Varicose veins in the area of the testicles and spermatic cords are called varicoceles. With this pathology, the pampiniform venous plexus is affected. Statistics show that dilated veins on the testicles occur much more often in adolescents than in other age categories. However, the disease can affect every man. Varicocele is considered the most common pathology of the scrotum, occurring in 15–20% of men. In addition, varicose veins on the testicles can lead to infertility.
This pathology is not life-threatening. Moreover, a man may not be aware of its presence for a long time and lead a normal lifestyle. Unfortunately, after the development of the clinical picture, few men turn to a specialist, which is why the moment of timely diagnosis is missed. Infertility associated with dilation of the veins of the scrotum is diagnosed in men in 60–80% of all cases, and its cause is the reluctance of patients to deal with the problem.
The pathogenesis of the disease is associated with an increase in pressure in the venous bed above 85 mm Hg, which causes expansion. Varicose veins of the scrotum are most often the result of three etiological mechanisms.
The cause of hypertension in the renal vein is a narrowing of its lumen. A decrease in the diameter of a vessel is most often associated with its pinching between two arteries. The main sign indicating such a cause of varicocele is the rapid manifestation of vein dilation in a vertical position and the disappearance of symptoms in a horizontal position. Due to the narrowing of the renal vein, the blood seeks a bypass route to provide nearby structures with adequate venous outflow. The most convenient option is to ensure the passage of blood through the pampiniform plexus of the testicle, which is not adapted to such volumes of blood, which is why it gradually expands.
Also, narrowing of the renal vein may be associated with birth defects. Varicocele caused by this problem most often occurs in childhood and is more severe than other forms, which is associated with severe circulatory disorders in this area.
A secondary increase in pressure is also associated with a narrowing of the renal vein, but changes in the lumen are caused by scar processes and other organic lesions. Also, the development of secondary hypertension can be triggered by compression of the artery by a tumor. Therefore, testicular varicose veins in men should be differentiated from oncological processes.
Insufficiency of the valve apparatus is usually associated with pathologies of a systemic nature, for example, venous insufficiency. All veins in the human body are equipped with valves that ensure the movement of blood in the right direction. When the functioning of these structures is disrupted, stagnation begins, which leads to varicose veins, including the testicular area.
During adolescence, the load on the body’s circulatory system increases, but the veins cannot cope with it, which is why the disease develops. The appearance of varicocele in elderly men is due to physiological changes of an age-related nature.
In most cases, veins are visible on the testicles on the left, which is due to certain anatomical features. The left testicular vein is completely dependent on the correct functioning of the renal vessel, as it communicates with it. On the right, the testicular vein connects to the inferior vena cava, so any changes in the pressure of the renal vessel do not affect it. In addition, the left testicular vein is more likely than others to lack valves.
Varicocele is asymptomatic for a long time, and men do not pay attention to the swollen veins on the testicles. However, with further progression of the pathology, the following symptoms may appear:
There is a classification adopted by doctors for the convenience of assessing the severity of pathology. With its help, the direction of further treatment is determined. The following degrees of damage are distinguished:
Varicocele can be primary in nature, arising for the reasons described above, or secondary. The symptomatic version of the pathology is characterized by compression of the venous vessels by any neoplasms, for example, cysts or tumors. Due to impaired venous outflow, varicocele develops, and due to testicular ischemia, its atrophy and decrease in basic functions. In addition, an inflammatory process may develop, which develops into a severe autoimmune reaction, since the testicle is protected by a special barrier, and during ischemia it is disrupted.
If a man discovers that a vein in his testicle is swollen, he should contact a specialist to find out the causes of this condition. Ignoring such a pathology as varicocele ends in infertility in almost all patients.
Spermatogenesis with varicose veins is disrupted due to the triggering of the following mechanisms:
In the absence of adequate treatment and a man’s untimely referral to a specialist, the following pathological changes gradually develop in his testicle:
Infertility with varicocele can only be avoided if you carefully monitor your own condition and make a timely diagnosis in a medical institution.
Diagnostic measures for testicular varicose veins are required to confirm the diagnosis, since often an examination of the patient already allows one to draw an approximate picture of the pathology. The following diagnostic methods are carried out:
Ultrasound and Doppler sonography are done in horizontal and vertical positions. During diagnosis, the causes and degree of blood return to the testicular veins should be taken into account, which will allow you to choose the right treatment and avoid relapses.
The only effective treatment option for varicose veins is surgery. In adolescents and children, surgery is recommended in any case to prevent the development of infertility. In older men, treatment is not always required and depends on the severity of the process and the presence or absence of a clinic. If the disease does not bother the patient, then a wait-and-see approach is prescribed to assess the progression of the pathology.
Indications for surgical intervention:
There are 4 types of surgical tactics when diagnosing varicocele:
A surgical incision is made in the iliac region on the affected side. The essence of the operation is to ligate the venous plexus. With this intervention there is a risk of ligation of the spermatic cord, so the surgeon must be very careful and careful. Also during the operation, the functionality of the testicle is assessed.
