Treatment of varicose veins of small pelvic veins in women

12 December 2023

Varicose veins of the pelvic cavity is a relatively new disease, doctors learned only at the end of the 20th century, when the ultrasound diagnostic method became widespread. This is one of the most common causes of chronic abdominal pain. Varicose veins of the pelvic veins, moreover, cause dangerous complications: thrombosis, thrombophlebitis, pulmonary embolism.

What are pelvic varicose veins?

The essence of the pathology is the expansion, filling with blood and excessive stretching of the vessels. The liquid part of the blood leaks through the walls, which causes tissue swelling.

Causes of enlarged pelvic veins

Three main mechanisms of pelvic varicose veins have been identified:

failure of the valves of the pelvic veins - they should allow blood to pass only towards the heart, but if the valve apparatus fails, some of the blood returns;
blockage of pelvic vessels (blockage, obstruction);
hormonal changes in a woman's body that increase the permeability of the venous wall.

In some women, the valves are underdeveloped or absent after birth. An important role of heredity in the development of varicose veins of the small pelvis has been determined. 50% of women have a severe family history: cases of pelvic varicose veins among close relatives. Some genes responsible for the development of uterine varicose veins have already been identified: FOXC2, TIE2, NOTCH3. Mutations in them cause weakness of the venous wall or valvular insufficiency.

Pregnancy can be a trigger for the development of varicose veins of the small pelvic veins. The hormonal level of a pregnant woman changes, the amount of blood circulating in the body increases by 30%. Moreover, the capacity of the pelvic vessels increases by 60% due to mechanical compression of the vessels by the enlarged uterus and increased progesterone production. The vessels remain dilated throughout pregnancy and for one month after delivery.

In addition to uterine compression, other risk factors include:

endometriosis;
long-term sitting or standing position (causes stagnation of blood in the pelvic organs);
congenital structural features of blood vessels.

May-Turner syndrome is the direct cause of the disease in 3% of women. This is compression of the left common iliac vein by the right common iliac artery.

Symptoms of enlarged pelvic veins

Varicose veins of the pelvic veins are accompanied by the following syndromes:

Varicose syndrome.It manifests itself as visually noticeable dilated veins of the vulva and perineum. In addition, in some women, the veins of the hips, pubis and groin are enlarged. At the end of the day, the labia may swell.
Pain syndrome.With enlarged varicose veins of the small pelvis, this is the main reason to consult a doctor and receive treatment. Characteristics of pain: constant, aching, localized in the lower abdomen (related to the uterus) and spreads to the thigh and perineum. Pain intensifies with physical activity and long static position of the body. After resting in a horizontal position, they decrease. Pain may increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
Pelvic organ dysfunction.Most often, the menstrual cycle is disturbed due to varicose veins of the pelvic veins. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after intercourse. They are associated with blood flooding of the venous bed of the pelvic organs. Pain can last from half an hour to 1 day after contact. The third most common group of symptoms is dysuria. Usually there is an increase in urination, less often - urinary incontinence.
Psycho-emotional disorders.They arise due to long-term pain and a decrease in the quality of sexual life. Mostly depression develops.

A characteristic of varicose veins is that the severity of symptoms does not have a direct relationship with the diameter of the enlarged veins. That is, severe forms of the pathology may not have symptoms, and vice versa: they may be very pronounced even at the initial stage.

Diagnosis of varicose veins

The main diagnostic method is ultrasound. It is performed transabdominally (through the abdomen) and transvaginally (through the vagina). Different methods allow you to see different ships.

The effectiveness of diagnosing varicose veins increases with modern ultrasound options: color mapping and power Doppler.

X-ray with contrast - pelvic phlebography and selective oophorography.
CT and MR venography are more informative diagnostic methods than conventional X-rays. In addition, they are less invasive: contrast can be injected into the cubital vein, and MRI is informative even without the use of contrast.
Radionuclide technique.

Conservative treatment of varicose veins

When there is no indication for surgery to remove the pelvic veins, conservative therapy is the main method. In addition, it completes the transaction. Varicose veins are not a local, but a systemic disease. If the veins are not already dilated, they can become dilated elsewhere, most commonly in the legs. The use of drugs and procedures can increase the tone of the venous wall and slow down the development of varicose veins.

drugs for varicose veins of the small pelvis;
compression form;
herbs (most of the drugs for varicose veins of the small pelvic veins are created on a plant basis);
physiotherapy;
physiotherapy.

The leading method of treating varicose veins is to take medication. All other methods are only auxiliary.

