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Varicose veins pelvic – ectasia, vascular of the venous system of small pelvis, resulting in a violation of the bleeding from the inside and the vulva. Manifests visible extension of all the veins, accompanied by local swelling, the direction of gravity and a strong pain, bleeding. Characterized pelvic pain, dysmenorrhea, dyspareunia, and other symptoms. The varicose vein pelvic is diagnosed by examination and ULTRASOUND, venography, KT, of laparoscopy. The treatment of the syndrome may be conservative (pills, GYMNASTICS) or surgical (embolization specific veins, phlebectomy, etc).
Varicose veins pelvic – disease-pelvic veins, associated with the violation of their architecture and the stagnation of venous blood in a small basin. In the literature, the varicose veins of the pelvic region is also indicated by the terms "the syndrome of the basin of venous blood", "the varicocele in women", "the syndrome of chronic pelvic pain". The prevalence of varicose veins of the small pelvis increases proportionally with age: 19.4% among girls under the age of 17 years up to 80% in women in the perimenopausal period. The more often a pathology of pelvic veins diagnosed at the time of the reproduction in patients in the age group of 25-45 years. In the majority of cases (80%) varicose veins transformation affects ovarian vienna and is extremely rare (1%) is observed in veins in the broad ligament of the uterus. According to modern medical approaches to treatment of varicose veins should be not so much with the positions of gynecology, but, above all, by the positions of phlebology.
The basis of varicose veins of the pelvic region is considered to be the dysplasia of the connective tissue, which is the case in 35% of healthy subjects. This state is innate and is characterized by the decrease of the content of certain types of collagen, which is a prerequisite for the reduction of the resistance of the connective tissue, including the component of the vessel wall. An extreme manifestation of such a pathology can be used to under-development or absence of any morphological component of the vascular wall. System of the defeat of the connective tissue explains the frequent combination of varicose veins pelvic with varicose veins of the veins of the lower limbs and hemorrhoids. Except for connective tissue dysplasia, a certain "debilitating" effect on the tone of the venous system of small pelvis in women are sex hormones (mainly progesterone), and thrombosis of the pelvic veins.
Factors, increase the risk of varicose veins pelvic, are used to intense exercise, the work, coupled with a forced exposure to long periods of sitting or standing positions; pregnancy and childbirth, the trauma of the basin, the lack of orgasm in women. Of gynecological diseases the most significant effects on the development of varicose veins have endometriosis, prolapse of the vagina and uterus tumors of the uterus and ovarian cancer, varicose veins of the uterus and the other is Not excluded, filling the role of hormonal contraception and hormone replacement therapy.
The varicose vein pelvic can manifest itself in two forms: varicose veins of vulva and perineum, and the syndrome of venous blood. More than half of the cases, these two forms of the condition and support during each other. Isolated strong and perineal varices often occurs following a reflux of blood through the special container with the defeat of the external sexual of vienna and the influx of the great saphenous vein. Occurs in 30% of pregnant women, after childbirth, is conserved in 2% to 10% of women. The main factor causing varicose veins of the perineum and the vulva serves as the growing pressure of the uterus, iliac and the bottom of the trough vienna. The prerequisite for varicose veins pelvic promotes the reflux of blood ovarian vienna.
Are 3 degrees of severity of varicose veins pelvic, depending on the diameter and localization of venous disease:
The basis of the clinical picture different of varicose veins is visible to the eye, the expansion of blood vessels, venous in this area. Subjective symptoms may include a feeling of itching, discomfort, severity, and a strong pain in the area of the external genitalia. During the inspection can be swelling of the lips. Perhaps the membership of spontaneous or post-traumatic hemorrhage, most often created by the sexual act and childbirth. Because of the thinning of the venous wall and the high pressure in the varicose veins stop such bleeding associated with certain difficulties. Another complication of varicose veins in this location can become acute thrombophlebitis of the veins of the perineum. In this scenario, you are experiencing severe pain, redness and swelling of the skin of the perineum. The dead of varicose veins of vienna become dense and painful to the touch. Develops hyperthermic syndrome, increased body temperature up to 37.5 and 38.0 °C.