Mini-access consists of making a small incision, which is located in the area of the inguinal ring where the spermatic cord emerges. With this access, the cord and the veins located next to it are found and ligated. Venous outflow in the future will be carried out through superficial vessels.
Endoscopic or laparoscopic surgery is one of the most successful and least traumatic types of treatment for testicular varicose veins. During the surgical procedure, several punctures are made in the abdominal area, through which a camera and instruments are inserted. Using a camera, the doctor sees on the screen what is happening in the body, and with the help of instruments, he identifies the vessels and ligates the necessary ones. The duration of the operation does not exceed half an hour, and complications or relapses are extremely rare.
With the help of such a surgical intervention, adequate blood supply to the testicle is restored. The essence of the surgical procedure is to transplant the testicular vein into the epigastric vein. From the point of view of the mechanism of development of varicocele, this type of treatment is the most appropriate.
Before choosing any treatment option and to predict the postoperative period, the following indicators are taken into account: the patient’s age, the functional activity of the testicle, the degree of development of the pathology, whether it is one-sided or whether the process affects both testicles, hormonal activity. In this case, the most successful operation can be expected in persons with a significantly developed varicocele, a testicle without pathological changes in the absence of an autoimmune reaction and with normal hormone levels. In such cases, complete recovery almost always occurs, with the exception of any individual characteristics of the patient. The worst results are expected in men who have slightly dilated veins, but have pathological changes in the testicles, decreased sex hormones and signs of the development of an autoimmune reaction.
In order for recovery to be successful and without dangerous consequences, you should consult a doctor in a timely manner.
Varicose veins of the scrotum are a common disease that often affects 14-17 year old boys. Varicocele is the most common reason for surgical intervention in Russia.
The causes of the disease can be varied.
The root cause is often arteriovenous conflicts:
Dysfunction of various systems in boys:
Vascular malformations:
One of the causes of this disease is a tumor near the gates of the kidneys:
In men, the tiny sex glands (testicles) are externalized and located in the scrotum. They have a special blood supply system: arteries and veins. There is a whole network of smaller capillaries functioning here, which extend from the main tube-like formations. The vessels tightly surround the testicle.
The functions of paired male gonads are very important:
The testes require a complete blood supply:
Often during adolescence, the veins surrounding the testis dilate:
The severity of clinical manifestations of the disease depends on the age of the patient:
There are three stages of varicocele:
To prescribe the necessary treatment, it is important to find out and eliminate the cause of varicocele.
You need to understand that there is an expansion of the veins of the scrotum:
It is necessary to find the reasons that caused their underdevelopment:
Sometimes this is associated with a kidney tumor:
Dilation of the veins of the scrotum occurs as a result of stagnation of blood. Varicocele develops. That is why this pathology requires a very serious, thorough examination of a teenage boy.
What is the danger of the disease?
The spermatogenic function of the testicles is impaired:
When is surgery necessary?
The mere presence of groin pathology is not a reason for surgical treatment. All world studies have shown that varicocele of one testicle does not affect the ability to have children.
This disease is not a cause of infertility because:
There are clear medical recommendations on this matter:
The main indications for surgical treatment of a patient with varicocele are:
Types of surgical intervention:
As a result of surgery:
Stenting the affected area:
A hypertrophied testicle is successfully treated.
There is no need to rush into surgery. It is important to use a differentiated individual approach to treating a patient with varicocele. The doctor chooses treatment tactics.
There are new modern treatment methods. If there are medical indications, surgical treatment will help .
This prevents male infertility of vascular origin.
Modern medicine claims that varicose veins of the small pelvis are a common pathology that can affect any vascular bed, disrupting their normal functioning. To date, the problem of pelvic vessels has not been fully studied; doctors do not have approved treatment regimens. Each time, the doctor uses an individual approach, selecting those methods, techniques and medications that will help eliminate varicose veins in the pelvis and eliminate debilitating symptoms.
After analyzing the statistics of women’s requests and factors preceding the disease, doctors found that changes in the pelvic veins in women are caused by the following reasons:
Today, doctors agree that the causes of this pathology lie in the presence of reflux, when blood returns back through the ovarian vein.
The following signs may indicate the development of pathology:
Also, varicose veins of the pelvis are signaled by irritation of the bladder and vaginal discharge. Very often, the expansion of the pelvic veins occurs in parallel with changes in the veins of the buttocks, perineum and thighs.
ARVMT is diagnosed in the following ways:
Having diagnosed pelvic varicose veins, the symptoms and research results should be studied by 2 doctors: a gynecologist and a phlebologist.
Having diagnosed changes in the veins of the pelvis, treatment should be carried out immediately.
Modern medicine can offer the following methods for eliminating pathology:
When choosing a conservative treatment method, it is necessary to provide an integrated approach to solving the problem. Varicose veins in the pelvis need to be treated with courses of drug therapy and special exercises, taking a contrast shower.
