This disease is poorly studied, although several thousand observations with diagnosis and subsequent treatment have been described.
A lot of diversity and non -specificity of the clinical picture of varicose veins of the pelvis lead to gross errors from the diagnosis, which in the future affects the consequences.
Characterization of Varicose veins of a small pelvis
The veins of the pelvis are several times longer than the arteries, which determines their large capacity.This is due to the phylogenesis of the vascular system of the pelvic region.The veins of the pelvis have high adaptation abilities and is potentially predisposed to restructure, which contributes to the formation of a densely interwoven network.
The speed and direction of the blood flow is regulated by valves, which are 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, stagnation of blood develops, this leads to the pathology of blood vessels and the formation of varicose veins.The uniqueness of the veins of the small pelvis lies in the fact that the wide ligaments of the uterus, which support the lumen of the vessel wide, can also narrow it, causing a pathology.
Causes
Pathological dilatation of the veins of the pelvis may be due to the following reasons:
- Violation of blood outflow paths;
- Venous barrel prison;
- Compression of collateral trunks by the changed position of the uterus, for example, in retroflexia;
- Valve ovary failure (congenital or acquired);
- Obstructive post -phlebitical syndrome;
- Pathology of connective tissue;
- Arteriovenous angiodisplasia;
- Prolonged sitting, hard physical labor;
- Varicose veins of the lower extremities;
- Pregnancy (3 or more) and childbirth (2 or more);
- Diseases of the female genital area (chronic salpingoophorite, ovarian tumors, uterine fibroids and genital endometriosis);
- The adhesive process of the pelvic organs;
- Obesity.
Classification by degrees of the disease
In terms of expanded vein, the following degrees are distinguished:
- up to 0.5 cm, “corkscrew” vascular stroke;
- 0.6-1 cm;
- more than 1 cm.
Options for the course of the disease
- varicose veins of the perineum and vestibule of the vagina;
- venous full -blooding syndrome of the pelvis;
Symptoms
- The most common - frequent pains in the lower abdomen, perineum after long static and dynamic overstresses.The pain intensifies in the second phase of the cycle, after hypothermia, fatigue, stress, exacerbations of various diseases.
- The feeling is “not at ease”, pain with sex and after it.
- Dysmenorrhea - menstruation disorders, including pain syndrome.
- Secretation, more than normal, galls of genital tract.
- Stagnation of blood leads to infertility, inability, termination of pregnancy.
- Violations of urination as a result of the expansion of the veins of the bladder.
Diagnostics
Diagnosis of the disease only by complaints is successful in only 10 % of cases.
Palpation of the internal walls of the pelvis, makes it possible to feel oblong seals and nodes of veins.When examined in the mirrors, the cyanosis of the mucous membrane of the vagina is visible.
The procedure for choosing is an ultrasound study with color Doppler mapping, which allows you to identify not only varicose extensions of ovarian veins, but also venous thrombosis, posttrombophlebitical occlusion.With ultrasound, it is visible, “worms”, the structure without reflection of the signal, localized on the side surface of the uterus.
The effect of Doppler study is based on “tinting” in blue and red color, venous and arterial blood, corresponding.
The apparatus for ultrasonic examination using a special program recognizes the movement of blood from the sensor and in the other direction, calculates blood flow velocity and the type of vessel.
But the exact definition of the vein is or the artery remains behind the doctor.The Doppler method works in almost all cases, our body dictates exceptions to the rules, since blood that flows from the heart is not always arterial and vice versa.
Thus, an ultrasonic diagnostic doctor sees an arterial or venous vessel, its size, blood flow rate in it and many indicators that an ordinary person does not need, but play an important role in making a diagnosis.To do this, use transabdominal and transvaginal sensors.
In 5.7% of cases, the disease is recognized by accident during screening.Normally, the diameter of Vena ovaric is 0.4 cm.