Another form of varicose veins of the pelvis the syndrome of venous blood, may give a polymorphic clinical picture, and often confused inflammatory gynecological pathology, colitis, cystitis, sciatica and More a permanent sign of pain in the lower abdomen, have different intensities, the nature and irradiation. In addition to the patient describe their feelings as a throbbing pain, giving to the lumbar region, the groin or perineum. Nearly half of all women with varicose veins pelvic note the strengthening of the pain in the second phase of the menstrual cycle. Often, the pain is caused the sexual act, a long bench or standing, the burden of physical work. For the syndrome of venous blood pelvic typically the presence explicit of premenstrual syndrome, dyspareunia, dysuric disorders.
The diagnosis of varicose veins of the pelvic region is folded from a standard of the examination, an ultrasound, OMT, and of the veins of the lower limbs, pelvic venography, CT and pelvic laparoscopy. In the investigation of patients with suspicion of varicose veins should participate to a gynecologist, et al.
During the examination of the external genitalia occur extended surface in the region of the vulva and perineum; and during the vaginal exam is determined by cyanosis of the vaginal wall, pain on palpation of the abdomen. Confirm the varicosities allows pelvic ultrasound, the more informative is combined with an ULTRASOUND of THE+TV free. The study not only gives the possibility to reveal organic pathology, but using the method of ULTRASOUND to discover the conglomerates of varicose veins modified by the circulation of the blood, the pathologic reflux of blood. According to the ULTRASOUND data of the vessels is determined by a reduction in the peak velocity of blood flow in the fallopian tubes and the inside of the veins iliac. In the framework of the evaluation of the vein to the patient's condition, it is recommended that ultrasound diagnosis of varicose veins of the lower limbs.
In order to study the localization and prevalence of varicose veins of the small pelvis, of the state of the valve of the venous system and anastomoses, as well as the detection of blood clots is made special venography. In the syndrome of venous blood can be displayed selective procedure, considering the introduction of contrast directly into the ovarian vienna. If isolated varicose veins used for the creation of contrast in the veins of the crotch. At the present time on the change of the x-ray comes CT of the pelvic region, not giving in to their diagnostic importance. In the context of the differential diagnosis, and, with a lack of informational content of these methods, the use of diagnostic laparoscopy.
In the course of pregnancy is possible only a symptomatic treatment of varicose veins pelvic. It is recommended to wear compression tights, taking medication on the recommendation of the vascular surgeon. II-III trimester of pregnancy can lead to the treatment of varicose veins in the crotch. If, because of varicose veins there is a high risk of bleeding for independent delivery, the choice is made in favor of the caesarean section.
Curator of the tactic can be effective when varicose veins of 1 to 2 degrees. Stability of the receipt of the special products, NSAIDS, physiotherapy sessions, the ascendant of a contrast shower, the standardization of conditions of work and physical activity, the selection of compression shirt and other measures can slow the progression of varicose veins and significantly improve the well-being. If you experience uterine bleeding that is assigned to a special treatment. In some cases, the patient may require the assistance of a therapist.
Strong pain syndrome, as well as the varicose vein pelvic 3-degree are used as an indication for the surgical treatment of pathology. Modern methods of minimally invasive surgery refers to the embolization of the ovarian vein, which run under the special control. During a procedure performed under local anaesthetic in the lumen of the vessel introduces the substance or installs a spiral special, which allows the obliteration/occlusion gonadal vienna. A possible alternative can be used for resection of the vein with an access or endoscopic clipping. If the cause of varicose veins serves as a disease of the uterus, is made of plastic of its ligamentous apparatus.
When the sandbox varicose veins can be performed phlebectomy in the crotch. The operation is often completed by the resection of the small or large lips. In the case of a combination of varicose veins of perineum and lower limb illustrates a particular procedure.
Of preventive measures aimed at reducing the risk of onset and progression of varicose veins pelvic, boil down mainly to the normalization of life. In this series, the main role belongs to the exclusion of long, static and intense physical activity, the correction of the power (the insertion of a large quantity of fruits and vegetables), abandonment of alcohol and tobacco. The first signs of varicose veins, it is recommended that sanitation and breathing exercises, wearing a jersey of compression, the courses held in preventative of conservative treatment. In this case, it is possible to achieve long-term remission and improve the quality of life of patients.
