Vaginal varices The Phlebology Clinic / Vaginal varices Introduction Description of the condition Risk factors Recognition and diagnosis Treatment methods Frequently asked questions Introduction Vaginal varices (vaginal varices) are, like uterine varicose veins, a symptom of pelvic venous insufficiency. Their occurrence is usually associated with progression of pelvic venous disease and descending dilatation of the veins draining the vaginal and vaginal wall. According to recent epidemiological studies, the problem of varicose veins of the vaginal area affects approximately 4-7% women of reproductive age, with a significant increase in incidence during pregnancy (up to 10-15% in the third trimester). In multiparous women, the problem is much more frequent and causes greater symptoms and impairment of daily life. Although this problem has been downplayed and overlooked in the medical literature over the years, recent studies indicate that vaginal varices are an important clinical issue, especially in terms of their impact on patients' quality of life. At the Phlebology Clinic, we have been treating patients with vaginal varices for more than 10 years. We have recognised that so-called 'vaginal varicose veins' are an important problem. venous dyspareunia, i.e. pain during sexual intercourse associated with venous congestion, is closely related to their occurrence and very often disappears after proper treatment of this problem. Description of the condition Vaginal varices are pathologically dilated venous vessels located in the vaginal wall, most often in its submucosal layer. In contrast to vulvar varices (vulvar varicosities), which are a separate disease entity, vaginal varicosities occur in the vaginal wall and are directly related to the presence of venous hypertension within the vaginal venous plexus. Vaginal venous plexus (vaginal venous plexus) is a network of venous vessels located in the vaginal wall and surrounding tissues. This plexus is closely linked to other venous structures of the vaginal area, such as: uterine venous plexus vesical venous plexus rectal venous plexus Blood from vaginal venous plexus is discharged mainly into the internal iliac vein in association with the uterine veins (uterine veins) and vaginal veins (vaginal veins). The vaginal veins (usually 2-4 venous trunks on each side of the vagina) may have venous valves to prevent backflow of blood. When they are overloaded with volume, they become excessively dilated and stagnate excess blood, resulting in the development of venous dilatation, which over time turns into varicose dilated venous plexuses. Risk factors Genetic and anatomical factors congenital anomalies in the structure of the pelvic venous system connective tissue disorders (e.g. Ehlers-Danlos syndrome) Physio-pathological factors pregnancies (especially ladies giving birth more than 3 times) chronic constipation deep pelvic vein thrombosis advanced pelvic venous insufficiency Lifestyle factors sedentary lifestyle prolonged standing weightlifting playing wind instruments for many years Iatrogenic factors history of surgery (including hysterectomy) or radiotherapy in the pelvic area post-operative scars or adhesions that interfere with venous outflow Żylaki pochwy to jeden z objawów zaawansowanej niewydolności żylnej miednicy. © Klinika Flebologii Mechanism of formation In most cases, a set of pathophysiological phenomena contributes to the formation of vaginal and vaginal varices. An increase in intra-abdominal pressure, pressure on the draining venous vessels in the small pelvis or an increase in circulating blood volume are only some of the phenomena that lead to the formation of vaginal varices. This most often occurs during pregnancy and as a result of too late treatment of pelvic venous insufficiency. Persistent vaginal varices usually appear in patients after their third pregnancy or in ladies after multiple pregnancies. Recognition and diagnosis Varicose veins located in the vaginal wall and peri-vaginally can give rise to many symptoms. Among the most common and significant are: venous dyspareunia (pain occurring during or after sexual intercourse), pain and heaviness on the side of the vaginal canal occurring after physical exertion or prolonged standing, a burning sensation and itching in the vaginal area, and visible dilated (often tortuous) venous vessels shining through the vaginal mucosa. The diagnosis of vaginal varicose veins is based on an accurate medical historywhich should take into account the timing of the first symptoms, their nature, severity and an analysis of the factors causing worsening or relieving the symptoms. It is important to take a detailed obstetric-gynaecological history and information on concomitant venous diseases with a thorough review of the veins of the lower limbs. Physical examination Includes a full gynaecological examination with particular emphasis on the visual assessment of varicose lesions. The location of the lesions, colour and size of the dilated vessels are assessed. The gynaecologist should be able to assess the significance of the varices and relate them to the co-occurrence of other symptoms typical of pelvic venous insufficiency. In the diagnosis of vaginal varices, a