Therapeutic exercise helps to establish venous outflow of blood, which will stimulate the normalization of blood circulation in the pelvic organs, forcing them to function fully.
In some cases, when treating varicose veins of the small pelvis, you have to resort to the help of a psychotherapist. Women, experiencing severe hormonal changes, can become depressed, nervous and irritable. The psychotherapist will correct behavior and help adapt to the physiological changes that occur inside.
Until recently, treatment for varicose veins of the pelvic organs involved removal of the uterus and ovaries. Women at a young age became infertile, hormonal levels were disrupted, and the aging process accelerated.
Embolization is an innovative method that allows you to safely get rid of the disease even in the case of a chronic form.
The entire procedure is performed in the following sequence:
With this operation, it is possible to restore venous outflow and preserve existing vessels.
Such operations are performed quickly and do not require large incisions, so rehabilitation therapy does not take much time. Recovery and disappearance of pain occurs on the 14th day after surgery.
In medicine, cases are recorded when a woman does not pay attention to the symptoms that the body gives. Being busy with work and the desire to get more money leads to the fact that health is relegated to the background, and then varicose veins of the small pelvis in women lead to complications.
Any ignoring or delay in treatment will always cause serious complications, such as:
If you detect even mildly noticeable symptoms, you should immediately contact a gynecologist. He will conduct an examination, diagnose and indicate treatment for pelvic varicose veins. Varicose veins of the pelvic organs are easier to prevent than to treat.
Doctors emphasize to women that by following these simple recommendations, they will be able to avoid the development of pelvic varicose veins:
Varicose veins of the esophagus are always a manifestation of impaired outflow from the common venous system of the liver. The disease is usually associated with a complication of high pressure in the portal vein (portal hypertension) and causes dangerous bleeding.
Statistics show that men over 50 years of age are most susceptible to esophageal varicose veins. This is consistent with data on the incidence of alcoholic cirrhosis of the liver.
To trace the connection between varicose veins of the esophageal venous network and liver pathology, you need to remember the features of the blood supply and the relationship of blood vessels.
The outflow of blood from the veins of the lower third of the esophagus goes in the direction: veins of the esophagus - portal vein (portal) - small and minute branches of the hepatic venules pass through hepatocytes, where the blood is cleansed of toxins - as in a collector they are collected into the common hepatic vein - flows into the inferior vena cava .
Since the liver is a very important organ, its blood supply is reinforced by anastomotic pathways that bypass the liver.
The opening of the rescue shunt between the portal and gastric veins is highlighted in color.
The diagram will look like this: portal vein - inferior vena cava. This mechanism involves the veins of the abdominal esophagus. If under normal conditions venous blood flows down through the vessels in the submucosal layer of the esophagus into the larger veins of the peritoneum, then with an increase in pressure in the portal system, a path with the opposite direction of blood flow opens through the left gastric vein and “excess” blood is discharged into the inferior vena cava. At the same time, the veins of the esophagus become significantly overfilled and dilate, but the load on the liver decreases.
The classification of types of varicose veins is associated with the degree of dilation of the esophageal veins and their type. The diameter size is determined by esophagoscopy.
The causes of dilation of the veins of the esophagus, which provoke severe internal bleeding, directly depend on the pressure in the portal vein and all diseases that lead to its increase.
The most common factor is liver disease. In chronic hepatitis, the interlobular spaces in which the venules are located gradually become overgrown. Blood from the portal vein cannot pass because a mechanical obstruction has been created. The pressure inside the portal venous bed increases, and the discharge mechanism into the shunts is triggered. As a result, the left gastric and esophageal veins involved in this process become overfilled.
Untreated hepatitis (especially alcoholic) quickly leads to cirrhosis of the liver. It is expressed in the complete replacement of liver cells of hepatocytes with scar tissue. There is no reverse mechanism. Only an organ transplant can save the patient, but it is still rarely used.
A similar mechanism in pathogenesis occurs in varicose veins of the esophagus in liver tumors, tuberculosis, and echinococcosis.
A mechanical obstruction can occur in the portal vein itself due to its thrombosis, thrombophlebitis. Thromboembolism is possible from any part of the adductor system: from the splenic, mesenteric veins. Thrombosis complicates the course of acute pancreatitis, pancreatic tumors, cholecystitis and cholangitis, and general sepsis.
Compression of the inferior vena cava by the tumor also affects the venous system of the esophagus.
Another variant of portal vein hypertension may be a severe stage of heart failure, especially with an increase in total blood pressure.
From the outside, you can see a similar expansion of veins on the skin of the abdomen
For a long time, varicose veins of the esophagus are asymptomatic and are detected only when bleeding occurs. The initial symptoms or warning signs are:
These manifestations are caused by functional malfunctions of the esophagus, slight narrowing, and reflux of acid from the stomach.
