Varicose veins the pelvic quite a common disease, especially in women. But because of the ignorance of many doctors, the characteristics of this disease, the diagnosis is exposed is rare, and the diagnosis of the disease, you feel almost clinical "exotic". Given the variety of symptoms and the domain of pain varicose veins pelvic often masked by gynaecological inflammatory diseases, and hormonal diseases, the pathology of the urinary system (cystitis), surgical disease (ulcerative colitis and Crohn's disease), lumbar, sciatica and also under the disease of the joint.
The frequency of the disease is equal to 5.4 – 80%, a similar bandwidth due to the ambiguity of diagnosis and principles of treatment. The incidence of this disease increases with age, teenage girls (under the age of 17) the percentage of the disease reaches 19,4, while in perimenopause the prevalence of the disease increases by up to 80%. Most often varicose veins the pelvic is diagnosed in women of childbearing age.
It should be noted that this condition often during pregnancy, about 30% of the future mothers the disease is diagnosed after 8 weeks of gestation.
Define the terms
Most of the women know of the existence of this disease, such as varicose veins of the lower limbs. Unlike varicose veins pelvic varicose veins of the legs you can see, as well as advanced vein usually found under the skin (it is the extension and venous) and are perfectly visible.
Varicose veins pelvic call the pathology of the veins located in the depth of the basin, a result not seen with the eye, and to suspect the disease difficult. When the disease is broken. (the structure of the vein wall) of the veins, reduced their elasticity, causing the venous blood in the pelvis stagnates. In other words, the veins are clogged, swell, and the outflow of venous blood is broken, which leads to venous expansion.
Varicose veins pelvic also called syndrome pelvic venous extension. In some sources it is possible to encounter the term "varicocele" women, that is not entirely correct. When varicocele in the process in question, the veins of the spermatic cord and of the egg, which are available only in men, but through a mechanism of development and symptoms of the disease like varicose veins the pelvic.
Also, the disease a number of authors called the syndrome of chronic pelvic pain, which is also correct. This syndrome may be due to several reasons (gynaecological, urological diseases, including varicose veins, pelvic.
The causes and mechanism of development
Until now it has been shown that the disease is due to the extension of the plexuses of veins, ovarian veins and large masterbatch ligaments. And the mechanism of development of pathology is insufficiency of the valves of the veins of the ovaries, which leads to reflux and causes an increase of the venous pressure and the development of venous stasis in the garland of the veins of the pelvis. In the background interrupted the flow of venous blood in the major veins develop collateral (for) circulation pathways.
Also in the development of illness is the content of hormones, in particular, the level of progesterone. Progesterone is the pregnancy hormone, reduces the tone of smooth muscles, not only of the uterus (prevention of abortion), but also of the vascular wall, and that causes their dilation (extension), and venous stasis. In addition, with the progress of pregnancy, the uterus growing, it begins to compress the great vessels, retroperitoneal (the inferior vena cava and iliac vein), which stimulates the formation of the loans. So the disease is much more frequent in the future the mothers of all the other women.
Confirmation of hormonal theory of the development of the disease and the detection of the disease among girls at the age of puberty, when hormonal jump associated with puberty. Of all the signs varicose of pelvic veins in the girls observe only one – increase in vaginal beloeil.
Another pair of a starting point for the development of pathology serves the dysplasia of the connective tissue, which has about 35% of people. On the background of dysplasia of the vascular wall is detected, the lack of collagen, that provides elasticity and strength of blood vessels. In extreme cases, the collagen may be entirely absent. System defeat of the connective tissue explains the frequent combinations of pelvic varicose veins with the varicose veins of the legs and hemorrhoids.
Predispose to the development of varicose veins the pelvic the following factors:
Increased the volume of blood in the blood vessels, increase in the content of progesterone, the uterus, and growth – all of this leads to dilation of the veins of the pelvis and compression of the large vessels.
- The developmental dysplasia of the connective tissue
Reduction of the tone of blood vessels and the underdevelopment of the venous valves leading to increased fragility of the veins.
- Multiple pregnancy
It increases the load on the female body, including blood vessels, a couple of times.
- Many labor and delivery complicated
Prolonged labor or childbirth first result, abnormalities generic the forces, and also a great I favor breaking the flow of blood in the pelvic veins small veins of the lower extremities and of hemorrhoids the garland.
- Sedentary life-style
As a "sit-in" and "walk" the work force constantly occurs inactivity causes venous stasis.
- Heavy physical loading and lifting weights
- Gynecologic pathology
This group includes an inflammatory disease of the uterus/adnexa, tumors (fibroids, cysts, and neoplasms of the ovary and endometriosis.
- Retroflessione of the uterus
The uterus retroverso back causes deflection in a large masterbatch bundles, which interrupts the flow of the venous blood in it, and then in the veins of the pelvis.
- The treatment with hormones and hormonal contraception
The effect of hormone replacement therapy and KOK confirms the following fact: in postmenopausal women, the severity of the manifestations of the disease decreases.
- Sexual dysfunction
When anorgasmia (lack of sexual satisfaction) occurs a stagnation of the blood in the basin, with the time of sexual frustration turns into a varicose veins of the pelvic veins. The venous stasis causes, and dyspareunia (pain during sexual intercourse and after him). Invasive venous blood circulation to the pelvic and coitus interruptus. The women, and the partners who adhere to this method of contraception, the more probability of the occurrence of varicose veins pelvic (due to the same anorgasmia).
