Varicose veins of small pelvis is a fairly common disease, especially in women. But because of ignorance by many doctors features of this disease diagnosis is exposed is rare and the diagnosis of the disease, feel almost "clinical exotic". Because of the variety of symptoms and the dominance of pain syndrome varicose veins of small pelvis often disguised as gynecological inflammatory and hormonal diseases, pathology of the urinary system (cystitis), surgical diseases (colitis and Crohn's disease), lumbar radiculitis and diseases of the hip joint.
The frequency of the disease is equal to 5.4% to 80%, this wide range is due to the ambiguity of diagnosis and principles of treatment. The incidence of this disease increases with age, adolescent girls (under 17) percent of the disease reaches 19,4, whereas in perimenopause, the prevalence of the disease increases to 80%. Most often varicose veins of the pelvis is diagnosed in women of childbearing age.
It should be noted that this pathology is not uncommon in pregnancy, approximately 30% of expectant mothers the disease is diagnosed after 8 weeks gestation.
Define the terms
Most women know about the existence of such diseases as varicose veins of the lower extremities. Unlike varicose veins pelvic varicose veins of the legs can be seen as dilated veins, usually located under the skin (sometimes the extension and the deep veins) and are perfectly visible.
Varicose veins of the pelvis called the pathology of the veins, located deep in the pelvis, respectively, they are not visible to the eye, and to suspect the disease is complicated. When the disease is disturbed architectonics (the structure of the venous wall) veins, decreases their elasticity, resulting in venous blood in the pelvis stagnates. In other words, the pelvic veins get blocked and swell the outflow of venous blood is disturbed, which leads to venous enlargement.
Varicose veins pelvic also called syndrome pelvic venous extension. In some sources it is possible to meet the term "varicocele in women", which is not quite correct. In varicocele, the process involves the veins of the spermatic cord and testis, which are present only in males, but the mechanism of development and symptoms of disease similar to varicose veins of the pelvis.
Also disease a number of authors called chronic pelvic pain syndrome, which is also wrong. This syndrome may be due to many reasons (gynecological, urological diseases), including pelvic varicose veins.
The causes and mechanism of development
It has been proved that the disease is caused by expansion of the venous plexus of the ovarian veins and broad uterine ligaments. And the mechanism of development of pathology lies in the insufficiency of venous valves of the ovary, which leads to reflux and provokes a rise of venous pressure and development of venous stasis in the venous plexuses of the pelvis. On the background of the compromised venous blood flow in the major veins develop collateral (additional) way circulation.
Also in the development of the disease, not the least is the content of hormones, particularly progesterone levels. Progesterone – the hormone of pregnancy reduces the tone of smooth muscles not only of the uterus (prevention of miscarriage) but also the vascular wall, which causes their dilation (expansion) and venous stasis. In addition, the pregnancy progresses the growing uterus begins to compress the large vessels in the retroperitoneal space (the bottom is hollow and iliac veins), which spurs the formation of collaterals. Therefore, the disease is much more common in pregnant women than all other women.
Confirms the hormonal theory of disease and detection of disease in adolescent girls, when there are hormonal surges associated with sexual maturation. Of all the signs of varicose pelvic veins in girls is only one – an increase in vaginal whiter.
Another starting point for the development of pathology is dysplasia of connective tissue, which has about 35% of people. On the background of dysplasia in the composition of the vascular wall detected by the lack of collagen, which provides elasticity and strength of blood vessels. In extreme cases, the collagen may not be present at all. Systemic lesions of connective tissue explains the frequent combination of pelvic varices varicose veins of legs and hemorrhoids.
Predispose to development of varicose veins of the pelvis following factors:
The increased volume of blood in the vessels, elevated levels of progesterone, the growing uterus all contribute to dilatation of the veins of the pelvis and compression of the great vessels.
- Congenital connective tissue dysplasia
Decreased tone of the vessels and hypoplasia of the venous valves result in increased fragility of the veins.
- Multiple pregnancy
Increases the load on the female body, including the vessels several times.
- Multiple births and complicated deliveries
Prolonged labor or childbirth large fetus, abnormal tribal forces, as well as a large number of genera contribute to impaired blood flow in the pelvic veins small veins in the lower limbs and hemorrhoidal plexuses.
- A sedentary lifestyle
Like "sitting" and "standing" work in the constantly evolving physical inactivity cause venous stasis.
- Heavy physical activities and lifting
- Gynecological pathology
This group includes inflammatory diseases of uterus or appendages, tumors (fibroids, cysts and neoplasms of the ovaries) and endometriosis.
- Retroflection of the uterus
Bend uterus posteriorly causes the inflection of the broad uterine ligaments that disrupts venous blood flow in it, and then in the veins of the pelvis.
- Hormone treatment and hormonal contraception
The effect of hormone replacement therapy and the cook confirms the following fact: in postmenopausal women, the severity of manifestations of the disease decreases.
- Sexual dysfunction
If anorgasmia (lack of sexual satisfaction) there is stagnation of blood in the pelvis, over time, of sexual frustration transformirovalsya in the pelvic varicose veins. Venous congestion provokes and dyspareunia (pain during sexual act and after it). Affects venous circulation of the pelvis and coitus interruptus. Women partners who adhere to this method of contraception, are more susceptible to occurrence of Varicose veins of the small pelvis (because of the same anorgasmia).
