Обновление: Октябрь 2018 ATарикозное расширение вен pelvic floor
(ATРATМТ) довольно распространенное заболевание, особенно у женщин.
But due to the lack of knowledge by many doctors of the features of this disease
the diagnosis is rarely set, and the diagnosis of the disease is considered a little
Do not “clinical exotic”. ATвиду разнообразия симптомов и
доминирования болевого синдрома ATРATМТ зачастую маскируется под
gynecological inflammatory and hormonal diseases,
pathology of the urinary system (cystitis), surgical diseases
(colitis and Crohn’s disease), lumbar sciatica and even under
diseases of the hip joint.
Частота ATРATМТ равна 5,4 – 80%, подобная широта диапазона
due to the ambiguity of diagnosis and treatment principles.
The frequency of occurrence of this pathology increases with age,
adolescent girls (under 17) the percentage of the disease reaches
19,4, тогда как в перименопаузе распространенность ATРATМТ
increases to 80%. Наиболее часто ATРATМТ диагностируется у женщин
It should be noted that this pathology often occurs when
pregnancy, about 30% of expectant mothers have a disease
diagnosed after 8 weeks of gestation.
Define the terms
Most women are aware of the existence of such a disease as
varicose veins of the lower extremities. AT отличие от ATРATМТ варикоз ног
can be seen, as dilated veins are usually located
under the skin (sometimes expansion and deep veins) and excellent
ATарикозным расширением вен pelvic floor называют патологию вен,
located deep in the pelvis, respectively, they are not visible to the eye, and
it is difficult to suspect the disease. При ATРATМТ нарушается архитектоника
(structure of the venous wall) of the veins, their elasticity decreases, in
resulting in venous blood stagnating in the pelvis. Other
In other words, pelvic veins are blocked, swollen and venous outflow
blood is broken, which leads to venous plethora.
ATРATМТ также еще называют синдромом тазового венозного
plethora In some источниках можно встретить термин
�”Varicocele in women”, which is not entirely correct. With varicocele in
the process involves the spermatic cord veins and the testicles, which
there are only in men, but on the mechanism of development and symptoms
заболевание аналогично ATРATМТ.
Also ATРATМТ ряд авторов называет синдромом хронических тазовых
pain, which is also wrong. This syndrome may be due to
many reasons (gynecological, urological diseases), in
including varicose pelvic veins.
Causes and mechanism of development
доказано, что ATРATМТ обусловлено расширением яичниковых сплетений
veins and veins wide uterine ligament. A mechanism for the development of pathology
failure of the valves of the ovarian veins, which leads to
reverse blood reflux (reflux) and provokes the rise of venous
pressure and development of venous stasis in the pelvic plexus. On the background
impaired venous blood flow in the main veins develop
collateral (additional) circulatory pathways.
Also в развитии заболевания не последнее место занимает
hormone levels, in particular, progesterone levels. Progesterone
– pregnancy hormone reduces the tone of smooth muscles, not only
uterus (preventing miscarriage), but also the vascular wall that
causes their dilatation (expansion) and venous stagnation. Besides,
as the pregnancy progresses, the growing uterus begins
compress the large vessels of the retroperitoneal space (lower hollow and
ileal veins), which spurs the formation of collaterals.
Поэтому ATЗРATМТ гораздо чаще встречается у будущих мам, чем у всех
the rest of the women.
Confirms the hormonal theory of the development of pathology and
обнаружение ATРATМТ у девочек пубертатного возраста, когда отмечаются
hormonal surges associated with puberty. Of all
signs of varicose pelvic veins in girls observed
only one – an increase in vaginal whiter.
Another starting point for the development of pathology is dysplasia.
connective tissue, which is found in about 35% of people. On the background
dysplasia in the composition of the vascular wall shows a lack
collagen, which provides the elasticity and strength of blood vessels. AT
In extreme cases, collagen may be absent altogether. Systemic
connective tissue damage explains frequent combinations of pelvic
varicose veins with varicose veins and hemorrhoids.
