Men's zone - venous disease

Venous insufficiency of the lower limbs

Venous insufficiency of the lower limbs affects men much less frequently than women, but the mechanism is complex. At the heart of the condition is an over-susceptibility of the veins to stretching and dysfunction of the venous valves, which may have a genetic basis (e.g. a sparse distribution in the venous vessel). Breakthroughs in diagnostic imaging, particularly venous Doppler ultrasound and magnetic resonance venography (MRV), have shed new light on the nature of this condition in men. Our long-term observations on a group of several thousand diagnosed male patients have contributed greatly to this. It turns out that a significant proportion of cases of limbic venous insufficiency are secondary to an underlying pelvic venous insufficiency, which is most often due to individual anatomical conditions and overuse of strength training.

Anatomy and more anatomy

In men, secondary lower limb venous insufficiency results from characteristic anatomical abnormalities in the vascular system. Two mechanisms play a key role: compression of the left iliac runoff and outflow abnormalities (with different backgrounds) at the level of the left renal vein runoff. One, but not the most common, form of this phenomenon is the clinical syndrome named: the "nutcracker" syndrome. This leads to insufficiency of the left testicular (gonadal) vein, resulting in the development of varicose veins of the seminal vas deferens. Of particular note is the fact that in most young men, the first symptoms appear as dilated small vessels (venous telangiectasias), and only later does an atypical varicose system develop. This is a characteristic pattern indicating pelvic venous insufficiency. In the majority of cases, the source of the problem is gonadal venous dysfunction, usually unilateral - concerning the left nuclear vein, less frequently occurring bilaterally.

Due to the complex nature of vascular disorders, precise diagnosis is required, including Doppler ultrasound examination of the veinsand in more complex cases magnetic resonance venography (MRV) or computed tomography venography (CTV). Proper assessment of the pelvic venous system allows for the implementation of effective treatment, which may include both conservative methods (e.g. compression therapy) and minimally invasive treatment, such as embolisation of insufficient gonadal veins.

Early detection of venous outflow disorders is crucial to prevent disease progression and complications such as chronic venous insufficiency of the lower limbs, varicose veins of the scrotum or chronic pelvic pain.

The role of power sports

The absence of cyclical hormonal changes and the mechanical pressure of an enlarged uterus (a characteristic phenomenon of pregnancy), mean that venous insufficiency in men is diagnosed almost four times less frequently than in women.

However, among men, the incidence of post-exertional venous insufficiency, a consequence of the use of high force loads during physical activity, especially in extreme sports and weight training.

The greatest threat to the venous system is posed by strength activities such as bodybuilding or crossfit, which lead to a surge in abdominal pressure (activation of the abdominal compression). Sudden surges in intra-abdominal pressure are transmitted to the veins and venous plexuses of the pelvis and the scrotal sac, causing the so-called 'scrotal pouch'. limb venous leakage. Their consequence is overloading of the venous bed and the development of varicose veins of the lower limbs.

In recent years, there has been a marked increase in the number of patients with venous insufficiency among regular gym users. In the case of advanced forms of venous insufficiency - such as large varicose veins, post-thrombotic syndrome or venous ulcers of the shin - it is often necessary to limit intensive strength training.

It is also important to remember that overuse of the legs during running can contribute to the development of venous insufficiency. Overloading of the intramuscular veins and damage to the perforators increases the risk of this condition. Therefore, those who prefer this type of activity are advised to use sports compression therapy to support the function of the venous system and minimise the risk of overload.