Treatment of small pelvic varicose veins in women

12 December 2023

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

What are pelvic varicose veins?

The essence of the pathology is that the vein expands, fills with blood, and becomes too stretched. The liquid part of the blood leaks through the wall, which leads to tissue swelling.

Causes of pelvic vein dilatation

Three main mechanisms of small pelvic varicose veins have been established:

insufficiency of pelvic vein valves - they should allow blood to flow only towards the heart, but if the valve device fails, part of the blood returns;
obstruction of the pelvic canal (blockage, obstruction);
hormonal changes in the female body that increase the permeability of the vein walls.

Some women have underdeveloped or absent valves from birth. The important role of heredity in the development of small pelvic varicose veins has been established. 50% of women have a burdened family history: cases of pelvic organ varicosities among close relatives. Several genes responsible for the development of uterine varicose veins have been identified: FOXC2, TIE2, NOTCH3. Mutations in it lead to weakness of the vein wall or valve failure.

Pregnancy can be a trigger for the development of small pelvic varicose veins. A pregnant woman's hormone levels change, and the amount of blood circulating in the body increases by 30%. In addition, pelvic venous capacity increases by 60% due to mechanical compression of the veins by the enlarged uterus and increased progesterone production. Blood vessels remain dilated throughout pregnancy and for another month after delivery.

In addition to uterine compression, other risk factors include:

endometriosis;
prolonged sitting or standing position (leading to blood stagnation in the pelvic organs);
congenital structural features of blood vessels.

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

Symptoms of enlarged pelvic veins

Pelvic varicose veins are accompanied by the following syndromes:

Varicose veins syndrome.It manifests itself as visually dilated channels on the vulva and perineum. In addition, in some women, the back, pubic and groin veins become enlarged. At the end of the day, the labia may swell.
Pain syndrome.With dilated small pelvic varicose veins, this is the main reason to see a doctor and undergo treatment. Characteristics of pain: persistent, aching, localized in the lower abdomen (related to the uterus) and radiating to the thighs and perineum. Pain increases with physical activity and prolonged static position of the body. They decrease after resting in a horizontal position. It is possible that the pain may increase in the second phase of the menstrual cycle, which is associated with hormonal changes.
Pelvic organ dysfunction.Often, due to pelvic varicose veins, the menstrual cycle is disrupted. The second most common syndrome in this group is dyspareunia. This is pain that occurs during or after sexual intercourse. They are associated with the overflow of the venous beds of the pelvic organs with blood. Pain may persist 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.It arises due to prolonged pain and a decrease in the quality of sexual life. Most depression develops.

The peculiarity of varicose veins is that the severity of symptoms does not have a direct correlation with the diameter of the dilated vessel. That is, symptoms may not be present in the form of severe pathology, and vice versa: they can be very noticeable even in the early stages.

Diagnosis of varicose veins

The main diagnostic method is ultrasound. It is performed transabdominally (through the stomach) 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 using contrast.
Radionuclide technique.

Conservative treatment of varicose veins

Conservative therapy is the main method if there are no indications for surgery to remove the pelvic veins. In addition, it completes the surgery. Varicose veins are not a local disease, but a systemic disease. Veins can dilate, if they are not already dilated, elsewhere, most often in the legs. The use of drugs and procedures can increase the tone of the vein walls and delay the development of varicose veins.

medicine for small pelvic varicose veins;
compression jersey;
herbs (most medicines for small pelvic varicose veins are created based on plants);
physiotherapy;
physiotherapy.

The main method of therapy for varicose veins is taking medication. All other methods are just extras.

Medicines are especially good because they affect the veins of the whole body, and not just the pelvis. They increase their tone and reduce the permeability of the vessel walls. Most often, diosmin preparations are used for varicose veins. According to the indications, hormonal agents are included in the treatment regimen. For symptomatic therapy, non-steroidal anti-inflammatory drugs are prescribed - they reduce pain. Many patients require antidepressants.

Compression therapy is most often used for varicose veins in the legs. When the pelvic veins are affected, they are rarely used. If, when the leg veins are affected, compression stockings or stockings are used, squeezing the lower part of the limb, then when the pelvic varicose veins are small, on the contrary, compression is needed in the upper part. Compression shorts are used that compress the upper third of the thigh, pelvic area and anterior abdominal wall. Note that the effectiveness of this method has not been confirmed, and it does not provide long-term results: it can be used exclusively for symptomatic purposes.

Surgical treatment of enlarged pelvic veins

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

Intervention on the perineal canal

Miniphlebectomy is used to remove veins in the perineum and buttocks. This is a minimally invasive intervention that involves removing the vein through a minimal incision. It has clear advantages: quick recovery, minimal risk of complications, good aesthetic results.