Medicines are good first of all, because they affect the veins of the whole body, not just the pelvis. They increase the tone and reduce the permeability of the vascular wall. Diosmin preparations are often used for varicose veins. According to indications, hormonal agents are included in the treatment regimen. For symptomatic therapy, non-steroidal anti-inflammatory drugs are prescribed - they reduce pain. Many patients need antidepressants.

Compression therapy is most often used for varicose veins in the legs. It is rarely used when the pelvic veins are affected. If the veins of the legs are affected, compression stockings or socks are used to compress the lower part of the limbs, while in the case of varicose veins of the small pelvis, on the contrary, compression is needed in the upper part. Compression shorts are used that compress the upper third of the thigh, the pelvic region, and the anterior abdominal wall. Note that the effectiveness of this method has not been confirmed and does not provide long-term results: it can only be used for symptomatic purposes.

Surgical treatment of enlarged pelvic veins

Invasive procedures and operations help to eliminate the manifestations of pelvic varicose veins and reduce the risk of complications. They are performed in different vessels of the pelvis depending on the characteristics of the disease.

Interventions in the vessels of the perineum

Miniphlebectomy is used to remove veins in the perineum and buttocks. It is a minimally invasive intervention involving the removal of veins through minimal incisions. It has obvious advantages: quick recovery, minimal risk of complications, good aesthetic result.

But miniphlebectomy is not always possible. It is not suitable for removing varicose veins in the labia majora and labia minora. Veins must be removed through longer incisions. In the case of varicose veins of the small lips, their resection and then plastic surgery may be required.

Minimally invasive procedures are also used: scleroobliteration of vulvar and perineal veins. Doctors inject liquid or foam sclerosants into the veins. As a result, these vessels stick together, become invisible, and blood flow through them stops.

These treatment methods to widen blood vessels are very effective: 95% of patients are satisfied with the result. The disadvantage is a high relapse rate - up to 60% within 7 years of observation after sclerotherapy, up to 40% within 7 years after surgical removal of enlarged vessels. To reduce the risk of relapse, the doctor should eliminate pelvic-subcutaneous venous reflux during treatment.

Interventions in the gonadal vessels

The goal of treating varicose veins is to eliminate retrograde (backward) blood flow in the ovarian veins. As a result, the blood supply to the pelvic venous plexus decreases. These interventions are considered the most effective.

The operation to remove varicose veins is technically simple and not very traumatic. When using the endoscopic technique, the trauma is further reduced - in this case, the operation is performed through minimal incisions. The surgical method is also very effective. Chronic pelvic pain after vein removal disappears in 100% of patients within 1-2 months after surgery. After 5 years of observation, the risk of recurrence does not exceed 3%.

You can do without surgery. Embolization is used for treatment. Sclerosing (gluing) drugs or coils are injected into the ovarian vein through blood vessels, which cause blood clots to form, remove the dilation, and close the vessel completely. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical removal of veins, the advantage is minimal invasiveness, so endovascular procedures are among the standard approaches in the treatment of pelvic varicose veins in women.

Interventions in the renal and iliac vessels

Use in moderation. Clinical situations requiring such interventions are rare.

In women, operations on the left renal vein are performed in compression, which causes an increase in pressure in it. The doctor moves the vein and creates a new anastomosis (connection) between the left kidney and the inferior vena cava. He also performs ovarian vein resection.

Operations are performed on the left iliac vein for May-Turner syndrome. Doctors perform intravascular stenting of the left common iliac vein (placing a frame inside the vein). This is a rare operation performed only in specialized centers.

Where to go

To treat varicose veins, contact SOYUZ clinic. We perform minimally invasive surgeries and operations. Interventions are performed by experienced doctors with the most modern equipment. All women experience pelvic pain after surgery.

Causes of varicose veins of the pelvic veins

The most common risk factors for varicose veins are:

sedentary lifestyle;
"aorto-mesenteric tweezers" syndrome;
history of pregnancy and childbirth;
genetic predisposition;
congenital anatomical features of renal vessels;
endometriosis;
pelvic injury etc.

Treatment of varicose veins of small pelvic veins in women

Causes of varicose veins of the pelvic veins

According to international studies, almost one third of all women experience chronic pelvic pain. The causes of chronic pelvic pain are varied, but are often associated with pathology of the ovaries or the presence of varicose veins of the small pelvis. The symptoms of venous stasis in the pelvis are similar to the symptoms of varicose veins in the legs.

