pelvic blood stasis

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Pelvic congestion syndrome (also known as pelvic septicemia) is a special condition caused by chronic pelvic venous stasis and is one of the main causes of chronic pelvic pain in gynecology. It is more common in women aged 30-50 years. Chinese medicine does not have this name. According to its clinical manifestations, it can be classified into abdominal pain, dysmenorrhea, and lowering. The pathogenesis is mainly blood stasis and dysfunction.

Cause

Cause

Any factor that causes the pelvic vein to flow out of the pelvis is poor or blocked, can cause pelvic venous stasis. Compared with men, gynecologic pelvic circulation is very different in terms of anatomy, circulation dynamics and mechanics. It is easy to form the basis of pelvic blood stasis.

Any factor that causes pelvic venous blood to flow out or is blocked can cause pelvic venous congestion.

1. Anatomical factors: Female pelvic circulation has the following characteristics:

(1) The number of pelvic veins is larger than that of arteries: the trunk of the pelvic vein is usually two veins accompanied by one artery of the same name (there are only one), while the medium vein is often two or three veins accompanied by one artery of the same name. And there is a large anastomosis between the large venous stems. The venous plexus, which originates from the mucosa, muscle layer and serosa of the organ, is pooled into two or more veins and flows into the thick internal iliac vein. The increase in the number of pelvic veins is to accommodate the need for pelvic venous blood flow delay.

(2) Characteristics of the pelvic vein wall: The pelvic vein is thinner than the vein wall in other parts of the body, lacking the outer sheath composed of fascia of the extremities, lacking intrinsic elasticity, and easily expanding and forming numerous curved venous plexus. Walk through the loose pelvic connective tissue. There are no valves in the venous small and medium veins, but only before it enters the large vein. These characteristics make the venous system of the pelvic organs like a swamp connected by a water network, capable of accommodating a large amount of rapidly flowing arterial blood.

(3) venous communication between pelvic organs: the venous plexus of the bladder, reproductive organs and rectum are connected to each other. Due to the lack of valves, any systemic circulatory disturbance between the three can affect the other two systems.

Based on these anatomical features of the pelvic vein, if affected by relevant factors, it will contribute to pelvic congestion syndrome and exhibit various clinical signs.

2. Physique factors: Some patients have weak vascular wall tissue, less elastic fibers and poor elasticity due to institutional factors, and are prone to venous stasis. Even in the first pregnancy, although you do not work for long periods of standing or sitting still, symptoms of pelvic congestion syndrome may occur.

3. Mechanical factors: Different mechanical factors have been shown to affect the flow rate of pelvic vessels, thus changing the pressure of local blood vessels, and the veins are more susceptible to it.

(1) Standing position: long-term engaged in standing workers, pelvic venous pressure continues to increase, easy to form pelvic congestion, long-term lower abdominal pain, increased back pain, increased vaginal discharge and menstrual flow. Such patients often complain that after a break, the symptoms are often alleviated.

(2) posterior uterus: Although the posterior uterus does not necessarily produce pelvic congestion, it is often an important factor causing pelvic congestion. Clinically, most of the uterus in patients with pelvic congestion is posterior hypertrophy. When the uterus is used to maintain the uterus in the posterior position, the back pain is significantly reduced. Some people have used uterine lipiodol angiography to prove that the uterus of the posterior hypertrophy is significantly reduced after hanging. In the posterior uterus, the uterine and ovarian vascular plexus descends with the uterus and flexes on both sides of the sulcus, causing the venous pressure to increase and the reflux to be affected, so that the vein is in a state of congestion.

(3) Early marriage, early childbirth and frequent maternity: those who are overburdened before sexual reproduction (sexual intercourse, childbirth) are prone to pelvic venous congestion. According to some studies, the blood volume of ovarian veins during pregnancy increased by more than 60 times compared with non-pregnancy, and the tension of ovarian veins increased by 2.86 times compared with non-pregnancy.

(4) constipation: constipation affects the venous return of the rectum, and the rectum and uterus guide veins are in line with each other. The congestion of the sacral plexus will inevitably cause congestion of the uterine vaginal plexus, so habitual constipation is prone to pelvic congestion.