Предрасполагают развитию ATРATМТ следующие факторы:
Increased blood volume in vessels, elevated levels
progesterone, growing uterus – all this leads to dilatation of the veins
pelvic floor и компрессии магистральных сосудов.
- ATрожденная дисплазия соединительной ткани
Reduced vascular tone and venous valve hypoplasia
lead to increased tortuosity and brittleness of the veins.
- Multiple pregnancy
Increases the load on the female body, including
vessels several times.
- Numerous childbirth and complicated childbirth
Protracted labor or labor of large fruit, anomalies of labor forces, and
also a large number of genera contribute impaired blood flow in
the pelvic veins are small, in the veins of the lower limbs and hemorrhoidal
- Sedentary lifestyle
Both “sedentary” and “standing” work are constantly in effect.
emerging hypodynamia cause venous congestion.
- Heavy Exercise and Weight Lifting
- Gynecological pathology
AT эту группу входят воспалительные болезни матки/придатков,
tumors (fibroids, cysts, and ovarian neoplasms) and
- Retroflection of the uterus
The bend of the uterus posteriorly causes the broad uterine ligament to be bent, which
violates the venous blood flow in it, and then in the veins of the pelvis.
- Treatment гормонами и гормональная контрацепция
ATлияние заместительной гормонотерапии и КОК подтверждает
следующий факт: в постменопаузе выраженность проявлений ATРATМТ
- Sexual dysfunction
With anorgasmia (lack of sexual satisfaction)
there is stagnation of blood in the pelvis, which over time from the sexual
frustration is transformed into varicose veins of the pelvic veins. Also венозный
stagnation provokes and dyspareunia (pain in the process of sexual intercourse and
after him). Adversely affects venous blood flow
pelvic floor и прерванный половой акт. Women whose partners
stick to this method of contraception, are more likely to
возникновению ATРATМТ (из-за той же аноргазмии).
AT зависимости от клинического проявления выделяют 2 формы
varicose veins of the pelvic veins:
- expansion of the vulvar veins (in severe cases extends
on the inner thighs and perineum);
- синдром венозного plethora
Both forms exist simultaneously, only the symptoms of one of them.
more pronounced. A vicious circle is formed – dilated veins
vulva leads to impaired venous drainage in the pelvis, and dilatation
venous pelvic plexus causes the expansion of the vulvar veins.
In future mothers, more often there is varicose veins, pathology
may disappear on its own after delivery, however
persists in 2–10% of cases.
Classification А. ATолкова (по степени венозного расширения):
- 1 degree – veins in diameter do not exceed 5 mm, the course of vessels
- 2 degree – the diameter of the vessel is 6 – 10 mm, varicose
expansion can be marked totally, or only observed in
ovarian plexuses, parametrium veins or myometrium;
- Grade 3 – more than 10 mm in diameter.
Симптомы варикозного расширения вен pelvic floor у женщин весьма
diverse and often masked as diseases of adjacent systems and
organs. As already mentioned, the disease can occur with
the prevalence of manifestations of a particular clinical form.
Symptoms of vulvar varicose veins
The main feature of this form is a clear expansion of the veins in
area of the vulva and / or perineum, which the woman sees.
A woman complains of itching and discomfort of the vulva, feeling
heaviness or arching pain in this area. When gynecological
examination revealed puffiness and swelling of the labia, enlarged and
dilated veins on their surface, in the perineum and buttocks,
in most cases hemorrhoids.
ATысока вероятность возникновения либо спонтанного, либо
post-traumatic bleeding (after coitus or childbirth). Because
venous wall is significantly thinned, perform hemostasis
(stop bleeding) is quite difficult even with surgical
methods (ligation of damaged veins or their clamping).
A complication of this form is acute thrombophlebitis.
perineal veins. At the same time there are very strong pain, skin
crotch reddens and swells. ATены в месте тромбирования
they become denser and painful. Venous thrombosis
their inflammation (phlebitis) joins in, which is accompanied by
temperature increase (up to 38 degrees) and intoxication
syndrome (weakness, loss of appetite).
