What happens to the veins of the pelvis
The veins of the uterus and ovaries form branched plexuses that drain blood upward to the renal and inferior vena cava. When the valves in the ovarian veins no longer hold blood, it rushes back under the influence of gravity, and the plexuses become overcrowded. The walls stretch, tissue swelling occurs around them, and irritation of the nerve endings produces chronic dull pain. Female sex hormones make their contribution: progesterone relaxes the vein wall, so complaints intensify in the second half of the cycle and during pregnancy.
- Incompetent valves of the ovarian veins
- Reverse blood flow and plexus congestion
- Stretching of the venous wall and tissue edema
- The effect of progesterone on venous tone
- Possible external compression of veins
- Often combined with varicose veins of the legs and perineum
Causes and risk factors
The main factor is pregnancy: blood volume increases, the uterus puts pressure on the veins, and hormones reduce their tone, so with each subsequent pregnancy the risk increases. Hereditary weakness of connective tissue, manifested by varicose veins of the legs, flat feet, and hernias, is important. Work associated with prolonged standing or sitting, heavy lifting, chronic constipation, as well as long-term use of hormonal drugs contribute to stagnation. Less commonly, the cause is compression of the vein from the outside, for example, due to the peculiarities of the location of the vessels.
- Multiple pregnancies and births
- Hereditary weakness of the venous wall
- Sedentary or standing work
- Lifting weights and strenuous exercise
- Chronic constipation
- Taking hormonal medications
- Compression of veins from the outside
Symptoms
The leading complaint is a dull nagging pain in the lower abdomen, usually on one side, radiating to the lower back, sacrum, perineum and thigh. Its dependence on body position and time of day is typical: in the evening, after a working day on your feet or at the table, the pain increases, and lying down with your legs elevated subsides. Many women note an increase in the second half of the cycle, pain during and after sexual intercourse, and heavy discharge. Enlarged veins may be noticeable in the perineum, buttocks and thighs, as well as increased urination.
- Nagging pain in the lower abdomen, worsening in the evening
- Pain after standing or sitting for a long time
- Pain during and after intercourse
- Increased complaints in the second half of the cycle
- Enlarged veins of the perineum and thighs
- Heavy discharge
- Frequent urination
What examinations are needed
First, the gynecologist excludes other causes of pain: inflammation, endometriosis, cysts. Then a pelvic ultrasound is performed with Doppler ultrasound, preferably in a standing position or with tests that increase the pressure in the veins - this is how the reverse flow of blood is better visible. Dilated tortuous veins around the uterus and ovaries are the main symptom. To clarify the anatomy and plan the intervention, MRI or CT venography is used. X-ray venography is usually performed simultaneously with the treatment procedure, when the decision about embolization has already been made.
- Examination by a gynecologist and exclusion of other causes
- Ultrasound of the uterus and ovaries
- Dopplerography of pelvic vessels
- Study in a standing position and with tests
- MRI or CT venography
- Phlebography when planning embolization
Treatment and prevention
They start with conservative measures: venotonic courses as prescribed by a doctor, compression garments, avoidance of heavy lifting, physical therapy, swimming and exercises that improve outflow from the pelvis. It is important to avoid prolonged standing and sitting without moving, adjust your chair and maintain a normal weight. If the pain persists, endovascular embolization of the ovarian veins is discussed - a low-traumatic procedure through puncture of the vessel, after which the pain is significantly reduced in most women. Surgical methods are used less frequently for certain anatomical variants.
- Venotonic drugs prescribed by a doctor
- Compression garments
- Physical therapy and swimming
- Avoiding heavy lifting and prolonged standing
- Normalization of stool and weight
- Endovascular embolization of ovarian veins
- Surgical treatment according to indications