CT and MRI have great accuracy.Using these methods, you can find accumulations of varicose veins in ligaments of the uterus, ovaries and around these organs.It is possible to determine the concomitant pathology.
A very reliable method is a phlebographic study.
Contrast is carried out at the height of the Valsalva sample, against blood flow.This allows you to see valve failure.
Retronenoscopy on the left, renal phlebography, super -sequenic phlebovarioscopy and phlebovariography on both sides are also used.These methods allow you to determine the hemodnam and anatomical changes in the renal veins and the places of falling into them Gonadny veins.
Super -spent phlebovarioscopy is performed by catheterization of gonad veins through a counterattotal femur or subclavian vein, with the subsequent introduction of contrast.
Most of the blood from the varicose hornless plexus is thrown away through the ovarian vein.But in conditions of hypertension, it occurs through non -cornuted uterine veins into the inner iliac vein.The plexus of the veins, through which the outflow can occur, include sacral and plexus of the bladder.
In left -sided phlebo -icigography, 3 stages of venous stagnation are distinguished in the cluster plexus of the left ovary:
- There is no outflow from the plexus of the left ovary or it is carried out along an additional short path.
- There is an additional long way.
- Two additional outflow paths or one additional and auxiliary are visible.
At 2 and 3 stages, varicose veins of the cluster plexus of the right ovary are formed.
Laparoscopy is used for differential diagnosis.Pathologically convoluted veins are in the ovary, in the direction of the round and wide ligaments.They look like large cyanotic conglomerates with a thin and tense wall.
The complexity of the diagnosis lies in the fact that the disease is often hidden behind the signs of the inflammatory process, is distinguished by clinical manifestations, masked under 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 late stages of the disease, the treatment of choice is surgery.
Conservative treatment
It consists in normalizing the tone of veins, improvement of hemodynamics and trophic processes.
Symptomatic treatment to eliminate individual symptoms.Nonsteroidal anti -inflammatory for pain, with bleeding - hemostatic therapy.
The main drugs in conservative treatment are venotonic drugs and antiplatelets.
Phlebotonics - improve the tone of the vascular wall and enhance blood flow.With this disease, it is better to consult a gynecologist about certain drugs.
An important method is physiotherapy exercises.
Surgical treatment
- Revival varicose veins.
- Gonado-Cavalry Shunting.
- Sclerosis for laparoscopy.
- Occrames of ovary veins using x-ray-endovascular methods.
Folk remedies
Since the main thing in the occurrence of the disease is the weakness of the valve apparatus, all folk remedies that are used for varicose expansion of veins of the lower extremities are also used for this pathology.
The most commonly used: ordinary hazel, hops, nettles, horse chestnut, dandelion root, tea mushroom, willow, oak, St. John's wort, a series, flower pollen and many more plants.
Effective is: Treatment with oak baths, chestnut, willow, chamomile, pharmacy, herbs of drying, St. John's wort.
Prevention
- The first thing to do if there are complaints, predictors or diseases listed above - contact a gynecologist.
- It is necessary to normalize the working regime and rest, try not to stay in an upright position for a long time, physical strain.
- Perform exercises for the prevention “pedal”, “stand-up stack”, “foot legs”
- Adhere to the diet: eat foods with a high content of vitamins E, R, C, try to eat only white meat, less fat, replace it with fruits, vegetables, cereals.
- Drink a sufficient amount of liquid, but not less than 1.5 liters per day.
- Get rid of excess weight, bad habits.
- Consult with the attending physician about wearing compression linen, it will improve the outflow of blood from the lower extremities, thereby there will be less stagnation in the pelvis.
- Avoid baths, saunas, steam rooms, hot baths.
In order not to get sick with such a difficult disease, it is necessary to follow the preventive recommendations listed above.Treat your health as the most valuable in life.
At the slightest suspicious symptoms that you cannot get rid of for several days, you should consult a doctor.He must provide you with highly qualified help and save you from suffering.