Varicose veins (varicose veins) is a disease that is accompanied by an increase in length, the formation of serpentine pathological distortions of the veins, irreversible enlargements of their lumen and valve insufficiency. The organs of the lower pelvis are involved in the process of varicose veins. The mechanisms of disease development are different. Doctors include the perineal area, external and internal genitals as atypical localizations.
General information about the pathology
The process of blood flow through the veins proceeds in such a way that, under normal conditions, conditions are created for the development of stagnation and blood flow.
Varicose veins (VV) - vasodilation of the external genitalia. The disease occurs in women suffering from varicose veins of the pelvis and legs, as well as in pregnant women. In 30% of cases, pelvic varicose veins affect the perineum and vulva.
The start of treatment of the disease is delayed due to the localization in a familiar place. Women are shy. In some cases, patients do not feel pain or discomfort. But varicose veins during pregnancy and not only during the transfer of a fetus proceed with complications: blockage of the veins by a thrombus (thromboembolism), disorders of sexual sensitivity, pain in the perineum, psycho-emotional problems and family.
The mechanisms of congestion of the pelvic vessels are not fully disclosed. The cause of the primary form of the disease is called dysfunction of the valves of the gonadal (ovarian) veins. This causes reverse blood flow and increases the pressure in the venous nodes of the lower pelvis. Valve insufficiency can be acquired or congenital. It worsens with age or pregnancy.
The secondary form VVV of the pelvic organs is associated with gynecological pathologies: endometriosis, tumors of the pelvic organs.
Diagnosis of the disease is difficult due to the fact that there are no specific symptoms of its course. It is based on the results of the ultrasound (ultrasound).
To distinguish between primary and secondary forms of pathology, the Valsalva test is used during the ultrasound examination. With a secondary cause of pelvic varicose veins, it is negative.
Varicose veins of the lips with VBT
To be diagnosed with varicose veins of the lips, a doctor's examination is required. The symptoms of the disease are as follows:
- varicose veins in the genitals.
- pain in the outer area of the genitals.
- feeling of heaviness and burning in the perineum.
- swelling of the perineum by the end of the day.
Chronic pelvic pain occurs less frequently (in 30% of cases).
After the diagnosis is made, a study is performed to determine the degree of complexity of the pathological process and to prescribe the appropriate treatment. Various events take place:
- examination of the veins of the perineum and legs by ultrasound angiography - USAS.
- performing an ultrasound of the pelvic vessels, including the veins of the vagina, uterus, peripherals, ovaries, pelvis, inferior vena cava and kidneys.
- According to indications, multislice computed tomography (MSCT), selective ovulation and pelvic venography (SOFT) are performed.
Doctors call a characteristic feature of varicose veins on the lips with VBT that the disease progresses steadily and is associated with the transformation of intrapelvic veins.
Treatment of varicose veins of the vulva
IV treatment is prescribed based on the symptoms and diagnostic results.
In complex drug therapy for the treatment of systemic chronic venous pathology, non-steroidal anti-inflammatory drugs and phlebotropic drugs are prescribed.
Prescribe pharmacotherapy with antiplatelet agents, intrapelvic block with antihypertensives, physiotherapy with ultrasound, therapeutic exercises. Antioxidants and enterobiotics are added to the treatment.
According to the indications, venous sclerotherapy is performed - sclerotherapy. The vessel is "sealed" with drugs and lasers. It stops working. The procedure does not use special methods of anesthesia. It is performed in outpatient clinics and produces a cosmetic effect.
With pelvic venous proliferation, expansion and reverse blood flow through the gonadal (ovarian) veins, venous removal surgery is indicated. In case of varicose veins of the labia minora it is removed.
Varicose veins of the vulva during pregnancy
Pregnancy is the first most common risk factor leading to VVV. A significant and prolonged increase in progesterone concentration already in the early stages of pregnancy reduces venous tone and worsens reduced blood flow. VBT, which affects the perineum and vulva, is also related to the compression of the large veins of the retroperitoneal region (pelvic veins and inferior vena cava) by the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Varicose veins often appear on both sides. Signs of illness:
- a sharp increase in the veins of the vulva over a period of 18-24 weeks during the first pregnancy, from 12 weeks with recurrent pregnancy.
- inguinal discomfort.
- pulling, pain, dull pain in the pelvic area.
- pain during sexual intercourse.
- itching of the vulva;
- swelling of the genitals and perineum.
The signs of pathology progress with the course of pregnancy. In addition to increasing the size of the varicose veins, its compression is determined by the third trimester. A typical symptom of IV is its combination with inguinal varicose veins during pregnancy or varicose veins in the legs.
The instrumental examination for varicose veins in pregnant women is limited to their ultrasound, as well as to the ultrasound of the legs, because the painful changes in the venous bed undergo postnatal period.
In most cases (about 80%), from the first days of labor, the symptoms of varicose veins during pregnancy begin to decrease and are minimized 2-8 months after the birth of the baby. There is no complete return of the diameter of the vessels to their original values.
In 4-8% of women, IV does not disappear after childbirth and the disease progresses.
An interesting feature is the relationship between the end of the feeding period or the reduction of breastfeeding volume with the rate of disappearance of varicose veins in the groin in women. A shortened lactation period is accompanied by reduction and disappearance of dilated veins and vice versa. This proves that perineal varicose veins during pregnancy are associated with changes in hormone levels.
Treatment of perineal varicose veins during pregnancy
The basis of treatment for varicose veins during pregnancy is venous treatment. In the majority of fertile women, IV begins in the II and III trimester. During this period, diosmin preparations may be used. The severity of the symptoms of the pathology is reduced by the micronized purified flavonoid fraction. Itching is relieved by zinc paste and H1-histamine receptor blockers.
Low molecular weight heparin in a prophylactic dose prevents venous thrombosis and pulmonary embolism (blockage of blood vessels).
As an option for compression therapy, it is recommended to wear tight elastic underwear using latex or gauze pads. Relieves swelling of the lips and the feeling of heaviness. A special compression shirt for women with varicose veins helps a lot.
If a complication develops, such as local thrombophlebitis, surgery is required.
When a cluster of varicose veins is found in the genitals, the question arises about how to give birth. Natural childbirth is allowed with varicose veins. In contrast, the risks of caesarean section surgery are higher than the occurrence of bleeding from painful vessels during childbirth. This rarely happens. But with varicose veins, a caesarean section is often performed.
Prevention of varicose veins of the lips
The main factor for the formation of varicose veins in the groin is the loading of the fetus. It is difficult to name any preventive methods, given the fact that during pregnancy there are some limitations to many therapeutic measures. Some tips to follow:
- eliminate physical and static stress.
- follow a diet;
- perform therapeutic exercises, in which the movements accelerate the outflow of blood from the legs and lower pelvic organs.
- In case of venous insufficiency, presence of varicose veins before pregnancy, it is necessary to take venous drugs, to wear compression underwear.
An effective method of prevention is considered the operation on the ovarian veins, the surgery for other pathologies related to varicose veins. This reduces the phenomenon of pelvic venous congestion, reduces the risk of varicose veins on the lips.
Varicose veins are a common disease in women with varicose veins of the pelvis, legs or during pregnancy.
In order to improve the quality of treatment of patients with chronic venous diseases, it is important to diagnose the disease, to distinguish between methods of diagnosis and treatment of this disease.