(5) Wide ligament laceration: Some people have observed fascia laceration at the base of the broad ligament, which is the only important reason for some pelvic congestion signs. They believe that the wide ligament fascia laceration makes the structure weak, lacks elasticity, and the vein lacking the intrinsic extravascular sheath loses support, and forms varicose veins, which also causes the uterus to fall back. During surgery, it was found that the basal laceration of the broad ligament may involve the front or back of the broad ligament and extend to both sides. Sometimes the rupture of the serosa is clearly visible, but sometimes the crevice is very small, like small smashes, bruises, and liquid seepage. After repairing the ligament fissure of the broad ligament and its base, not only the posterior uterus is effectively corrected, but also the symptoms of broad ligament varicose veins and pelvic congestion disappear. Wide ligament laceration is associated with childbirth.

4. Autonomic disorders: Despite these various causes and anatomical lesions, but not young women obstetricians believe that the main symptoms of pelvic congestion are fatigue, low back pain, sexy discomfort, etc., to a large extent due to autonomic disorders result.

5. After tubal ligation: Some scholars believe that because the oviduct mesangium is rich in uterine and ovarian vein distal anastomosis, the uterine horn is returned through the ovarian vein, and the ligation operation mechanically interferes with pelvic hemodynamics, but more importantly. It is related to the injury of the oviduct mesangial blood vessels during operation, which affects the uterine and ovarian venous return, resulting in pelvic venous congestion.

6. Others: clinically found uterine fibroids, chronic pelvic inflammatory disease (especially those who form tubal ovarian cysts), lactation amenorrhea, cervical erosion (moderate or higher) and other patients, in the pelvic venography, some show Pelvic venous congestion, and mental effects (long-term depression, chronic illness, insomnia, etc.) and estrogen levels fluctuations (premenstrual, perimenopausal) have similar symptoms of pelvic congestion. The pelvic venous congestion image of the former category can be considered as a concurrent change; the latter case can be considered as an aggravating factor for pelvic congestion.

Examine

an examination

Related inspection

Laparoscopic pelvic and vaginal ultrasonography

First, the basic inspection

1. Vaginal B-ultrasound is helpful in diagnosing this disease.

2. Pelvic venography: can clearly and dynamically display pelvic varicose images, objectively prove the existence of pelvic venous stasis.

Second, further inspection

Laparoscopy: the uterus is enlarged, the surface is purple-blue or the surface of the uterus is "spotted". The ovary on one or both sides is cystic enlargement edema, varicose veins in the ovary, and the vascular stenosis in the broad ligament is distorted. Form a venous tumor or sputum.

Third, the diagnosis points

1. Patients with or with partial clinical manifestations mentioned above, especially those with lower abdominal or pelvic bulge and signs.

2. Pelvic venography can be diagnosed with varicose veins.

3. Difficult cases can be further laparoscopic.

Diagnosis

Differential diagnosis

The disease needs to be differentiated from chronic pelvic inflammatory disease, endometriosis, and neurosis.

1. Chronic pelvic fall or falling pain, gradually increased from the middle of menstruation, menstrual cramps or fatigue after aggravation, accompanied by deep pain and low back pain, sometimes unbearable, cyclical.

2. Extreme fatigue, the doctor can not find the relevant lesions.

3. More than half of the blood stasis dysmenorrhea has this symptom, the day before menstruation or the first day of menstruation is the heaviest, the second day after menstrual blood increase significantly reduced or disappear.

4. Too much leucorrhea is a transparent mucus or watery leucorrhea.

5. Menstrual changes in the menstrual cycle are significantly changed, but there may be an increase in menstrual flow, menstrual blood is a sauce color, and a quarter of patients have a small amount of bleeding during ovulation.

6. Breast pain occurs before menstruation, the pain is quickly relieved after menstruation, or completely disappeared.

7. Vulvar swelling, falling pain, vaginal wall can be purple blue, swelling of the labia and venous filling.

8. About 1/3 of patients with urinary tract symptoms have obvious symptoms of frequent urination and dysuria before menstruation, and are suspected of urinary tract infection.

9. Anal bulge is obvious in defecation and premenstrual, especially in the uterus.

10. Autonomic dysfunction Symptoms of neurasthenia, irritability, insomnia, headache, nausea in the precordial area or palpitations, body aches and discomfort.

L1. Abdominal examination of the lower abdomen with mild deep tenderness.

12. Women with vulvar vein filling, vaginal and cervical mucosa are often purple-blue, the uterus is mostly soft, and the accessory area around the palace has obvious tenderness and fullness, but there is no obvious thickening and mass.

diagnosis