Pelvic Phleboliths: What Causes Them and How Are They Treated?
What are phleboliths?
Phleboliths are tiny calcifications (masses of calcium) located within a vein. They are sometimes called “vein stones.” The phlebolith starts as a blood clot and hardens over time with calcium.
When these calcified masses are found in your pelvis, they are called pelvic phleboliths.
Pelvic phleboliths are round or oval and usually 2 to 5 millimeters in diameter. They can form in many parts of the body, but the pelvic area is the most common area affected by phleboliths.
Pelvic phleboliths are fairly common. They’re estimated to occur in roughly 35 per cent of adults over the age of 40. They don’t usually cause any problems or affect day-to-day life.
If you’re experiencing pain, talk to your doctor. Pelvic phleboliths should not cause pain.
What are the symptoms of pelvic phleboliths?
Most pelvic phleboliths don’t cause any symptoms. If you are experiencing pain in the pelvis, it’s likely caused by something else, such as varicose veins.
Varicose veins are sometimes considered a symptom of phleboliths. Varicose veins are enlarged veins overfilled with blood. These veins appear swollen and raised and are bluish or purple in color. They can be very painful.
What causes pelvic phleboliths?
Pelvic phleboliths form when pressure builds up in a vein. The pressure leads to thrombosis (the formation of a blood clot). The blood clot then calcifies over time.
Examples of conditions or events that could lead to a build-up of pressure in the veins include:
- straining from constipation
- varicose veins (considered both a symptom and a cause of phleboliths)
Pelvic phleboliths may also be caused by an uncommon condition known as venous malformation, which results in abnormal development of veins. These veins stretch or enlarge over time. The blood circulates very slowly, resulting in blood clots that calcify over time to create phleboliths.
Venous malformations are rare and usually present at birth. Their exact cause isn’t known, but researchers think a number of genetic mutations are involved.
Who is at risk for pelvic phleboliths?
People over the age of 40 are at a higher risk of having pelvic phleboliths. The risk increases with age and affects both genders equally.
Other factors that might increase your risk of developing pelvic phleboliths include:
- prolonged consumption of a diet low in fiber and high in processed food
- Maffucci’s syndrome, a rare condition that leads to vascular malformations
Research has shown that pelvic phleboliths are less common in developing countries. They occur at the same rate in both black and white Americans. This suggests that phleboliths are caused by environmental, not genetic, factors, most likely due to differences in diet between developing and developed countries.
Diagnosing pelvic phleboliths
If you go to the doctor because of pelvic pain, your doctor may want to run tests to rule out other conditions, like kidney or ureteral stones (ureteral calculi). A ureteral stone is a type of kidney stone that travels through the tubes that connect the kidneys to the bladder (the ureters).
Your doctor will likely take a medical and family history and ask you questions about your symptoms. They may also perform a physical examination.
Imaging tests to help in diagnosing your condition may include:
- MRI scan
- CT scan
In an X-ray image, phleboliths look like rounded white or light-colored spots and have a radiolucent (transparent) center, which can help doctors to distinguish them from ureteral stones.
Many times, pelvic phleboliths are discovered accidentally during an X-ray or CT scan of the legs or pelvis for another unrelated health issue.
How are pelvic phleboliths treated?
Because pelvic phleboliths are typically asymptomatic, you likely will not need to treat them.
If you’re experiencing pelvic pain, your doctor may recommend home treatment with over-the-counter pain medications, such as ibuprofen (Advil, Motrin).
You can also place a warm, wet washcloth over the painful area a few times a day to help relieve the pain.
Compression stockings might help relieve the pain of varicose veins and keep blood from pooling and clotting.
If the pain doesn’t go away or gets worse, see your doctor.
Treatment for varicose veins
If the vein with the phleboliths is a painful varicose vein, your doctor may recommend a treatment option known as sclerotherapy. In sclerotherapy, a salt solution is injected into the vein. The solution irritates the lining of the vein and eventually destroys it.
Treatment for venous malformations
Most vascular malformations eventually need to be treated to alleviate pain and swelling. Treatment options include:
- Embolization. This minimally invasive procedure closes the abnormal blood vessels from the inside.
- Laser treatment. This procedure uses a laser to reduce the malformation through the skin.
- Sclerotherapy. This procedure involves injecting a substance into the malformation to irritate the wall of the vessel and destroy the malformations.
If other treatments don’t help, you may need surgery to remove the phlebolith or venous malformation. Surgery is typically only used as a last resort.
Can pelvic phleboliths be prevented?
Not all pelvic phleboliths can be prevented.
However, eating a diet high in fiber and low in processed foods might help prevent constipation, which can lead to phleboliths.
You can also take steps to help prevent blood clots from forming within the blood vessels. Some ways to help prevent clot formation include:
- exercising daily (even just a short walk)
- taking a daily aspirin
- staying hydrated
- monitoring your salt and sugar intake to help lower your blood pressure
- avoiding wearing tight clothing
What is the outlook?
In most cases, pelvic phleboliths are benign. They don’t require any further treatment or evaluation. They are recognized as a normal part of ageing.
In rare cases, the presence of phleboliths in the pelvis can alert your doctor to the possibility of more serious conditions, such as venous malformations.
Venous malformations may also increase your risk of developing blood clots in the deep veins (deep vein thrombosis) and in the blood vessels of the lungs (pulmonary embolism), which can be fatal. Rarely, venous malformations can result in internal bleeding. It’s important that venous malformations are monitored and treated to prevent complications.
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