key role is played by the Ultrasound diagnostics with Doppler blood flow assessment. Doppler ultrasound allows for a comprehensive evaluation of the venous system and finding the cause of venous disease in most patients. Transvaginal ultrasound rather, it is used to make an initial diagnosis and is a tool in the hands of gynaecologists who use this method to routinely assess the small pelvic organs. For symptomatic and qualifying patients with pelvic venous insufficiency causing vaginal varices, it is necessary to perform a thorough venographic studywhich is most often carried out in the setting of a magnetic resonance imaging (MRI) laboratory. MR venography). Computed tomography venography (CT venography) has less diagnostic value than MR venography in the assessment of vaginal and vaginal varices. Treatment methods Treatment vaginal varices should always be considered in a wider context. Varicose veins in this area most often arise in the course of untreated and advanced pelvic venous insufficiency. The treatment of vaginal varicose veins requires a comprehensive approach, taking into account both local treatment and therapy of the underlying pelvic venous pathology. Venous embolisation with percutaneous access is the method of choice for the treatment of pelvic venous insufficiency and vaginal varices secondary to it. Treatment of vaginal varices alone (e.g. by obliteration) usually results in failure, recurrence and worsening of symptoms. In fact, this is a general principle that should be applied to the treatment of pelvic and lower limb venous insufficiency. When performed correctly, venous embolisation aims to reduce pressure in the vaginal venous plexuses and relieve vaginal veinswhich contributes to improving the function of the pelvic venous system and reducing complaints associated with congestion of the vaginal walls and vaginal area. Venous embolisation - what is the procedure like at the Phlebology Clinic? You are awaiting treatment venous embolisation? See how this procedure goes step by step at the Phlebology Clinic! ? We dispel all doubts and show you that there is nothing to be afraid of. Over the years, we have developed treatment techniques that minimise the sensations of our patients! Efficacy, low dose of radiation and contrast and, above all, treatment according to the principles of haemodynamics and not in instalments - these are our priorities! Mostlyquestions asked Are vaginal varices and uterine varices one and the same? No, vaginal varices (vaginal varices) and uterine varices (uterine varices) are two different manifestations of pelvic venous insufficiency, but often coexist. Vaginal varices occur in the vaginal wall and involve the vaginal venous plexus. Uterine varices develop within the uterine body and involve the uterine venous plexus. Vaginal varices mainly cause vaginal discomfort, pain during intercourse and a burning and heavy feeling. Uterine varices are more likely to cause heavy menstrual bleeding, lower abdominal pain and a feeling of pushing in the abdominal fossa. Can vaginal varices rupture during childbirth? Rupture of vaginal varices during childbirth is a very rare complication. Doctors and midwives delivering babies are aware of their occurrence and adjust the delivery management accordingly. In the case of large vaginal varices in the perinatal period, careful perineal incision under controlled conditions, special care when supplying the birth canal after delivery and, in special cases, termination of the pregnancy by caesarean section are necessary. Can vaginal varicose veins disappear on their own? I noticed them after my second pregnancy. Vaginal varicesthat appeared during the first or second pregnancy often resolve spontaneously within a few months after delivery. However, if they persist longer (especially if they affect women after their third pregnancy and above) or have occurred independently of pregnancy (e.g. after a hysterectomy), they usually require appropriate treatment. Spontaneous resolution of the lesions outside the postpartum period is unlikely. Are vaginal varices dangerous during pregnancy? I am 23 weeks pregnant and have just been diagnosed with them. Vaginal varices, although they can cause discomfort, do not usually pose a threat to the course of the pregnancy. They are quite common occurring in an average of 10-15% pregnant women. If they do occur, post-pregnancy gynaecological follow-up approximately 4-6 months after termination of pregnancy is important. In most cases, vaginal varices diminish or significantly resolve after delivery. During pregnancy, mainly conservative treatment and symptom relief methods are used. What exercises can I safely do if I have vaginal varicose veins? If vaginal varicose veins are present, moderate walking, swimming, yoga (excluding positions and exercises that increase intra-abdominal pressure) and skilful breathing exercises, among others, are recommended. Intense weight-bearing exercise, prolonged standing exercise, contact sports, jumping and long running should definitely be avoided. Related issues 01 / Pelvic venous insufficiency in women 02 / Uterine varices 03 / Varicose veins of the vulva Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment
