Varicose veins (varicose veins) is a disease that is accompanied by an increase in length, the formation of serpentine pathological twisting of veins, irreversible vascular dilatations 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. Physicians include the perineal region, external and internal genitals as atypical localizations.
General information on pathology
The process of blood flow through the veins proceeds in such a way that under physiological conditions conditions are created for the development of stagnation and outflow of blood.
Varicose veins in the vulva (VV) - vasodilation of the external genitalia. The disease manifests itself in women suffering from varicose veins in 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 in the labia during pregnancy and not only when carrying a fetus, continue with complications: clogging of the veins of a thrombosis (thromboembolism), disorders of sexual sensitivity, pain in the groin, psychoemotional problems and family conflicts.
The mechanisms of occurrence of pelvic vessel overload are not fully revealed. The cause of the primary form of the disease is called a malfunction of the valves in the gonadal (ovarian) veins. This causes a backflow of blood and increases the pressure in the venous nodules in the lower pelvis. Insufficiency of valves may 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 varicose veins in the pelvis, it is negative.
Varicose veins in the labia with VBT
To establish a diagnosis of varicose veins in the labia, a medical examination is required. The symptoms of the disease are as follows:
- varicose veins on the genitals;
- pain in the external genitalia;
- a feeling of heaviness and burning in the perineum;
- swelling of the perineum at the end of the day.
Chronic pelvic pain occurs less frequently (in 30% of cases).
After the diagnosis is established, an examination is performed to identify the degree of complexity of the pathological process and to prescribe appropriate treatment. A number of events are held:
- examination of the veins of the perineum and bone by ultrasound angioscanning - USAS;
- performing ultrasound ultrasound of the pelvic vessels, including the vaginal, uterine, parametric, ovarian, iliac, inferior vena cava and renal veins;
- after indication, multispiral computed tomography (MSCT), selective ovarianography and pelvic phlebography (SOFT) are performed.
Doctors call a characteristic feature of varicose veins on the labia with VBT that the disease progresses steadily and is combined with transformation of intrapelvic veins.
Treatment of varicose veins in the vulva with varicose veins in 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, non-steroidal anti-inflammatory drugs and phlebotropic drugs are prescribed.
Prescribe pharmacotherapy with platelet inhibitors, intrapelvic blockade with antihypoxants, physiotherapy with ultrasound, therapeutic exercises. Antioxidants and enterobiotics are added to the therapy.
According to the indications, phlebosclerosis treatment is performed - sclerotherapy. The vessel is "sealed" with drugs and a laser. It stops working. The procedure does not use special anesthesia methods. It is performed on an outpatient basis and provides a cosmetic effect.
With pelvic overflow of veins, expansion and backflow of blood through the gonadal (ovarian) veins, a surgical operation to remove the veins is indicated. In case of varicose vein enlargement of the labia minora it is removed.
Varicose veins in the vulva during pregnancy
Pregnancy is the first most common risk factor leading to outbreaks of VVV. A significant and sustained increase in the concentration of progesterone already in the early stages of pregnancy reduces venous tone and worsens decreased blood flow. VBT, which involves the perineum and vulva, is also associated with the compression of the large veins in the retroperitoneal region (iliac veins and inferior vena cava) of the pregnant uterus.
Doctors recommend compression garments during pregnancy.
Varicose veins in the vulva often occur bilaterally. Signs of illness:
- a pronounced increase in the veins of the vulva for a period of 18-24 weeks during the first pregnancy, from 12 weeks with a repeated pregnancy;
- discomfort in the groin;
- pulling, sore, dull pains in the pelvic region;
- pain during intercourse;
- pruritus of the vulva;
- swelling of the genitals and perineum.
Signs of pathology progress during pregnancy. In addition to increasing the size of varicose veins, its compression is determined by the third trimester. A characteristic symptom of IV is its combination with groin varicose veins during pregnancy or varicose veins in the legs.
Instrumental examination for varicose veins in the labia of pregnant women is limited to their ultrasound as well as ultrasound 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 birth, 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 vessels' diameter to their original values does not occur.
In 4-8% of women, IV does not disappear after birth 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 in the perineum during pregnancy are associated with a change in hormonal levels.
Treatment of varicose veins in the perineum during pregnancy
The basis of therapy for varicose veins during pregnancy is phlebotropic treatment. In the majority of fertile women, IV begins in the II and III trimesters. 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 pads. It relieves the swelling of the labia and the feeling of heaviness. Special compression sweater for women with vulva varicose veins helps a lot.
If a complication occurs, such as local thrombophlebitis, surgical treatment is required.
When a conglomerate of varicose veins is found on the genitals, the question of the method of delivery arises. Natural birth is allowed with varicose veins in the vulva. On the contrary, the risk of surgery during a caesarean section is higher than the onset of bleeding from painful vessels during childbirth. This rarely happens. But with varicose veins in the vagina, a caesarean section is often made.
Prevention of varicose veins in the labia
The main factor in the formation of varicose veins in the groin is to carry the fetus. It is difficult to name any preventative 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 interruption of the work of the veins, the presence of varicose veins before pregnancy, it is necessary to take phlebotropic medication, wear compression underwear.
An effective method of prevention is considered to be surgery on the ovaries, 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 are a common disease in women with varicose veins in the pelvis, legs or during pregnancy.
To improve the quality of treatment of patients with chronic venous diseases, it is important to detect the disease, distinguish between the methods of diagnosis and treatment of this condition.