What is varicose veins in the pelvic and genital area?
As with varicose veins in the legs, the veins in the pelvic and genital area can also be damaged. In women, a congenital weakness of the walls and venous valves, usually of the left ovarian vein, causes pelvic vein congestion syndrome. Blood congestion in the pelvic veins leads to a number of symptoms in young women.
Varicose veins in the veins of the genital area can also occur in men, although this is a different clinical picture (varicose testitis).
Frequency and age: Varicosis in the pelvic area mainly affects younger women
Varicose veins in the pelvic and genital area affect around 15 percent of women of childbearing age between 18 and 50. Interestingly, many women (estimated at up to 35 percent of all women) are said to have varicose veins in the pelvic veins, but these do not cause any symptoms.
Slender women who were pregnant at least twice at a younger age are most affected. Pelvic vein congestion syndrome is often the cause of chronic lower abdominal pain. Varicose veins on the labia, on the other hand, only occur in around four percent of women.
Causes and risk factors
The cause of pelvic vein congestion syndrome is thought to be the anatomical peculiarities of the left ovarian vein: in contrast to the right ovarian vein, which flows directly into the great vena cava, the left ovarian vein takes a detour and usually flows at a right angle into the left renal vein. The resulting “longer path” creates a higher column pressure when standing. If you are predisposed to weak vein walls and insufficient venous valves, this can lead to dilation of the veins. As a result, blood backs up in the deeper venous plexuses of the reproductive organs, which can cause the corresponding symptoms.
However, experts suspect that this is not the only cause of pelvic vein congestion syndrome. Since the symptoms occur or worsen during the period, there is a hypothesis that estrogens could be involved. This is because the ovarian veins also dilate during every pregnancy – the oestrogen level rises sharply during this time. This is possibly one reason why women with more than two children are more frequently affected by varicose veins in the pelvic and genital area. Medical professionals see this as a further indication of a connection between the hormone oestrogen and varicosis with symptoms in this area.
Symptoms of pelvic vein congestion syndrome: intense menstrual cramps
The symptoms of varicosis in the pelvic and genital area are reminiscent of severe menstrual cramps. This is why it is often difficult for the gynecologist to find out the actual cause. Women with varicose veins of the left ovarian vein have cycle-related lower abdominal discomfort and sometimes also leg discomfort. The lower abdominal pain comes in episodes, lasts a long time and returns again and again. They should last for at least three months. Affected women describe the pain either as dull or as stabbing and throbbing. They worsen after long periods of standing or sitting and improve when lying down. Increased pain during or after sexual intercourse, during menstruation or when pushing (for example during bowel movements) are also among the main symptoms. The pain is often accompanied by a feeling of heaviness and fullness. Cramps can also occur at various points in the pelvic floor area. Other symptoms include tiredness, mood swings, headaches and bloating.
Differential diagnosis of pelvic venous congestion syndrome
The following diseases, which are similar to the symptoms of pelvic venous congestion syndrome, should be ruled out beforehand:
- Endometriosis: Small “islands” of endometrial cells form outside the uterus on the lower abdominal organs. The endometriosis islets react to the cyclical hormonal changes by increasing in thickness until bleeding occurs during menstruation.
- Inflammation and infections of the ovaries or fallopian tubes.
- Uterine and/or ovarian cysts.
- Inflammatory bowel diseases (e.g. Crohn’s disease, ulcerative colitis).
- Psychosomatic illness: This diagnosis is made when all physical causes can be ruled out and there is psychological stress that manifests itself in physical complaints.
Symptoms of varicosis of the vulvar veins
Varicosis of the labia causes pain that radiates deep into the pelvis and up to the kidneys. Other symptoms include a feeling of pressure and swelling in the pelvic floor area down to the lower abdomen, pain when urinating, menstrual cramps and sexual dysfunction.
Varicosis of the pelvic and genital area: diagnosis at the USZ
Gynaecology specialists can detect varicose veins in the area of the internal genital organs during a routine ultrasound examination of the abdomen and can form a well-founded suspicion of pelvic vein congestion syndrome. This allows other diseases with similar symptoms to be ruled out.
The ultrasound examination by the vascular specialist is important for detecting constrictions in the deep vein system. The magnetic resonance examination, in which a contrast medium is administered, confirms the pelvic varicose veins.
Further investigations are:
- Venography: This is an X-ray examination of the veins using a contrast agent that makes the veins visible on an X-ray film
- Laparoscopy: This minimally invasive surgical method allows the organs of the pelvis to be examined using a special optical device. We insert the laparoscope into the pelvis through a small incision in the abdomen.
- Doppler ultrasound: This special ultrasound can be used to visualize the blood flow in the blood vessels. This method is helpful for the diagnosis of varicose veins in the labia.
Varicosis of the testicles: Diagnosis at the USZ
A physical examination by urology specialists is necessary for the diagnosis of testicular varicose veins. Possible questions during the urological examination are, for example:
- Do your testicles feel heavy or swollen?
- Are you in pain?
- Are the symptoms worse when standing?
First, the testicles are examined in a standing position. If the testicular varicose veins are not visible, you will be asked to squeeze or tense your abdominal muscles. This makes it easier to recognize the swelling of the vessels.
Further examinations for the diagnosis of testicular varicose veins are:
- Ultrasound examination
- Clinical examination
Prevention, early detection, prognosis
According to current scientific knowledge, there is no way to prevent pelvic vein congestion syndrome. If you suffer from intense pelvic pain, especially during menstruation or pregnancy, you should seek medical advice and have varicosis in the pelvic and genital area ruled out.
Course and prognosis: very variable
Although pelvic vein congestion syndrome does not affect life expectancy, it can significantly impair quality of life. For some sufferers, chronic pain causes them to restrict their physical activities, have difficulty coping with work and everyday life and may also lead to depression. However, the severity and course of the disease vary considerably. However, successful treatment is possible.
Treatment - mostly symptomatic
In most cases, pelvic vein syndrome can be treated using minimally invasive (catheter) techniques. The success rate with a proven diagnosis is over 80 percent, with most women becoming symptom-free.
Treatment is usually carried out on an outpatient basis. Complications following the procedures described are rare and can be easily treated. Around one to ten percent of patients are affected. Typical complications include accidental perforation of the vessel (vascular perforation), which can result in a haematoma in the groin, cardiac arrhythmia, thrombosis (blockage of the veins) in unintended areas and allergic reactions to the contrast medium.