But miniphlebectomy is not always possible. It is not suitable for eliminating varicose veins on the labia majora and minora. The vein needs to be removed through a longer incision. In the case of varicose veins of the labia minora, their resection followed by plastic surgery may be necessary.

Minimally invasive procedures are also used: scleroobliteration of the veins of the vulva and perineum. The doctor injects a sclerosant liquid or foam into the vein. As a result, these veins stick together, become invisible, and blood flow through them stops.

This treatment method to widen blood vessels is very effective: 95% of patients are satisfied with the results. The disadvantage is the high recurrence rate - up to 60% within 7 years of observation after sclerotherapy, up to 40% within 7 years after surgery to remove dilated veins. To reduce the risk of relapse, during treatment the doctor must eliminate pelvic-subcutaneous venous reflux.

Intervention on the gonadal duct

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

Surgery to remove varicose veins is technically simple and not too traumatic. Trauma is further reduced when using endoscopic techniques - in this case, the operation is performed through minimal incisions. Surgical methods are also very effective. Chronic pelvic pain after vein removal disappears in 100% of patients within 1-2 months after surgery. The risk of recurrence within 5 years of observation does not exceed 3%.

You can do it without surgery. Embolization is used for treatment. A sclerosing drug (gluing) or coil is introduced through the blood vessel into the ovarian vein, which causes the formation of a blood clot, eliminating the dilation and closing the vein completely. According to various authors, the effectiveness of the method is 65-95%. Although less effective than surgical vein removal, the advantage is that it is minimally invasive, which is why endovascular procedures are among the standard approaches to treating pelvic varicose veins in women.

Intervention on renal and iliac vessels

Has limited use. Clinical situations in which this type of intervention is required are rare.

Surgery on the left renal vein in women is performed in case of compression, which leads to increased pressure in it. The doctor moves the vein and creates a new anastomosis (connection) between the left renal and the inferior vena cava. She also performed an ovarian vein resection.

Surgery on the left iliac vein was performed for May-Turner syndrome. The doctor performs an intravascular stent on the left common iliac vein (installation of a frame inside the vein). This is a rare operation that is only performed in specialized centers.

Where do you want to go?

To treat varicose veins, contact the SOYUZ clinic. We perform minimally invasive procedures and surgeries. Interventions are performed by experienced doctors using the latest equipment. All women experienced pelvic pain after surgery.

Causes of pelvic varicose veins

The most common risk factors for varicose veins are:

sedentary, sedentary lifestyle;
"aorto-mesenteric tweezers" syndrome;
history of pregnancy and childbirth;
genetic predisposition;
congenital anatomical features of the renal vein;
endometriosis;
pelvic area injuries, etc.

Treatment of small pelvic varicose veins in women

Causes of pelvic varicose veins

According to an international study, almost a third of all women suffer from chronic pelvic pain. The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian pathology or small pelvic varicose veins. The symptoms of venous stagnation 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 become weak and do not close properly. This allows blood to flow backwards through the ovarian veins, which increases venous pressure and causes varicose veins. The outflow of blood is disturbed by the same mechanism, as with varicose veins of the legs. The dilated ovarian veins do not have the ability to control the return flow of venous blood due to the insufficiency of the venous valves. An overcrowded venous system leads to stretching of the vein walls and secondary dilatation of the pelvic canal, so the disease persists.

Because the cause of pelvic pain is often undiagnosed, no treatment is offered, although treatments do exist. If you have pelvic pain that may worsen 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 using endovascular surgical methods. Gynecology does not offer effective treatment for this disease.

Treatment of small pelvic varicose veins in the clinic

As part of conservative therapy, anticoagulants, vetonics, and vitamins are prescribed. Efforts are aimed at reducing blood cholesterol levels and correcting women's lifestyles. If surgical intervention is required, the use of minimally invasive techniques is preferable.

Sometimes the pathology in question may be the cause of the inability to conceive or cause problems during pregnancy. No matter what stage of life you face reproductive health problems, experienced gynecologists and obstetrician-gynecologists will help you overcome them. The clinic creates the best conditions and prescribes effective treatment so that women and their families are healthy.

With the help of a special instrument, a special spiral is installed into the lumen of the vein, which prevents improper blood flow, which leads to pelvic varicose veins

No stitches are 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
Weight in the pelvis
Bursting pain in the pelvis

These symptoms may worsen with prolonged standing and sitting, during menstruation and sexual intercourse. Causing discomfort and suffering to women.

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

These factors are:

Physical training
Prolonged standing and sitting
Pregnancy and childbirth
Pelvic trauma
Uterine and ovarian tumors
Endometriosis
Indications for embolization are:
pelvic varicose veins with chronic pelvic pain syndrome
painful menstruation
Varicose veins of the external genitalia
pain during intercourse

Pelvic varicose veins have symptomatic and asymptomatic forms (that is, they can occur without symptoms). Asymptomatic forms usually do 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 buttocks is rarely observed. Urinary disorders due to congestion of the venous plexus of the bladder.

