnancy is phlebotropic treatment. In most fertile women, IV begins in trimesters II and III. During this period, diosmin preparations can be used. The severity of the symptoms of the pathology is reduced by the micronized purified flavonoid fraction. The itching is relieved with zinc paste and histamine H1 receptor blockers.
Low molecular weight heparin in prophylactic dose prevents venous thrombosis and pulmonary embolism (blockage of blood vessels).
As an option for compression treatment, it is prescribed to wear tight elastic underwear with latex or gauze pillows. Relieves swelling of the lips and the feeling of heaviness. The special compression jersey for women with vulvar varicose veins helps a lot.
If a complication develops, such as local thrombophlebitis, surgical treatment is required.
When a conglomeration of varicose veins is found on the genitals, the question arises about the method of delivery. Natural childbirth is allowed with varicose veins of the vulva. On the contrary, the risks of surgery during a cesarean section are greater than the appearance of bleeding from the painful vessels during delivery. This happens rarely. But with varicose veins in the vagina, a cesarean section is often performed.
Prevention of varicose veins of the lips.
The main factor in the formation of varicose veins in the groin is the fetus. It is difficult to name any preventive method, taking into account the fact that during pregnancy there are a number of restrictions on many therapeutic measures. Some tips to follow:
- exclude physical and static stress;
- follow a diet;
- perform therapeutic exercises, in which movements accelerate the outflow of blood from the legs and lower pelvic organs;
- in case of interruption of the work of the veins, the presence of varicose veins before pregnancy, it is necessary to take phlebotropic drugs, wear compression underwear.
An effective method of prevention is considered to be an operation on the ovarian veins, surgery for other pathologies associated with varicose veins. This reduces the phenomenon of pelvic venous congestion, reduces the risk of varicose veins on the lips.
Vulvar varicose veins is a common disease in women with varicose veins of the pelvis, legs, or during pregnancy.
To improve the quality of treatment of patients with chronic venous diseases, it is important to detect the disease, differentiate between the methods of diagnosis and treatment of this condition.