Varicose veins (varicose veins) is a disease accompanied by an increase in length, the formation of serpentine pathological tortuosity of veins, irreversible saccular enlargements of their lumen, and valve insufficiency. The organs of the lower pelvis are involved in the varicose process. The mechanisms of development of the disease are different. Doctors include the perineal region, external and internal genitalia as atypical localizations.
General information about pathology
The process of blood flow through the veins proceeds in such a way that, under physiological conditions, prerequisites are created for the development of stagnation and outflow of blood.
Varicose veins of the vulva (VV) - vasodilation of the external genitals. The disease manifests itself in women who suffer from varicose veins of the pelvis and legs, as well as in pregnant women. In 30% of cases, pelvic varicose veins involve the perineum and vulva.
The beginning of treatment for the disease is delayed due to the location in an intimate place. Women are shy. In some cases, patients do not experience pain or discomfort. But varicose veins of the labia during pregnancy and not only when carrying a fetus proceeds with complications: clogging of the veins by a thrombus (thromboembolism), disorders of sexual sensibility, pain in the perineum, psychoemotional problems and family conflicts.
The mechanisms of the occurrence of congestion of the vessels of the pelvis are not fully disclosed. The cause of the primary form of the disease is called a malfunction of the valves of the gonadal (ovarian) veins. This provokes a backflow of blood and increases the pressure in the venous nodes of the lower pelvis. Insufficiency of valves can be acquired or congenital. It gets worse with age or with pregnancy.
The secondary form of 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 ultrasound (ultrasound).
To distinguish between the primary and secondary forms of pathology, the Valsalva test is used during sonographic examination. With a secondary cause of pelvic varicose veins, it is negative.
Varicose veins of the labia with VBT
To establish a diagnosis of varicose veins of the labia, a doctor's examination is required. The symptoms of the disease are as follows:
- varicose veins on the genitals;
- pain in the external genital area;
- a 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 established, a study is carried out in order to identify the degree of complexity of the pathological process and to prescribe adequate treatment. A number of events are being held:
- examination of the veins of the perineum and legs by ultrasound angioscanning - USAS;
- conducting ultrasonography of the pelvic vessels, including the vaginal, uterine, parametric, ovarian, iliac, inferior vena cava and renal veins;
- according to indications, multispiral computed tomography (MSCT), selective ovarycography and pelvic phlebography (SOFT) are performed.
Doctors call a characteristic property of varicose veins on the labia with VBT that the disease is steadily progressing and is combined with the transformation of intrapelvic veins.
Treatment of varicose veins of the vulva with varicose veins of the lower 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, physiotherapy with ultrasound, therapeutic exercises. Antioxidants and enterobiotics are added to the therapy.
According to the indications, phlebosclerosing treatment is carried out - sclerotherapy. The vessel is "sealed" with drugs and a laser. It stops functioning. The procedure does not use special methods of anesthesia. It is performed on an outpatient basis and produces a cosmetic effect.
With pelvic plethora of veins, dilation and backflow of blood through the gonadal (ovarian) veins, a surgical operation to remove the veins is indicated. In the 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 leading to the onset of VVV. A significant and sustained increase in the concentration of progesterone already in the early stages of pregnancy reduces venous tone and aggravates impaired blood flow. Also, VBT, involving the perineum and vulva, is associated with the compression of the large veins of the retroperitoneal region (iliac veins and inferior vena cava) by the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Often varicose veins of the vulva occurs bilaterally. Signs of illness:
- a pronounced increase in the veins of the vulva at a period of 18-24 weeks during the first pregnancy, from 12 weeks with a repeated pregnancy;
- discomfort in the groin;
- pulling, aching, dull pain in the pelvic region;
- pain during intercourse;
- pruritus of the vulva;
- swelling of the genitals and perineum.
Signs of pathology progress with the course of pregnancy. In addition to increasing the size of the 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 in the legs.
Instrumental examination for varicose veins of the labia in pregnant women is limited to their ultrasonography, as well as ultrasonography of the legs, because painful changes in the venous bed undergo involution in the postpartum period.
In most cases (about 80%), from the first days of childbirth, the symptoms of varicose veins during pregnancy begin to decrease and are minimized 2-8 months after the birth of the baby. A complete return of the diameter of the vessels to their original values does not occur.
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 a reduction in the volume of breastfeeding on the rate of disappearance of varicose veins in the groin in women. A shortened lactation period is accompanied by a decrease and disappearance of dilated veins and vice versa. This proves that varicose veins of the perineum during pregnancy is associated with a change in hormonal levels.
Treatment of varicose veins of the perineum during pregnancy
The basis of therapy for varicose veins during pregnancy is phlebotropic treatment. In the main part of fertile women, IV begins in the II and III trimester. During this period, diosmin preparations can be used. The severity of the symptoms of 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 treatment, it is prescribed to wear tight elastic underwear using latex or gauze pillows. It relieves the puffiness of the labia and the feeling of heaviness. Special compression jersey for women with vulvar varicose veins helps a lot.
If a complication develops, such as local thrombophlebitis, surgical treatment is required.
When a conglomerate of varicose veins is found on the genitals, the question arises about the method of delivery. Natural childbirth is permissible with varicose veins of the vulva. On the contrary, the risks of surgery during a cesarean section are higher than the onset of bleeding from painful vessels during childbirth. This happens rarely. But with varicose veins of the vagina, a cesarean section is often done.
Prevention of varicose veins of the labia
The main factor in the formation of varicose veins in the groin is bearing the fetus. It is difficult to name any preventive methods, taking into account the fact that during pregnancy there are a number of restrictions on many therapeutic measures. Some tips to follow:
- exclude physical and static stress;
- follow a diet;
- perform therapeutic exercises, in which movements accelerate the outflow of blood from the legs and lower pelvic organs;
- in case of malfunction of the veins, the presence of BPV before pregnancy, it is necessary to take phlebotropic drugs, wear compression underwear.
An effective method of prevention is considered to be an operation on the ovarian veins, surgery for other pathologies associated with varicose veins. This reduces the phenomenon of pelvic venous congestion, reduces the risk of varicose veins in the labia.
Vulvar varicose veins is a common disease in women with varicose veins of the pelvis, legs, or during gestation.
In order to improve the quality of treatment of patients with chronic venous diseases, it is important to detect the disease, differentiate between the methods of diagnosis and treatment of this condition.