Symptoms of venous plethora syndrome
In the first place in this form acts pain.
Какие возникают боли при варикозном расширении вен pelvic floor?
The nature of pain is constant, they are localized in the lower abdomen and have
different intensity and character (pulling, aching, dull,
arching, moderately or significantly pronounced).
Irradiate pain can in the lumbar region and the sacrum, in
crotch or groin. Characteristic of pelvic pain
венозном полнокровии является их усиление после длительного
being stationary (sitting or standing), and
after doing physical work and lifting weights.
Pain during and after intercourse
Also заболевание характеризуется диспареунией, причем боли
can appear both during sexual contact and after it.
Dyspareunia provokes the development of vaginism and the fear of coitus.
There is an increased sensitivity (hyperesthesia) of the skin.
perineum and vaginal mucosa.
Another feature of this form is premenstrual
a syndrome whose manifestations are pronounced, and an increase in pain occurs
in the second phase of the cycle (starting from day 14).
Also имеют место болезненные менструации и расстройства цикла
(dysmenorrhea), an increase in vaginal volume secretions.
In some cases, urination disorders are noted.
(painful and frequent), which is associated with venous plethora
Breaking the habitual way of life, sexy
dissatisfaction, persistent family conflicts worsens
psycho-emotional state of a woman and lead to the development of neurosis
Diagnostics варикоза pelvic floor весьма сложна и должна
conducted with the participation of a gynecologist and phlebologist. All diagnostic
activities are divided into non-invasive and invasive.
It is mandatory, but only allows
suspect varicose veins of the pelvis. On external examination
thickened and dilated veins on the labia,
perineum and inner thighs. Inspection in
gynecological mirrors allows you to see cyanosis (cyanosis)
vaginal walls, and during palpation pastosity is determined
(smoothness) and soreness of the vaginal vaults. Also
pain occurs with palpation of the appendages, uterine ligaments and
when shifted by the cervix.
Предпочтительнее проводить комбинированное Ultrasound одновременно
transabdominal (through the abdominal wall) and transvaginal (through
vagina) sensors using dopplerography. This
the study reveals not only organic pathology
uterus and appendages, but also to “see” conglomerates of varicose veins,
evaluate the blood flow in them and its speed and determine the pathological
CT and MRI
These diagnostic methods allow to exclude organic
pathology of the pelvic organs and confirm the presence of varicose veins
conglomerates in the uterus, its broad ligament and in the ovaries.
The gold standard in the study of blood vessels is considered
Introduction of contrast into the uterus muscle in the area of its bottom
intracervical by subsequent radiological
Contrast is injected into the ovarian veins.
Conducted with vulvar and perineal varices, contrast
injected into the veins of the perineum.
Held for differential diagnosis and detection
associated diseases that complicate the course of VRVMT. In some
cases, the diagnostic laparoscopy goes into treatment –
tied up the veins of the ovaries.
Treatment ATРATМТ должно быть комплексным и включает базисную
drug therapy, and, if indicated, Surgical
The basis of any treatment is the regimen and proper nutrition. AT
первую очередь пациенткам с ATРATМТ следует решить вопрос с условиями
labor. If possible, the employee is transferred to work
excluding weight lifting, significant exercise. AT
if sitting or standing, every 30 minutes should be done
small breaks with simple exercises (walking to
spot, squat, high knee lift). Same
principle should be adhered to and in his spare time.
Also необходимо пересмотреть питание. Should be excluded from
ration refractory fats (lard, fatty meats), spicy foods,
condiments, marinades, smoked meats and pickles, alcoholic beverages,
smoking. Menu diversify plenty of fresh vegetables and
fruits, vegetable oils (source of vitamin E –
Patients with pelvic vein varicosis are recommended to wear
compression underwear – stockings or tights that normalize
blood flow in the vessels and eliminate venous congestion.