In both cases, the venous valves that help return blood to the heart against gravity weaken and don't close properly. This allows blood to flow backwards from the ovarian vein, which increases venous pressure and causes varicose veins. The outflow of blood is disturbed by a similar mechanism as in varicose veins of the legs. The dilated ovarian vein does not have the ability to regulate the reverse flow of venous blood due to the lack of venous valves. An overcrowded venous system causes stretching of the venous wall and secondary dilation of the pelvic vessels, so the disease progresses continuously.

Because the cause of pelvic pain is often undiagnosed, no cure is offered, although treatment is available. If you have pelvic pain that gets worse during the day when you are upright, you may want to get a second opinion from an endovascular surgeon to help find the cause of the problem. Pelvic varicose veins can be effectively treated with endovascular surgical techniques. Gynecology does not offer effective treatment for this disease.

Treatment of varicose veins of the small pelvic veins in the clinic

Anticoagulants, vetotonics and vitamins are prescribed as part of conservative therapy. Efforts are aimed at reducing blood cholesterol levels and improving a woman's lifestyle. If surgical intervention is necessary, minimally invasive methods are preferred.

Sometimes the said pathology can be the reason for not being able to get pregnant or cause problems during pregnancy. No matter what stage of your life you face reproductive health problems, experienced gynecologists and obstetricians will help you overcome them. The clinic creates the most favorable conditions for the health of women and their families and prescribes effective treatment.

With the help of special instruments, special spirals are installed in the vein lumen, which prevents improper blood flow and causes varicose veins of the pelvic veins.

No stitching required. The duration of the procedure varies from 30 minutes to several hours, depending on the complexity of the situation.

Symptoms of pelvic varicose veins include:

Pelvic discomfort
Heaviness in the pelvis
Bursting pain in pelvis

These symptoms may worsen during prolonged standing and sitting, menstruation, and sexual intercourse. It causes anxiety and distress in women.

The reason for the development of pelvic varicose veins (PVVV) is weak connective tissue. However, the presence of provoking factors is required for the development of the disease.

These factors are:

Physical exercise
Standing and sitting for long periods of time
Pregnancy and childbirth
Pelvic trauma
Tumors of the uterus and ovaries
Endometriosis
Indications for embolization are:
varicose veins of the pelvis with chronic pelvic pain syndrome
painful menstruation
Varicose veins of the external genitalia
pain during intercourse

Varicose veins of the pelvis have symptomatic and asymptomatic forms (that is, they can occur without symptoms). The asymptomatic form usually does not require any treatment

Symptoms of pelvic varicose veins in men and women

Visual symptoms are few. During the examination, expansion of the superficial veins in the perineum and hips is rarely noted. Violation of urine output due to obstruction of the venous plexus of the bladder.

The disease is accompanied by internal feelings. Patients complain of vague pain in the lower abdomen and inner thigh. There is a feeling of heaviness and swelling. Men and women may complain of pain in the lower abdomen of varying intensity during sexual intercourse.

Chronic pelvic pain:

nagging and dull pain in the lower abdomen;
pain in the sacrum and coccyx region;
pain in the back and groin;
frequent urination;
urinary incontinence;
false urge to empty the bladder.

Enlarged veins in the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin area, behind the thigh, in the buttocks).

Dilated vein of the inner thigh.

Varicose veins of the pelvis and its treatment

Painful varicose veins of the pelvis are more often found in the fairer sex. The disease is quite common, but the diagnosis of the disease is a complex process. More women walk with abdominal pain all their lives and treat an imaginary pathological process without thinking that they have varicose veins in the small pelvis.

What are pelvic varicose veins?

Pelvic varicose veins (PVVV) is a disease that affects the elasticity of blood vessels. In medicine, the disease is called differently: varicocele (found in representatives of both sexes), varicose veins of the small pelvis, chronic pelvic pain syndrome.

Women of reproductive age usually suffer and it is very important to treat the disease in time.

What are pelvic varicose veins?

Varicose veins of the small pelvis are the dilation of the veins through which blood flows from the genitals. With this disease, the vessels expand to a diameter of more than ten millimeters, which causes compression of the nerve endings and pain. Vienna

Why do pelvic varicose veins occur?

The causes of varicose veins of the small pelvic veins in women are considered to be the following:

compression of blood vessels by the growing uterus during pregnancy;
lifting weights and other physical activities;
sedentary work, sedentary lifestyle;
gynecological diseases: inflammation of the ovaries, endometriosis;
irregular menstrual cycle;
hormonal imbalance and treatment with drugs containing estrogens;
congenital anomalies of the vascular wall;
frequent protection with lack of orgasm or interrupted sexual intercourse.