The main manifestation is acute bleeding. In this case, the patient experiences:
The disease can be detected by X-ray examination: the doctor pays attention to the uneven “scalloped” contours of the esophagus, significant tortuosity of the folds of the mucous membrane, small areas of “filling defect” when swallowing a barium mixture.
During esophagoscopy, the vein looks like a tuberous cord; on an x-ray with the introduction of a contrast agent, an enlarged portal vein is visible
The most reliable diagnostic method is esophagoscopy. The procedure must be carried out very carefully so as not to injure the walls of the veins and not promote bleeding. Usually, an enlarged venous network of the stomach is also detected at the same time.
It is necessary to distinguish the resulting signs from an ulcer, a tumor of the esophagus, or esophagitis.
Treatment of varicose veins of the esophagus is carried out in the intensive care unit or intensive care unit.
The patient urgently needs to replenish the lost blood volume. Therefore, a glucose solution, rheopolyglucin, is administered under the control of blood pressure levels.
In order to improve coagulation, transfusions of red blood cells and platelets, fresh blood or fresh frozen plasma are carried out.
If patients have manifestations of impaired brain activity or increased excitability, we must not forget about alcohol withdrawal syndrome and hepatic encephalopathy. Therefore, any sedatives are contraindicated.
Antibiotics are prescribed to prevent infectious complications and re-bleeding. Not all doctors agree with their use.
For five days, the patient is administered vascular drugs Octreotide, Terlipressin, Vapreotide. They are considered substitutes for endoscopic therapy.
When endoscopically identifying the source of bleeding, injections of sclerosing (scarring) drugs are used as the next stage of the procedure. The effect after the first injection allows you to stop bleeding in 80% of cases. The negative point is a reaction to the drug in the form of fever, chest pain.
Ligation of a bleeding vessel (ligation) is carried out with a special attachment. Up to three ligatures are applied to each vessel. The method is considered more effective than sclerotherapy. Some authors use both methods.
For liver diseases, they resort to the technique of installing a stent in an artificial shunt inside the hepatic vein.
The connection of the splenic vein with the left renal vein creates an additional outflow pathway from the portal system.
Esophageal balloon tamponade is used as a temporary procedure to save the patient's life. Under intubation anesthesia, a special probe is inserted into the lower third of the esophagus. About 200 ml of air is blown in, while the balloon expands, squeezing the walls of the esophagus and blood vessels. The probe tube is fixed in the patient's mouth and left for no more than 12 hours.
The Blackmore probe for temporarily stopping bleeding has holes for suctioning gastric contents and pumping air
Treatment of patients who have suffered acute bleeding from esophageal varices is aimed at preventing hypertension in the portal system.
Continuous use of β-blockers (Propranolol) is prescribed, and monitoring of the pulse rate is necessary: do not allow it to drop below 55 per minute.
A good effect was noted from prolonged action nitrates (Nitroglycerin group).
Surgical operations are performed as planned.
Patients need to follow a strict diet throughout their lives, regardless of their health:
Alcohol, carbonated drinks, and beer are strictly contraindicated.
Dispensary observation is carried out by a gastroenterologist. The patient must undergo all types of examination and follow the doctor’s instructions. This is the only way to prevent bleeding.
Varicose veins is the general name for diseases in which the first and most striking sign will be the expansion of the venous network and its overflow with blood. Thinned vessels with varicose veins become fragile and are extremely easily damaged. And since at the time of damage they contain a large amount of stagnant blood, such vascular damage results in large blood losses.
Classically, the phrase “varicose veins” directly refers to varicose veins of the lower extremities. But the general concept of varicose veins includes not only this diagnosis. There are also varicose veins of the esophagus, and varicose veins in pregnant women, as well as varicose veins in the pelvis. The latter, by the way, occurs not only among women, but also for the most part among the stronger half of humanity.
This subtype of varicose veins is the most widespread and best known. It is, in turn, one of three types of chronic venous insufficiency. This disease is characterized by the fact that the venous network of the lower extremities loses its ability to pump blood from the lower to the upper sections, as well as the appearance of pathological reverse reflux of small volumes of blood. These blood flows appear both in the vertical direction (to the previous and underlying sections of the veins) and in the horizontal direction (throws are carried out into the auxiliary network of veins).
This failure of the venous system occurs for a number of reasons. Among them, as always, one can distinguish both hereditary and causes that arose after exposure to certain conditions. These include working conditions, which are accompanied by heavy loads and prolonged standing, exposure to diseases, and hereditary defects. These reasons are all completely different, but lead to the same effect - the normal flow of blood through the vessels is disrupted. Dilation of the veins of the lower extremities, visible “tortuosity” of the vessels and insufficient functioning of the venous valves appear. Normally, these valves are similar in their work to heart valves: they coordinate blood flow and create its unidirectional movement. But the valves of the veins are responsible for transporting blood from the lower to the upper sections. In addition, like all valve systems of the body, the valves of the veins prevent the reverse and pathological flow of blood during relaxation of the heart.