Depending on the clinical manifestations distinguish 2 forms of pelvic varicose veins:
- extension vulvar veins (in severe cases extends to the inner thighs and perineum);
- syndrome of venous plethora.
Both forms exist simultaneously, only the symptoms of one of them is more pronounced. Formed a vicious circle – dilated veins of the vulva leads to the violation of the venous outflow in the pelvis, and the pelvic dilatation of the venous plexus causes dilation of vulvar veins.
In pregnant women more common varicose veins of the vulva, pathology may disappear on their own after delivery, but persists in the 2 – 10% of cases.
Classification A. Volkov (according to the degree of venous extension):
- Stage 1 – Vienna in diameter not exceed 5 mm, the vessels tortuous;
- Stage 2 – the vessel diameter is 6 – 10mm, varicose may be totally or only occur in the ovarian plexus, the veins of the parameter or of the myometrium;
- Stage 3 – greater than 10 mm in diameter.
The clinical picture
Symptoms of varicose veins of small pelvis in women are very diverse and often masquerading as diseases related systems and organs. As already stated, the disease can occur with a prevalence of manifestations of one or another clinical form.
Symptoms of vulvar varicose veins
The main feature of this shape is obvious varicose veins in the area of the vulva and/or perineum, which sees the woman. Woman complained of itching and discomfort of the vulva, a feeling of heaviness in this area. Gynecological examination revealed swelling and swelling of the labia, enlarged and dilated veins on the surface of the perineum and buttocks, in most cases hemorrhoids.
High likelihood of either spontaneous or post-traumatic bleeding (after intercourse or childbirth). Since the venous wall is much thinned, to perform hemostasis (stop bleeding) is quite difficult even surgical methods (ligation of the damaged vein or clamping).
A complication of this form of acute thrombophlebitis of veins of the perineum. In this case, there is a very strong pain, the skin of the perineum is red and swollen. Veins thicken and become painful. To the thrombosis itself with inflammation (phlebitis) accompanied by an increase in temperature (to 38 degrees) and intoxication syndrome (weakness, loss of appetite).
Symptoms of the syndrome of venous extension
In the first place when this form acts as a pain syndrome. What is there pain with varicose veins of small pelvis? The nature of the pain is constant, they are localized in the abdomen and have different intensity and nature (nagging, aching, dull, arching, moderately or significantly expressed).
Pain may radiate to the lumbar region and the sacrum, in the crotch or groin. A characteristic feature of the pain associated with pelvic venous expansion is strengthening after a long stay in a fixed position (sitting or standing), and after performing physical work and heavy lifting.
Pain during intercourse and after it
Also, the disease is characterized by dyspareunia, and pain can occur both during sexual intercourse and after it. Dyspareunia causes the development of vaginismus and fear of sex. There is increased sensitivity (hypersensitivity) of the skin of the perineum and of the vaginal mucosa.
Another sign of this form of premenstrual syndrome, the manifestations of which are expressed, and increased pain occurs in the second phase of the cycle (from 14 days).
There are also painful menstruation and disorders of the cycle (dysmenorrhea), increase in vaginal discharge.
In some cases, marked disorders of urination (painful and frequent) that is associated with venous extension of the bladder.
Violation of habitual way of life, sexual dissatisfaction, constant family conflicts affects the psychosocial status of women and lead to the development of neurosis and depression.
Diagnosis of varicose veins of the pelvis is highly complex and should involve a gynecologist and phlebologist. All diagnostic events are divided into Noninvasive and invasive.
Is mandatory, but only allows to suspect the varicose veins of the pelvis. At external examination revealed thickened veins on the labia, perineum and inner thighs. The gynecological mirror allows you to see the cyanosis (blueness) of the vaginal walls, as determined by palpation pasty (smoothness) and soreness of the vaginal vaults. Also pain occurs on palpation of the appendages, uterine ligaments and the displacement of the cervix.
It is preferable to simultaneously combined ultrasound transabdominal (through the abdomen) and transvaginal (through the vagina) sensors with the use of dopplerography. This study allows to identify the organic pathology of the uterus and appendages, but also to "see" conglomerates of varicose veins and assess blood flow in them, and his speed and to identify pathological reflux.
CT and MRI
These methods of diagnostics allow to exclude organic pathology of the pelvic organs and confirm the presence of varicose conglomerates in the uterus, its broad ligament and ovaries.
The gold standard for research vessels is considered to be an x-ray with injection of a contrast agent (angiography):
The introduction of contrast into the muscle of the uterus in the region of its bottom intracervical followed by radiological study.
Contrast is introduced into the ovarian vein.
Held with vulvar and perineal varicose veins, contrast is injected into the veins of the perineum.
Performed for differential diagnosis and identifying comorbidities that complicates the course of illness. In some cases, diagnostic laparoscopy goes into treatment – ligation of veins of the ovaries.
Treatment of varicose veins of the pelvis should be comprehensive and include basic therapy, medication.