Pelvic Varicose Veins

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Pelvic Varicose Veins

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What are they?

Pelvic varicose veins are dilated veins that appear mostly on women, affecting the uterus, but can also affect Fallopian tubes or the ovaries. 

They have no cure, but symptoms, if they exist, can be controlled with medication or with embolization.

Why feminine pelvic varicose veins are called pelvic venous congestion syndrome?

A syndrome is a set of symptoms, that is to say: complaints such as pain and signals, something objective to the objective examination like vulvar varicosities. It is called pelvic venous congestion syndrome because it is a set of symptoms and signals (like pelvic pain, pain during intercourse, feeling of pelvic heaviness, and varicose veins on the vagina, vulva, thighs, or in the gluteal area) associated with the presence of dilated or varicose veins in the pelvic area. 

These dilated veins lead the venous blood to accumulate in the pelvic area, resulting in pelvic venous congestion. Since the main complaint is long-term chronic pelvic pain, the association between varicose veins and chronic pelvic pain/pelvic venous congestion syndrome was made in 1938.

What are the causes?

Pelvic varicose veins are often secondary to the left ovarian vein dilatation and reflux. 

The varicose veins in the pelvic area can only arise from genetic factors. However, they are more common after pregnancy, because the body needs to dilate the veins in that area to move all the necessary blood to gestation. 

Besides, hormones produced during pregnancy also dilate all the veins of the woman’s body. 

The valves inside the pelvic veins stop functioning and the venous blood accumulates in the pelvic veins, resulting in stasis dermatitis and ectasia or increasing of the pelvic veins – varicose veins. 

The pelvic venous congestion syndrome causes are many

It can result from obstructive anatomic abnormalities, pathologies that originate secondary venous congestion, hormonal factors, hereditary factors, pelvic surgeries, varicose veins preceding or multiparity. 

The absence of ovarian veins valves, 15% on the left and 6% on the right can explain the greater frequency of pelvic varicose veins in the dependency of the left ovarian veins, in comparison with the right one, which is rare.

What are the complaints associated with?

Pelvic varicose veins usually don’t cause any type of symptoms. However, some women can present:

  • Visible varicose veins on the vagina, thigh, or the gluteal area; 
  • Abdominal pain; 
  • Pain during intimate contact; 
  • Feeling of heaviness on the genital area; 
  • Urinary incontinence; 
  • Increase of menstruation

Symptoms can differ when the woman is sitting or lying down because it makes it easier for the blood to go back to the heart. However, several women mention one pain that is always present. 

Usually, the gynecologist diagnoses pelvic varicose veins through exams, such as Doppler ultrasound, abdominal or pelvic CT, and MRI, for example.

How can I make the diagnosis?

The pelvic venous congestion syndrome diagnosis is not easy. 

It is usually visible in middle-aged women, multiparous, with chronic pelvic pain, exacerbated by efforts and orthostatic position, sometimes related to painful intercourse (dyspareunia) or during menstruation (dysmenorrhea), urgency in urinating, feeling of heaviness on the pelvic area and perineum. 

There are no pathognomonic signals nor pelvic venous congestion syndrome and pelvic varicose veins typical signals, but in some cases, they present themselves as vulvar varicosities or as recurrence of lower members varicose veins, after surgery. 

Most exams, including gynecological and several imaging exams, can be negative. 

Varicose veins diagnosis can be done by gynecologic ultrasound or by Doppler ultrasound. 

Sometimes, varicose veins can also be evident on computerized tomography (CT) and magnetic resonance imaging (MRI).

However, many women can have chronic pain and still don’t suffer from pelvic varicose veins or pelvic venous congestion syndrome. 

It is also true that many women can have pelvic varicose veins, but no complaints at all (varicose veins without pelvic venous congestion syndrome). 

There is also the possibility of women having small-dimension pelvic varicose veins and a lot of pelvic venous congestion syndrome complaints (pelvic pain and feeling pelvic heaviness), and the exams still be negative. 

In these cases, laparoscopy is used to make a diagnosis. 

However, selective ovarian veins phlebography (catheterization made before the embolization), a quite simple and minimally invasive procedure, performed as an outpatient treatment, safely confirms/excludes the possibility of the patient having pelvic varicose veins.

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Are pelvic varicose veins dangerous?

They usually are not dangerous. However, there is a very small risk of developing blood clots inside those veins, which can move to the lung and cause a pulmonary embolism, a very serious situation that must be treated as soon as possible, in the hospital.

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