With varicose veins of the lower extremities, the valves cannot prevent blood from flowing in the opposite direction. This occurs due to dilation of the vein itself. In turn, the vein usually expands due to exposure to increased pressure in the bloodstream or due to disturbances in its structure. Valves with varicose veins of the extremities seem to “stretch” in different directions and their valves cannot close. Naturally, blood rushes through the hole that appears and, under the influence of gravity, accumulates in the lower parts of the body, and in the case of varicose veins of the extremities, in certain sections of the veins (usually next to incompetent valves). A large volume of blood gradually stretches the vein and it becomes thinner. In the same way, bypass veins can be activated - collaterals, which also become overfilled with blood and become thinner. Most often, it is the superficial and collateral veins deformed by varicose veins that are visible on the extremities of patients.
Such significant dilation of the veins and stagnation of a large amount of blood in them will lead to a “crown” complication and the manifestation of varicose veins of the lower extremities - the appearance of ulcers on the skin of the legs, which are called “trophic”. They appear due to the fact that in the lower leg area the pressure of stagnant blood volumes is greatest. As a result, the smallest types of veins - venules - become extremely permeable, and the liquid part of the blood (plasma) leaks into the space surrounding the venule. Significant swelling will develop in this area and the nutrition of the surrounding tissues will be disrupted. As a result, those same ulcers appear.
Varicose veins have two subtypes, according to the veins that are affected: primary and secondary varicose veins of the lower extremities. In the presence of primary varicose veins of the lower extremities, only the superficial veins are damaged. Secondary varicose veins of the lower extremities are accompanied by damage to the deep veins. By the way, it is the secondary variant of the lesion that is hereditary and occurs due to a congenital disorder of the valve structure.
There are the following stages of varicose veins:
— Varicose veins of superficial veins located under the skin or inside the skin, and not accompanied by the presence of pathological discharges of blood
— Varicose dilatation of segments of individual veins with discharge through superficial veins or collateral veins
— Common varicose veins, accompanied by discharge through superficial veins or collateral veins
— Common varicose veins with pathological discharge through the deep veins
varicose veins on legs photo
Varicose veins of the pelvis appear in both men and women. In women, varicose veins of the pelvis most often affect the ovarian veins, and in men, varicose veins affect the veins of the spermatic cord. It is varicose veins in men that is an extremely unpredictable disease. In advanced stages, it can lead to complete infertility in a man.
Like all subtypes of this disease, varicose veins of the pelvis have the following reasons for its occurrence: probable failure of the venous valves, disruption of the “pumping” of blood through the vessels and its stagnation, subsequent activation of the auxiliary network of vessels to ensure blood transport bypassing areas of stagnation.
During certain problems, the ovarian veins or veins of the spermatic cord cannot carry out the necessary volumes of pumping blood into subsequent vessels. As a result, in certain areas the blood is not transported, but stagnates and accumulates. Large volumes of blood put pressure on the vascular wall of the veins and expand it. But the veins have one secret - they are provided with an additional system of assistants - vein collaterals. These veins act as escape routes in the human body. Along them, stagnant blood rushes in its own circle, bypassing the idle sections of the main veins. But these helper veins are even thinner than the main veins. This means that after some time they also expand. And signs of varicose veins of the pelvis appear.
As mentioned above, pelvic varicose veins are dangerous for both sexes due to the fact that they can cause infertility. It is now believed that varicose veins of the pelvis in women is a disease that has its preconditions even in intrauterine development. To be more precise, it is believed that varicose veins of the pelvis appear due to congenital defects in the elasticity of the venous apparatus. Most likely, these defects are a consequence of the body’s congenital inability to produce certain types of collagen, which is part of the vein wall and ensures its elasticity.
Therefore, there are no etiological reasons for varicose veins of the small pelvis in women. But there are factors - prerequisites that, with a certain and prolonged exposure, can cause the appearance of varicose veins of the small pelvis in a woman. Typically, this is a job where a woman is forced to remain in an upright position for a long time, work in difficult physical conditions, a large number of pregnancies and births, gynecological diseases, as well as possible exposure to hormonal therapy and oral contraceptives.
Among the clinical manifestations of varicose veins of the pelvis in women, two subtypes are distinguished: the first is varicose veins of the vulva, perineum and varicose veins of the uterus. The second variant of varicose veins of the small pelvis is a syndrome accompanied by venous congestion of the small pelvis.
In men, varicose veins are manifested by the appearance of a so-called varicocele. It appears due to the fact that a reverse flow of blood appears in the testicular vein. This return passage enters the pampiniform venous plexus of the testicle and rushes into the common iliac vein.
Most often, the reverse flow of blood with varicocele in men occurs due to the fact that the lumen of the renal vein narrows or the pressure in it increases, which stimulates the appearance of this pathological course. The renal vein with varicose veins of the spermatic cord may narrow due to possible scar processes or if it is incorrectly located behind the aorta. Also, reversal and varicose veins of the spermatic cord can cause similar changes (stenosis or high blood pressure) in the common iliac vein.
