Pelvic varices are a type of varicose veins that develop in the pelvic region, that is, in the small pelvis. They are related to increased pressure in the veins of the pelvic area, which leads to the expansion of the veins and their dilation. Insights from Dr. Michel Dadon, vascular doctor in Paris and member of the French Society of Vascular Medicine (SFMV)
Definition: what is a pelvic varices? Where are they?
Varicose veins refer to a permanent dilation of veins. They most often develop in the legs, but any vein in the body can be affected. Pelvic varices are located in the region of the small pelvis, at the level of the uterine or ovarian venous plexuses. They are therefore invisible and their presence can only be confirmed by imaging tests.
There are two “types” of pelvic varices:
- THE asymptomatic varicose veinswithout consequences, which do not necessarily require treatment
- and the varicose veins responsible for clinical signs.
Pelvic varices are common and often well tolerated, but they are sometimes very debilitating. This is why they should not be trivialized!, warns Dr. Dadon.
What is pelvic congestion syndrome?
“Pelvic congestion syndrome, related to pelvic varices, is a reality that is often misunderstood or neglected“, regrets the doctor. It is characterized by chronic pelvic pain (which last more than six months) and usually combines several symptoms, to varying degrees, including dyspareunia (pain during and following intercourse), dysmenorrhea (pain during menstruation) and dysuria (an urge to go to the toilet when the bladder is empty).
Abdominal pain, urination problems, constipation… What are the symptoms of pelvic varices? Do they hurt?
The impact of pelvic varices can be significant. They can be sporadically painful, during menstruation and / or during sexual intercourse. Urinary symptoms are also described (dysuria).
“Pelvic pain can be increased when women remain standing for a long time. Conversely, they decrease when lying down”, specifies Dr. Dadon.
In addition, pelvic varices can feed varicose veins, perineal varicose veins, gluteal varicose veins or varicose veins in the lower limbs (thus associating a feeling of heaviness in the legs).
These symptoms can have many psychological and relational complications: fatigue, anxiety, irritability, depression, “frigidity”, etc.
“Functional disability can be very debilitating for some women who struggle to stand up during crises!“, underlines the doctor.
Risks: can a pelvic varices “burst”?
No, pelvic varices can’t “burst”assures the doctor, who recalls that the formation of clots in these veins (venous thrombosis or phlebitis) is extremely rare and occurs mainly in the postpartum period, often associated with an infection.
Can these varicose veins be disturbing during sexual intercourse?
Pelvic varices can be extremely painful during sex. If you feel the slightest discomfort or pain, do not hesitate to consult your doctor or a gynecologist for obtain an accurate diagnosis and appropriate treatment.
Diagnosis: which doctor to consult? What exams to perform?
“Vulvar and pelvic varices are often neglected out of modesty and/or lack of thorough examinations“, regrets Dr. Dadon, who insists on the importance of listening to patients and not minimizing their symptoms.
Pelvic varices are very difficult to locate, as they are invisible to the naked eye. They require an in-depth clinical examination, supplemented by endovaginal, pelvic or perineal ultrasound, echo-doppler and/or pelvic venography. There presence of varicose veins in the perineum, buttocks or posterior aspect of the thigh can be a warning sign, since these varicose veins are usually fed by pelvic varices, points out the doctor.
What are the causes of varicose veins in the pelvic region?
As you have probably already understood, pelvic varices are linked to increased pressure in the pelvic, ovarian and uterine veins.
The main trigger? The pregnancywhich increases the flow of the pelvic veins and promotes dilation of the veins.
More other abdominal and/or pelvic vein abnormalities may be responsible for these varicose veins. These can be secondary to an episode of thrombophlebitis of the iliac veins and/or inferior vena cava, or to venous compression phenomena which will modify venous return and thus overload the pelvic venous plexuses.
Prevention: how to avoid these varicose veins?
It is not really possible to avoid these varicose veins, whether they are related to pregnancies or congenital anomalies of the veins.
The classic measures to prevent venous insufficiency in the lower limbs can however be useful:
- wear compression socks, stockings or pantyhose that promote venous return;
- practice a sport that promotes blood circulation (such as walking, swimming, yoga, etc.);
- perform draining massages in the legs (from the toes to the groin) to improve circulation;
- avoid crossing your legs in a seated position, this can alter venous return;
- apply ice packs in case of pain (cold relieves instantly);
- limit showers and baths that are too hotdeleterious for blood circulation, then end your shower with a jet of cold water going up along the legs;
- favor loose clothing and avoid wearing clothes that are too tight around the pelvis ;
- elevate his feet when lying down, to promote venous return.
Treatment: veinotonics, embolization, sclerotherapy… How to treat pelvic varices?
The pain is never anecdotal and must be taken care of. Several treatments can be considered depending on the intensity of the symptoms:
- the prescription of phlebotonics “often little (or not) effective”, specifies the doctor;
- of the restraint measures (in case of edema of the lower limbs or vulvar varices, especially during pregnancy);
- and the specific treatment, embolization, a kind of sclerotherapy of the pelvic veins. Embolization consists of “gluing” the varicose veins using a synthetic glue injected on an outpatient basis. In some cases, the veins can also be obliterated using coils, platinum or stainless steel springs.
