Varicose veins (varicose veins) are a disease accompanied by an increase in length, the creation of a serpentine pathological curvature of the veins, irreversible saccular expansion of their lumen and valve insufficiency. The organs of the lower part of the pelvis are involved in the varicose process. The mechanisms of disease development are different. Doctors include the perineal region, external and internal genitalia as atypical localizations.
General information on pathology
The process of blood flow through the veins takes place in such a way that in physiological conditions, preconditions are created for the development of stagnation and outflow of blood.
Varicose veins of the vulva (VV) - vasodilation of the external genitalia. The disease is manifested in women who suffer from varicose veins of the pelvis and legs, as well as in pregnant women. In 30% of cases, varicose veins of the pelvis affect the perineum and vulva.
The start of treatment of the disease is delayed due to accommodation in an intimate place. Women are shy. In some cases, patients do not feel pain or discomfort. But varicose veins in pregnancy, and not only in carrying a fetus, are accompanied by complications: clogging of the veins by thrombosis (thromboembolism), disorders of sexual sensibility, pain in the perineum, psycho-emotional problems and family conflicts.
The mechanisms of pelvic congestion have not been fully elucidated. The cause of the primary form of the disease is called gonadal (ovarian) valve failure. This causes the return flow of blood and increases the pressure in the venous nodes of the lower pelvis. Valve insufficiency can be acquired or congenital. It gets worse with age or pregnancy.
The secondary form of VVV pelvic organs is associated with gynecological pathologies: endometriosis, pelvic organ tumors.
The 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 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 varicose veins of the pelvis, it is negative.
Varicose veins of the labia with VBT
A doctor's examination is required to diagnose varicose veins. The symptoms of the disease are as follows:
- varicose veins on the genitals;
- pain in the external genitalia;
- 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 conducted to determine the degree of complexity of the pathological process and prescribe adequate treatment. Numerous events are held:
- examination of the veins of the perineum and legs with ultrasound angioscanning - USAS;
- performing ultrasonography of the pelvic vessels, including vaginal, uterine, parametric, ovarian, iliac, inferior vena cava and renal veins;
- according to the indications, multislice computed tomography (MSCT), selective ovaricography and pelvic phlebography (SOFT) are performed.
Doctors call the characteristic feature of varicose veins on the lips with VBT that the disease is constantly progressing and that it is combined with the transformation of intrapelvic veins.
Treatment of varicose veins of the vulva with varicose veins of the lower part of the pelvis
IV treatment is prescribed based on symptoms and diagnostic results.
In complex drug therapy for the treatment of systemic chronic venous pathology, nonsteroidal anti-inflammatory drugs and phlebotropic drugs are prescribed.
Prescribe pharmacotherapy with antiplatelet agents, intrapelvic blockade with antihypoxants, ultrasound physiotherapy, therapeutic exercises. Antioxidants and enterobiotics are added to the therapy.
According to the indications, the treatment of phlebosclerosis is performed - sclerotherapy. The vessel was "sealed" with drugs and a laser. It stops working. The procedure does not use special methods of anesthesia. It is performed on an outpatient basis and gives a cosmetic effect.
With pelvic abundance of veins, dilation and return flow of blood through the veins of the gonads (ovaries), surgery to remove the veins is indicated. In case of varicose enlargement of the labia minora, it is removed.
Varicose veins of the vulva during pregnancy
Pregnancy is the first most common risk factor that leads to the appearance of VVV. Significant and permanent increase in the concentration of progesterone in the early stages of pregnancy reduces venous tone and worsens impaired blood flow. Also, VBT, which includes the perineum and vulva, is associated with compression of the great veins of the retroperitoneal region (iliac veins and inferior vena cava) by the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Varicose veins of the vulva often occur bilaterally. Signs of the disease:
- marked increase in vulvar veins in the period of 18-24 weeks during the first pregnancy, from 12 weeks with repeated pregnancy;
- groin discomfort;
- withdrawal, pain, dull pain in the pelvic region;
- pain during intercourse;
- pruritus vulva;
- swelling of the genitals and perineum.
Signs of pathology progress during pregnancy. In addition to increasing the size of varicose veins, its compaction is determined by the third trimester. A characteristic symptom of IV is its combination with inguinal varicose veins during pregnancy or varicose veins on the legs.
Instrumental examination of varicose veins in pregnant women is limited to ultrasound, as well as ultrasound of the legs, because in the postpartum period, painful changes in the venous trough are involuted.
In most cases (about 80%), from the first days of birth, the symptoms of varicose veins during pregnancy begin to decrease and are minimized 2-8 months after the birth of the child. There is no complete return of the vessel diameters 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 breastfeeding period or the reduction in the volume of breastfeeding to the rate of disappearance of varicose veins in the groin in women. The shortened lactation period is accompanied by the reduction and disappearance of varicose veins and vice versa. This proves that varicose veins during pregnancy are associated with changes in hormone levels.
Treatment of varicose veins of the perineum during pregnancy
The basis of varicose vein therapy in pregnancy is phlebotropic treatment. In most fertile women, IV begins in the II and III trimesters. Diosmin preparations can be used during this period. The severity of pathology symptoms is reduced by the micronized purified fraction of flavonoids. Zinc paste and H1-histamine receptor blockers relieve itching.
Low molecular weight heparin in a prophylactic dose prevents venous thrombosis and pulmonary embolism (clogging of blood vessels).
As an option for compression treatment, it is prescribed to wear tight elastic underwear with a latex or gauze pillow. Relieves puffiness of the lips and feeling of heaviness. A special compression jersey for women with varicose veins of the vulva helps a lot.
If a complication, such as local thrombophlebitis, develops, surgical treatment is required.
When a conglomerate of varicose veins is found on the genitals, the question of the method of childbirth arises. Natural childbirth is allowed for varicose veins of the vulva. On the contrary, the risk of surgery during a caesarean section is higher than the beginning of bleeding from painful blood vessels during childbirth. This rarely happens. But with varicose veins, a caesarean section is often performed.
Prevention of varicose veins of the labia
The main factor in the development of varicose veins in the groin is carrying the fetus. It is difficult to name any preventive methods, taking into account the fact that during pregnancy there are numerous limitations of many therapeutic measures. Here are some tips to follow:
- exclude physical and static stress;
- adhere to a child;
- perform therapeutic exercises, in which movements accelerate the outflow of blood from the legs and lower pelvic organs;
- in case of venous dysfunction, the presence of varicose veins before pregnancy, it is necessary to take phlebotropic drugs, wear compression underwear.
An effective method of prevention is considered to be surgery on the ovarian veins, surgery for other pathologies related to varicose veins. This reduces the occurrence of venous congestion of the pelvis, reduces the risk of varicose veins on the lips.
Varicose veins of the vulva 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 detect the disease, distinguish methods of diagnosis and treatment of this condition.