Esophageal varicose veins have slightly different causes than varicose veins of the lower extremities. In addition, it never appears on its own and occurs in combination with a disease such as portal hypertension. All this happens because, for a number of specific reasons, the pressure gradient in the portal vein system (which leaves the liver) increases.
The esophageal veins, according to their anatomy, are connected to the portal vein of the liver, and when the pressure there increases, the esophageal veins do not escape this fate. Excessive pressure leads to stretching of the venous wall. Unlike arteries, veins, although they have a muscular wall, are much less developed than those of arteries. Therefore, they cannot cope with the pressure for a long time. After some time, the veins thin out and become fragile. Therefore, they can break at any moment. And since these vessels contain a larger amount of blood, such bleeding from varicose veins is characterized by large losses of blood volume and can lead to death.
Also, varicose veins of the esophagus can appear in situations characterized by their compression. This may occur when the esophagus is compressed by a tumor.
The surest clinical symptom of varicose veins will be bleeding. They may appear suddenly, without any prior worsening of the condition. These bleeding may also occur in situations where a patient with varicose veins may accidentally strain. In addition, lifting heavy objects can also lead to rupture of esophageal varices and subsequent bleeding. High blood pressure, especially its surges, are also extremely dangerous for patients with esophageal vessels affected by varicose veins.
In some patients, a sensation that most closely resembles tickling may be a kind of “beacon” of upcoming bleeding. This “tickling” will be accompanied by a special sourish-salty taste in the mouth. And then, these harbingers will be replaced by profuse vomiting of blood. Most often it is scarlet in color, sometimes it can be “the color of coffee grounds.” The color of the blood when varicose veins of the esophagus rupture will depend on the veins of which part of the esophagus are affected by varicose veins.
If blood loss due to varicose veins of the esophagus is large, then it will be accompanied by weakness and dizziness. Patients may also complain of a gradual “darkening in the eyes” or loss of sensation in the limbs. Typically, patients with such bleeding are extremely restless; they feel a kind of “fear of death.”
Varicose veins of the esophagus can develop in completely different ways. It can develop either extremely quickly, lightning fast, or develop over a long period of time. Interestingly, patients who are at risk of bleeding with large and possibly fatal blood loss may feel some “precursors” - for several days before the bleeding, they note the appearance of a characteristic chest tightness.
Both lightning-fast development and prolonged manifestation of varicose veins of the esophagus are life-threatening for patients. With the fulminant form of development of varicose veins of the esophagus, everything happens very quickly and suddenly. Often, if a bleeding attack is not stopped, it will lead to death. Patients with long-term (“slow”) forms of varicose veins most often do not even know about their disease until the moment of bleeding.
varicose veins in the esophagus photo
Varicose veins are a category of diseases that are caused by a large number of factors. The genetic aspects described above, as well as the effects of hormones (ingestion of certain substances by women, as well as pregnancy), excess body weight and the load of a taller person all play a role here. Also, the features of working and living conditions that cause varicose veins have already been described (inappropriate load exercises, stress on the legs and carrying such weights for which the body is not adapted).
In addition, it was decided to identify factors for the development of varicose veins, which can become prerequisites for the disease. That is, with such factors, varicose veins may either appear or, with proper observation, not develop even in the initial stage. Such factors are usually called predisposing.
The predisposing factors are the above-described congenital insufficiency of the venous valves and the incompetence of the vein wall. With these factors, even during the process of fetal development, a malfunction occurs and from then on, certain types of components of the vein wall and valves are not produced.
There are also producing factors for the development of varicose veins: these include diseases and conditions that lead to an increase in the level of pressure in the body and in the vessels. Diseases include: COPD (chronic obstructive pulmonary disease, constipation, obesity). Conditions include pregnancy and heavy static loads.
In addition to the causes of varicose veins, it is necessary to understand the main reasons due to which certain clinical manifestations arise. These reasons have already been discussed separately when individual subtypes of varicose veins were described.
And besides the factors that predispose and cause varicose veins, there are also risk factors. These are factors that increase the likelihood of varicose veins: these include conditions characterized by an imbalance between hormones in the body. At the same time, both a risk factor and a factor that can provoke the disease are the already described above pregnancy, obesity and characteristics of life and work.
Thus, it becomes clear that certain factors can both increase the chances of morbidity and directly cause varicose veins. Everything depends only on the strength of their influence, combination with other factors and the individual capabilities of the body.
The main pathological link is the pathological reflux of blood (reflux). Normally, blood flows along the channel from the lower to the upper sections. That is, it counteracts the effects of gravity. This phenomenon provides the heart and venous system, which “pumps” blood from the bottom up. As already described above, there are valves in the veins that prevent blood from flowing in a direction that is unfavorable to the body - from top to bottom. Normally, the valves close during diastole of the heart and do not let blood back in.
