Pelvic venous congestion and genital varices

Pelvic venous congestion is one of the first diagnoses that come to mind when painful menstruation and inguinal varicose veins are seen in women. This table is seen in approximately 10-15% of women, more in women between the ages of 20-45. With the advancing technology in recent years, significant advances have been made in the diagnosis and treatment of the disease.

The reason for this table, called pelvic congestion, is similar to the varicose veins in the legs. In these cases, the main reason is that the valves, which allow one-way flow in the veins, regain blood. Leakage in these patients is most common in the ovarian veins. There are many reasons for this leak.

These; congenital ovarian veins are not covered by the capillaries, multiple births, hormones, genetically weak vascular wall, and pressure on a veins passing over the vein.

In this disease, varicose veins are seen in the abdomen, around the ovaries, around the ovaries, in the genital area, groin and leg. Accordingly, pain develops in the lower abdomen and groin, especially during menstrual periods. Menstrual bleeding is excessive and prolonged. During these periods, varicose veins in the genital area and groin swell. Especially towards the end of the day, pain increases and sexual intercourse is painful. In pregnant women, pain increases in the months close to birth. In addition, irritable bowel syndrome is accompanied in 65-70% of these patients.

When diagnosing the disease, other diseases that may be confused should be ruled out first. Considering that the disease is a picture of pelvic venous congestion, researches should be advanced from simple to complex. By combining these investigation results, it should be shown which vein originates the problem. For this, first of all, the structure and leaks of the veins in the abdominal and inguinal region should be evaluated with doppler ultrasound. Then, the structure of intra-abdominal organs and vessels is evaluated by performing magnetic resonance (MR) imaging or tomography. If the diagnosis is not clear with these, direct vein angiography is performed.

In the treatment of the disease, there are attempts to eliminate or reduce leakage in the vessel with leakage. At the beginning of these approaches, occlusion called embolization is performed to prevent backward escape especially in the ovarian veins. This process is entered through the groin or neck vein and the ovarian vein is reached and the leak area is closed. In the following process, varicose veins in the abdomen, genitals and leg areas regress. To speed up this process, varicose veins can be removed with small incisions or sclerotherapy can be applied.

With these treatment approaches, a significant improvement can be achieved in 70% of patients. In the rest of the patient group, complaints may continue, though less.
In conclusion, pelvic congestion disease is an important health problem that is very common in women and the results are quite satisfying with the correct diagnosis and effective treatments.

ANTALYA VARICOSE VEINS/Dr.İlhan Gölbaşı

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