Types of varicose veins of the small pelvic veins

Phlebologists distinguish two types of small pelvic varicose veins:

caused by primary, congenital or acquired dyspareunia
Advanced pelvic varicose veins can present with symptoms such as swollen veins in the groin, thighs, and hips. Manual examination can also reveal venous nodules.

Thromboembolic processes can be a complication of varicose veins of the small pelvis.

The first stage of varicose veins is characterized by a vein diameter of up to 5-7 mm located along the upper edge of the left ovary. In the second stage, vessels (up to 8-9 mm in diameter) occupy the entire left ovary, and are also observed in the right ovary and uterus. In the third stage, open varicose veins of the right ovary, uterus and small pelvis and veins with a diameter of 10-13 mm located under the lower edge of the left ovary are determined. Moreover, in the third stage, the diameter of the vessels of the left and right ovaries is almost the same.

Treatment of varicose veins

The treatment package depends on the degree of development of varicose veins. Doctors are supporters of conservative and gentle treatment: achieving maximum effect with minimal intervention on the body. And when the disease can be treated without surgery, drugs, injections and vitamins are prescribed to reduce pain and other symptoms of pelvic varicose veins. Also to normalize blood flow and eliminate risk factors for blockage of blood vessels. Doctors accurately calculate the dosage of drugs for each case to help the body cope with the disease almost independently.

Strict adherence to normal working conditions is envisaged, except for heavy physical exertion and prolonged stay in one position. Rest. This improves the patient's quality of life: physical and social activity increases, the psychological state normalizes.

It is recommended to adjust the nature of the diet, the diet is determined by increasing the level of fiber and moderate consumption of vegetables, fruits and vegetable oils. 80% of fatty and spicy foods are excluded from the diet, and alcohol is completely excluded. For overweight people, weight correction is recommended to reduce intra-abdominal pressure on organs and the venous system.

A phlebologist may also recommend stopping smoking and taking hormonal contraceptives to reduce the effects of estrogen and progesterone hormones on the body. Because these hormones reduce the tone of the walls of blood vessels and reduce their elasticity.

A contrast shower is recommended in the perineal area. Breathing exercises: slow and deep inhalation and exhalation using the abdominal muscles. Water procedures. Various unloading exercises.

We strongly recommend not to self-medicate without consulting a phlebologist. Each patient requires an individual selection of a treatment package, including a specific set of physical exercises.

The treatment complex includes wearing compression knitted clothes: tights or shorts of a certain compression class, suitable for a certain situation. Wearing compression stockings improves blood flow from the lower extremities, including the venous plexus of the perineum and buttocks. On average, wearing is prescribed for up to 14 days: several hours a day. How to choose the size, compression class and manufacturer, you will learn from the Compression Stockings article, or the phlebologist will provide complete information during the consultation.

When the patient often complains of unbearable pain in the pelvic region, the phlebologist prescribes non-steroidal anti-inflammatory drugs and pain relievers. Use should be in accordance with the doctor's recommendations.

If conservative treatment does not work or the disease is in an advanced stage, the phlebologist prescribes sclerotherapy or phlebectomy (surgical intervention) to remove the affected vessels. The procedure is completely painless and is performed under anesthesia. Many patients are worried about pain during and after surgery and are surprised that they completely disappear. Therefore, do not be afraid, painlessness has been proven by many years of experience of doctors. You will be able to go home the day after the operation.

In the absence of timely and proper treatment, the patient experiences deterioration of symptoms and quality of life. For women: getting pregnant and not being able to give birth on their own. For men: heaviness and inability to lead an active lifestyle.

With conservative treatment, the patient's recovery occurs gradually, directly during treatment. After the operation, the patient recovers easily and quickly. You will be able to walk independently the day after the operation.

Measures to prevent varicose veins of small pelvic veins

Prevention aims to eliminate the risk and symptoms of disease. Here are some simple steps to help you:

Moderate physical activity: walks, exercises. The movement of your muscles keeps blood flowing through your veins, so it's important to move.
If you have a sedentary or standing job, try to take a break every 30 minutes to move around a bit. For example, go for a walk, put the kettle on, put things on the shelf.
It is recommended that women avoid heavy and extreme sports activities: swinging, lifting heavy loads and walking incredible distances. Such loads are unnatural for a woman's body.
Stick to your drinking regimen. An adult person needs 30 ml per 1 kg per day.
Eat right. Eat more vegetables and fruits. Eat less fast food, fatty, floury and spicy food.
Consult a phlebologist and perform a series of exercises at home.