With varicose veins, the valves do not close during cardiac diastole. This occurs due to various reasons: in some places the valves are defective from birth, and in others the veins themselves stretch due to pressure on them (as, for example, with portal hypertension). Due to improper operation of the valves, blood flow is disrupted and reflux occurs. Refluxes leave unnecessary volumes of blood in the veins, which stretch the vessels. Gradually, secondary increased pressure in the veins develops. Therefore, the cause-and-effect relationship of varicose veins is also called a “vicious circle”: violations of the principles of hemodynamics in varicose veins and cause and effect.
Symptoms of varicose veins directly depend on its subtypes and the levels of affected veins.
So, with varicose veins of the lower extremities, painful symptoms in the legs will be the main symptoms. They begin with subjective feelings of heaviness, and then, according to the degree of deterioration, they turn into pain. It is important to know that with mild degrees of varicose veins of the lower extremities, the pain may go away when the position of the limb is changed or the patient assumes a horizontal position. In advanced stages, the horizontal position in patients causes even more severe pain attacks. Along with pain attacks comes swelling. Most often they appear on the legs towards the end of the day.
Another striking symptom will, of course, be various visual changes in the veins: various sets of dilated “cyanotic” veins, “stars” of vessels and small “twisted” veins.
In the final stages, ulcers appear (the reason for their occurrence is described above) and convulsions.
Varicose veins of the pelvis are characterized by pain in the lower abdomen. In women, these pains are also accompanied by the appearance of an unpleasant discharge, and in men, the pain is more localized in the scrotum and testicles, and in them they intensify with physical activity or excitement.
In women, varicose veins of the small pelvis worsen the normal course of menstruation: severe pain appears that was not previously observed, or the cyclicity of menstruation is disrupted. Also, half of women with varicose veins of the small pelvis can find the appearance of dilated veins in the gluteal region, perineum or on the outer surface of the thigh. The perineum and vulva become extremely painful and sensitive.
With varicose veins of the esophagus, the main symptom is bleeding. Before bleeding appears, this type of varicose veins practically does not manifest itself in any way. This is precisely where its danger lies.
In pregnant women, the signs of varicose veins are similar to those of varicose veins of the extremities. Swelling and heaviness in the muscles appear. The skin shows characteristic signs of varicose veins. The peculiarity is that these signs will appear or significantly accelerate during a woman’s pregnancy.
It is no secret that pregnancy is an important and at the same time quite difficult test in the life of any woman. The body is subjected to heavy stress: physical, mental and hormonal. Therefore, quite often a pregnant woman may develop varicose veins. Moreover, according to modern surveys, it has been revealed that almost every third or second woman encountered varicose veins during her pregnancy. Most often, varicose veins in a pregnant woman affect the veins of the legs.
So what causes the appearance of varicose veins during pregnancy? The thing is that the uterus has the ability to stretch significantly. During pregnancy, together with the gradually growing fetus, the uterus exceeds its size several times. It is clear that such changes do not pass without leaving a mark on the body. A heavy and enlarged uterus causes increased intra-abdominal pressure, due to which the veins have to make greater efforts to push blood from the lower to the upper sections. Constantly placing this pressure on the walls of the veins will gradually cause them to stretch and become unable to pump any more blood. Stagnation will appear and all the signs of varicose veins will gradually develop.
The first “bells” of varicose veins in pregnant women will be the appearance of minor changes, which will initially occur only in the superficial veins. These will be the so-called “stars” - characteristic expansions in the form of dilated and tortuous vessels on the legs. Then pain and cramps will appear in the muscles that will be adjacent to the vessels affected by varicose veins.
In addition, during pregnancy, the weight of the woman herself may increase, which will also cause difficulties in pumping blood in vessels accustomed to normal loads. Also, during pregnancy, the volume of the blood itself increases and the vessels no longer have to cope with large pressure gradients, but with large volumes of blood.
Therefore, it is extremely important for a pregnant woman to engage in the prevention and treatment of varicose veins. If a woman already had the first manifestations of varicose veins before pregnancy, then she needs to be observed by a phlebologist and follow all the recommendations that will be prescribed. Also, special elastic bandages and stockings have been specially developed for the prevention of varicose veins in pregnant women, which are prescribed to the woman for constant wearing. These devices exert a certain pressure on areas affected by varicose veins and become an additional link in the “pump” - they stimulate the veins to pump blood with increased volumes or increased pressure.
Treatment of varicose veins also depends on the manifestations of this disease.
For varicose veins of the esophagus, the patient is given vasoconstrictor drugs and undergoes therapy aimed at stopping the bleeding. In case of large lost volumes of blood, its volume in the body is restored. If the bleeding cannot be stopped with drugs, then surgery is performed. It consists in the fact that a special probe-balloon is inserted into the cavity of the esophagus at the level of damage, which is then inflated. Thus, it applies pressure to the damaged area and stops bleeding. Various coagulations of bleeding varicose veins of the esophagus are also possible: electrical and using cryological influence.