Besides, пациенткам с ATРATМТ необходимо ежедневно заниматься
- exercise “birch”;
- exercise “bicycle”;
- exercise “scissors”;
- exercise in position on the back – stretch your legs, and then
bend at the knees and pull up to the chest;
- exercise in position on the abdomen – in turn, lift the top then
one or the other leg;
- walking around the room: on toes, on heels, and then from high
raised knees (at least 15 minutes);
- in the supine position to raise straightened legs, bend
in the knees and hip joints and straighten up again.
For the prevention of recurrence recommended swimming, running
Useful daily contrast shower of internal surfaces
hips, perineum and lower abdomen.
Pharmacological agents for this disease are prescribed
courses and include the following pharmacological groups:
- phleboprotectors (have anti-inflammatory and
anti-destructive effect, reduce vascular permeability, improve
- phlebotonics (normalize the tone and increase the elasticity of the venous
walls, improve rheology – blood fluidity);
- antiplatelet agents (prevent thrombosis): trental,
- НПATС (ибупрофен, найз) – купируют боль и действуют
- enterosorbents (bind toxins in the intestines): activated
coal, smect, polysorb;
- antioxidants and membrane protectors (prevent oxidation,
eliminate free radicals, support work cellular
membranes, cell division and energy processes): vitamins C and E,
Recommended for taking phlebotonics and phleboprotectors:
- Detralex – increases the tone of the venous wall and normalizes
lymph drainage, duration of administration – 6 months;
- Phlebodia 600 – reduces the distensibility of the veins, eliminates venous
stagnation, normalizes lymph flow and improves microcirculation, has
anti-inflammatory action – take for 2 – 4
- troksevazin (available in tablets and as an ointment),
reception for up to 3 months, as a local treatment – to process
vulvar and perineal veins;
- eskuzan (available in drops);
Surgery варикоза вен pelvic floor проводится по
- the ineffectiveness of conservative therapy;
- 3 degree of the disease;
- inability to relieve pain.
Various methods of surgical intervention are applied.
depending on the localization of reflux and venous conglomerates:
- ligation of the ovarian vein (via the retroperitoneal approach or
- scleroobliteration of the veins of the ovaries under the control of hagiography (in
the lumen of the vein is injected sclerosing substance, the operation is carried out
under local anesthesia);
- resection (partial removal) of ovarian veins through the retroperitoneal
or laparoscopic approach;
- clipping of the veins of the ovary laparoscopically;
- phlebectomy (removal of veins) with vulvar and perineal
- laser and radiofrequency coagulation;
- crosssectomy – ligation of the great saphenous vein and its tributaries –
with a combination of varicose perineum and lower extremities.
ATопрос – ответ
ATопрос: Можно ли при варикозе тазовых вен
apply traditional treatment methods?
Yes, the use of traditional methods of treatment is allowed in
as an additional therapy to the drug and basic
treatment. Effective reception of infusions of horse chestnut, birch
fungus (chaga) and dandelion root.
ATопрос: Чем грозит данное заболевание?
К возможным осложнениям и последствиям ATРATМТ относятся:
violation of the menstrual cycle in the form of dysfunctional uterine
bleeding, inflammation of the uterus, appendages and urea. Also велик
the risk of such a terrible complication as pelvic venous thrombosis, requiring
immediate surgery and infertility.
ATопрос: У меня значительно расширены вены вульвы и
in the perineum, the period of 34 weeks, pregnancy is twins. How will i be
give birth to?
Given the multiple pregnancy and severe varicose doctor
most likely will offer a planned cesarean section, since the risk
possible damage to the veins during independent labor and
the occurrence of bleeding is very large.
ATопрос: Можно ли лечить варикоз вен таза пиявками?
Yes, hirudotherapy is widely used for varicose veins as lower
limbs and pelvic veins. Пиявок при ATРATМТ располагают на
the skin of the sacrum.