This disease is poorly understood, although several thousand observations with diagnosis and subsequent treatment have been described.
The multitude of diversity and non-specificity of the clinical picture of varicose veins of the small pelvis leads to gross errors on the part of the diagnosis, which in the future will affect the consequences.
Characteristics of varicose veins of the small pelvis
Pelvic veins are many times longer than arteries, which leads to their increased capacity. This is due to the phylogeny 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 intertwined network.
The speed and direction of blood flow are regulated by valves, controlled by complex humoral mechanisms. The valves balance the pressure in different parts of the venous network.
When the valves cease to perform their functions, blood stagnation develops, this leads to vascular pathologies 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 pathologies.
Causes of occurrence
Pathological pelvic venous dilation may be due to the following reasons:
- Interruption of the blood outflow tract;
- Obliteration of the venous trunk;
- Compression of the collateral trunks from an altered position of the uterus, for example, in retroflection;
- insufficiency of the ovarian venous valve (congenital or acquired);
- Postphlebitic obstructive syndrome;
- Connective tissue pathology;
- Arteriovenous angiodysplasia;
- Prolonged sitting, hard physical work;
- Varicose veins of the lower limbs;
- 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 by degree of disease
Based on the size of the dilated vein, the following grades are distinguished:
- up to 0, 5 cm, path of the "corkscrew" vases;
- 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;
- venous congestion syndrome of the small pelvis;
Symptoms
- The most common pains - frequent in the lower abdomen, perineum after a long static and dynamic overload. 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.
- More than normal secretion from the glands of the genital tract.
- Stagnation of blood leads to infertility, miscarriage, miscarriage.
- Violation of urination due to the expansion of the veins of the bladder.
Diagnostics
Diagnosis of the disease only through complaints is successful only in 10% of cases.
The palpation of the internal walls of the pelvis allows you to feel the oblong seals and venous nodes. When viewed in the mirrors, cyanosis of the vaginal mucosa is visible.
The procedure of choice is an ultrasound examination with color Doppler mapping, which allows to detect not only ovarian varicose veins, but also venous thrombosis, post-thrombophlebitic occlusions. Ultrasound shows tortuosity, "worm-like" structures with no signal reflection, located on the lateral surface of the uterus.
The Doppler effect is based on the blue and red hue 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 flowing from the heart is not always arterial and vice versa.
Therefore, the doctor of ultrasound diagnostics sees this arterial or venous vessel, its size, the speed of blood flow in it and many indicators that are not necessary for an ordinary person, but play an important role in making a diagnosis. For this, transabdominal and transvaginal sensors are used.
In 5, 7% of cases, the disease is recognized by chance at screening. Normally the diameter of the ovarian vein is 0. 4 cm.
CT and MRI are extremely 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 Valsalva test, against the blood flow. This allows you to see exactly the failure of the valve.
Left rethngenorenoscopy, renal phlebography, superselective phleboovarioscopy and double-sided phleboovariography are also used. These methods allow you to determine hemodynamic and anatomical changes in the renal veins and in 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 discharged through the ovarian vein. But in conditions of hypertension, it occurs through the extraorganic uterine veins into the internal iliac vein. The plexus of the veins, through which outflow can occur, includes the sacral and bladder plexus.
In left IV, 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.
- Two additional flow paths or one additional and auxiliary are visible.
At 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 found in the ovarian region, in the direction of the round and broad ligaments. They look like large cyanotic conglomerates with a thin, tight wall.
The complexity of the diagnosis lies in the fact that the disease is often hidden behind the 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 remove 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 the 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 agents.
Phlebotonics: improves the tone of the vascular wall and increases blood flow. With this disease, it is better to consult a gynecologist about certain medications.
Physiotherapy is an important method.
Surgical treatment
- Resection of varicose veins.
- Gonado-caval maneuver.
- Laparoscopic sclerotherapy.
- Occlusion of the ovarian vein using endovascular X-ray methods.
Folk remedies
Since the main factor in the onset of the disease is the weakness of the valvular apparatus, all folk remedies used for varicose veins of the lower limbs are also used for this pathology.
The most used are: common hazel, hops, nettle, horse chestnut, dandelion root, kombucha, willow, oak, St. John's wort, twine, pollen and many other plants.
It is effective: treatment with baths of oak, chestnut, willow, chamomile, pharmacy, cayenne herbs, St. John's wort, twine.
Prevention
- The first thing to do if you have any complaints, predictors or diseases listed above is to contact your gynecologist.
- It is necessary to normalize the working regime and rest, try not to stay upright for a long time, physical overload.
- Do prevention exercises "pedal", "stand-birch", "scissor legs"
- Stick to a diet: eat foods rich in vitamins E, P, C, try to eat only white meat, less fat meat, replace it with fruits, vegetables, cereals.
- Drink plenty of fluids, but not less than 1. 5 liters per day.
- Get rid of excess weight, bad habits.
- Consult your doctor about wearing compression garments, it will improve blood flow from the lower limbs, thus reducing congestion in the pelvis.
- Avoid baths, saunas, steam rooms, hot baths.
In order not to get sick with such a difficult to diagnose disease, it is necessary 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 get rid of within a few days, you should see your doctor. He must provide you with highly qualified care and save you from suffering.