With varicose veins of the pelvis in women, it is important to stop the pathological flow through the ovarian veins. This implies the use of both medications and various surgical aids. With varicose veins of the female pelvis, three goals must be achieved: restore the tone of the vein wall, improve blood flow in the right direction and improve the nutrition processes of the pelvic organs. Venotonics and antiplatelet drugs are prescribed. For severe pain attacks, drugs with anti-inflammatory effects are indicated. If the pain does not disappear with the use of painkillers, then this is a direct path to surgical treatment. Most often, the varicose ovarian vein is clogged with a special embolus. The operation is performed under X-ray control.
In men, varicose veins of the small pelvis can only be treated surgically. The testicular vein is ligated and divided. This manipulation interrupts the pathological blood flow. It is important to remember that the sooner such an operation is performed on a man, the higher the prognosis for restoring the function of the affected testicle will be.
Of course, treatment methods for varicose veins during pregnancy are greatly limited by the woman’s condition itself. After all, when prescribing therapy to a woman, it is important not to harm her unborn child. For varicose veins, pregnant patients are most often prescribed special venotonic ointments. Tablet drugs are prescribed only to pregnant women who are already in the 2-3 trimester of pregnancy. Also, a patient with varicose veins is sent to childbirth in elastic bandages. Moreover, it does not matter whether the patient gives birth naturally or is scheduled for a cesarean section. In addition, in each case of varicose veins in pregnant women, the issue of the method of delivery is decided separately: subjective factors and signs of the disease are usually taken into account.
For patients with varicose veins of the lower extremities, wearing medical jersey and prescribing venotonics are prescribed. Medical knitwear is prescribed individually and depending on the stage of the disease. The specific time for wearing this knitwear is also calculated, it is calculated according to the clinical manifestations of the disease. Of the surgical methods of treatment, operations such as the intersection of the dilated saphenous veins with their subsequent ligation are very good for the treatment of varicose veins of the lower extremities.
To prevent postoperative complications, patients are prescribed an active motor regimen as early as possible. If small saphenous veins are affected, then a smaller volume of surgical procedures is performed - sclerotization of the affected vein with a special embolus consisting of a drug with sclerotizing properties. Once in the right place, this embolus “glues” the walls of the vessel together.
In addition to surgical and therapeutic treatment of varicose veins of the lower extremities, physical therapy, adjustment of the existing one and adherence to a certain (new) lifestyle are also used.
Preventive methods for varicose veins follow two guidelines: one helps prevent complications in patients with already present varicose veins (secondary prevention of varicose veins), the second will prevent the appearance of the first signs of varicose veins (primary prevention of varicose veins).
Primary prevention of varicose veins contains the following points. Firstly, you should not wear shoes with excessively high heels. Its optimal size should not exceed 6 cm. In addition, the chosen shoes should be comfortable and light, this is when they will help prevent varicose veins. It is necessary to exercise and increase your physical activity: cycling and exercises to warm up your feet will help a lot with this. The appearance of this disease is blocked by constant swimming. In addition, it is necessary to correctly distribute the loads and capabilities of your body, because lifting weights or strength exercises can also lead to disruption of the venous valves and the appearance of varicose veins. It is also necessary to adjust working conditions according to the needs of the body. People with prerequisites for varicose veins should not stand for a long time or take on such a load that could have a detrimental effect on the veins.
Prevention of already clinically manifested varicose veins consists, as mentioned above, in preventing the occurrence of further complications. Most often this is the preventive wearing of special knitted stockings. The type of medical knitwear will depend on the stage of the disease and the manifestations of varicose veins.
Massage is also a good method for preventing varicose veins. It can be carried out both to prevent the appearance of the first signs of varicose veins, and for patients with already appeared manifestations of this disease. The main criterion is a diagnostically confirmed absence of a tendency to thrombosis and the absence of any neoplasms (both malignant and benign).
Also, patients with varicose veins are prescribed a special diet. It contains a large number of dishes with vegetable fiber and vegetable oils, but at the same time does not tolerate excessive amounts of meat, as well as spicy dishes. This diet helps the body strengthen the walls of the veins and thus fight the appearance of varicose veins. At the same time, such a diet easily and harmoniously reduces excess weight, which can also lead to the appearance of this disease.
The strength of the venous wall can be strengthened with the help of certain drugs - venotonics. They are usually prescribed based on each individual case of the disease.
Strange as it may seem at first glance, diseases such as chronic colitis or constant constipation can also cause varicose veins. As described above, varicose veins easily appear with high intra-abdominal pressure and inflammatory processes in the internal organs. Therefore, it is important to find and treat these problems promptly.
What’s also interesting is that patients with varicose veins should carefully monitor the hygiene of their legs and feet. For them, toileting the skin of the feet must be done several times more often than for ordinary people. The whole point lies in the fact that even the smallest wound on the feet or in the area between the toes can cause inflammation of the veins of the extremities and worsen the condition of a patient with varicose veins.