This disease is accompanied by internal sensations. The patient complains 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 of varying intensity in the lower abdomen during sexual intercourse.

Chronic pelvic pain:

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

Varicose veins on the external genitalia (in the perineum, in the lower abdomen, above the pubis, in the groin area, behind the thighs, buttocks).

Enlargement of the veins on the inner thigh.

Pelvic varicose veins and their treatment

Painful varicose veins in the small pelvis are more often detected in the fairer sex. This disease is quite common, but diagnosing the disease is a complex process. More women walk around with abdominal pain throughout 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, this disease is called differently: varicocele (found in representatives of both sexes), small pelvic varicose veins, chronic pelvic pain syndrome.

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

What are pelvic varicose veins?

Small pelvic varicose veins are widening of the vessels through which blood flows from the genitals. With this disease, the veins grow to be more than ten millimeters in diameter, which causes compression of the nerve endings and pain. Vienna

Why do pelvic varicose veins occur?

Causes of small pelvic varicose veins in women are considered to be:

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

Types of small pelvic varicose veins

Phlebologists distinguish two types of small pelvic varicose veins:

primary, due to congenital or acquired dyspareunia
Small pelvic extension varicose veins can manifest themselves with symptoms such as swollen veins in the groin, thighs and buttocks. Manual examination may also reveal venous nodules.

Thromboembolic processes can be a complication of small pelvic varicose veins.

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, veins (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, a vein with a diameter of 10-13 mm is identified, located under the lower edge of the left ovary with clear varicose veins from the right ovary, uterus, and small pelvis. Moreover, in the third stage, the diameter of the left and right ovarian veins is almost the same.

Treatment of varicose veins

The treatment package depends on the stage of development of varicose veins. Doctors are adherents of conservative and gentle treatment: to get the maximum effect through minimal intervention in the body. And, when the disease can be treated without surgery, drugs, injections and vitamins are prescribed to reduce pain and other manifestations of pelvic varicose vein symptoms. Also to normalize blood flow and eliminate risk factors for blood vessel blockage. The doctor calculates exactly the dose of medicine for each case to help the body cope with the disease almost independently.

Strict adherence to normal working conditions is prescribed, with the exception of heavy physical exertion and long stays in one position. Take a break. This improves the patient's quality of life: physical and social activity increases, and the psychological state returns to normal.

It is recommended to correct the nature of the diet; the diet is prescribed with increased levels 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.

Phlebologists may also recommend quitting smoking and taking hormonal contraceptives to reduce the effects of estrogen and progesterone hormones on the body. Because this hormone reduces the tone of the blood vessel wall and reduces its elasticity.

A contrast bath in the perineal area is recommended. Breathing exercises: inhaling and exhaling slowly and deeply 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 socks: tights or shorts of a specific compression class, suitable for specific cases. Wearing compression socks increases blood flow from the lower legs, including the perineal and buttock venous plexuses. On average, wear is set for up to 14 days: several hours a day. You will learn how to choose the size, compression class and manufacturer from the Compression Stockings article or during the consultation, the phlebologist will provide full information.

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

If conservative treatment does not bring results or the disease is at an advanced stage, then the phlebologist prescribes sclerotherapy or phlebectomy (surgical intervention) to remove the affected vein. This procedure is completely painless and is performed under anesthesia. Many patients worry about pain during and after surgery and are surprised that they are completely absent. Therefore, do not be afraid, pain has been proven by many years of experience of doctors. You will be able to go home the day after surgery.

In the absence of timely and correct treatment, patients feel a deterioration in symptoms and quality of life. For women: inability to conceive and give birth on their own. For men: weight and inability to lead an active lifestyle.

With conservative treatment, the patient's recovery occurs gradually, directly during treatment. After surgery, the patient recovers easily and quickly. The day after surgery you will be able to walk freely.

Steps to prevent small pelvic varicose veins

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

Moderate physical activity: walking, exercise. Moving your muscles keeps blood flowing through your veins, which is why it's important to move.
If you have a sitting or standing job, try to take a break every 30 minutes to move around a bit. For example, go for a walk, use the kettle, carry things to the shelves.
Women are advised to avoid strenuous and excessive sports activities: swinging, lifting heavy weights, and overcoming unusual distances. Such a burden is unnatural for a woman's body.
Stick to your drinking regimen. Adults need 30 ml per 1 kg per day.
Eat properly. Eat more vegetables and fruits. Eat less fast food, fatty, starchy and spicy.
Consult a phlebologist and do a set of exercises at home.