Depending on the clinic are 2 forms of varicose veins of pelvic veins:
- the extension vulvar veins (in more serious cases, it is applied on the inner surface of the thighs and the groin);
- syndrome venous plethora.
Both forms are present simultaneously, only the symptoms of one of their most pronounced. It forms a vicious circle – advanced vein vulva lead to the rupture of the venous outflow in the basin, and the venous dilatation pelvic plexuses causes the extension vulvar veins.
The future mothers most often observed varicose vulva, the disease may disappear by itself after birth, however, stored at 2 – 10% of cases.
Classification A. Volkova (according to the degree of the extension):
- 1 degree – the veins of a diameter not exceeding 5 mm, stroke of the blood twisted;
- A 2-degree – diameter of the pot is 6 – 10 mm, varicose veins can be totally or there is only in the crown of ovarian, veins, parameter, or myometrium;
- 3 the degree greater than 10 mm in diameter.
The clinical picture
The symptoms of varicose veins pelvic in women are very different, and often masked by diseases related systems and organs. As already said, the disease can proceed with the prevalence of manifestations of one or another clinical form.
The symptoms of varicose veins vulvari
The main feature of this form is the dilation of the veins in the area of the vulva and/or perineum, which sees the same woman. The woman complaint to the itching and discomfort of the vulva, a feeling of heaviness in this field. When gynecological examination identifies the swelling and swelling of the lips, rose and advanced to vienna, on their surface, in the perineal area and buttocks, in most of the cases the hemorrhoids.
Is high the probability of occurrence or the spontaneous or post-traumatic bleeding (after intercourse or childbirth). As well as the venous wall is significantly thinning, and perform hemostasis (stop bleeding) is quite difficult to even ways of tying the damaged veins or clamping).
A complication of this form is present thrombophlebitis acute veins of the perineum. When they appear, very strong pains, the skin of the perineum becomes red and swells. Vienna compacted and become painful. Thrombosis of the veins is in the inflammation (phlebitis), which is accompanied by an increase of temperature (up to 38 degrees), and intoxication syndrome (weakness, loss of appetite).
The symptomatology of the syndrome of expansion
In the first place, in this form there is the pain. As you experience the pain of varicose veins pelvic? The constant pain, they are localized in the lower abdomen and have different intensity and nature (pulling, aching, stupid, arching, moderately, or very pronounced).
The pain may radiate in the lumbar region and the sacrum, a crotch or groin. A feature of pelvic pain venous expansion is their gain after a long stay in a fixed position (sitting or standing), and also after the execution of physical activity, and lifting weights.
The pain during sexual intercourse, and after him
The disease is characterized by dyspareunia, and pain can appear as during sexual contact, and after him. Dyspareunia causes the development of vaginismus and fear of coitus. Observed hypersensitivity (hyperaesthesia) of the skin of the perineum and the mucous membrane of the vagina.
Another symptom of this form is present in the premenstrual syndrome, the manifestations of which are expressed, and the increase of pain takes place in the second phase of the cycle (from 14 days).
They also have a place in painful menstruation and menstrual disorders (dysmenorrhea), increased volume of vaginal secretions.
Disorders of urination
In some cases, is celebrated in disorders of urination (painful and palpitations), which is associated with the venous extension of the bladder.
Violation of the habitual style of life, in sexual dissatisfaction, constant family conflict worsens the mental state and emotional of the woman and lead to the development of neurosis and depression.
The diagnosis of varicose veins the pelvic is very complex and must be conducted with the participation of a gynecologist and phlebologist. All the diagnostic events are divided into noninvasive and invasive.
A pelvic exam
Mandatory, but only allows to suspect of varicose veins of the veins of the small pelvis. The visual examination detected the thickened vienna, genital, lips, groin and inner surfaces of the thighs. The inspection and gynecological mirrors allows you to see the cyanosis (cyanosis) of the vaginal walls, and by palpation determined spongy nature (smoothness) and pain vaginal of arché. The pain occurs when the vagina and appendices, of the tube of the ligaments, and when you move the back of the neck of the uterus.
It is preferable to make combined ULTRASOUND also transabdominal (through the wall of the stomach) and transvaginal (through the vagina) of the sensors with the application of doppler. This study allows to identify not only the organic pathology of the uterus and adnexa, but also to "see" conglomerates of varicose veins, to assess the flow of blood in them, and his speed and determining pathologic reflux.
CT and magnetic RESONANCE imaging
Data diagnostic methods allow you to exclude organic pathology of the organs of the pelvis and to confirm the presence of varicose veins of asphalt in the uterus, the more wide-ranging collaboration and in the ovaries.
The gold standard in the study of blood vessels is considered to be the x-ray examination with the introduction of contrast medium (angiography):
Introduction of contrast in the muscle of the uterus in the area of his or her dna intracervical through followed by radiologically the research.
The contrast is injected in the ovarian of vienna.
It takes place with vulvar and perineal varicose veins, contrast dye is injected into a vein in the perineum.
It is developed for the differential diagnosis and to identify underlying diseases, complicating disease. In some cases, a diagnostic laparoscopy enters the healing – ligation of the veins of the ovaries.
The treatment of varicose veins pelvic must be comprehensive and includes basic drug therapy.