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Most commonly we are asked to evaluate patients for spider and varicose veins on the legs.  However, as some patients are well aware, abnormally dilated veins can appear just about anywhere on the body, including the buttocks, face and even vaginal area.  While the location of these veins may seem surprising, fortunately there are only a few instances where special attention is needed.

Varicose Veins on the Vagina or Vulva

Dilated veins on the vagina or vulva often appear during pregnancy.  After childbirth, the same veins often regress and disappear as the pressure lessens from the pregnant uterus.  The persistence of varicose veins on the vulvar regions, buttocks or inner thighs may suggest pelvic congestion syndrome. 

In pelvic congestion syndrome, the internal veins remain dilated and symptoms of chronic pelvic disease persist for greater than 6 months.  This is a medical condition and warrants investigation for symptomatic patients.  Often, the cause can be found as reflux in the pelvic veins including the ovarian vein or internal iliac vein.  It is not an easy condition to diagnose and requires a multi-specialty approach.  Any patient with chronic pelvic symptoms, especially in the presence of visible varicose veins in the pelvic region, should seek expert consultation with a vein specialist in collaboration with their gynecologist.   With proper diagnosis, the condition can be effectively cured with minimally-invasive treatments.  

In patients with co-existing varicose veins on the legs and signs of pelvic congestion syndrome, it is recommended to consider a thorough evaluation before proceeding with vein treatment.  Effective vein treatment requires eliminating the most proximal sources (highest point) of reflux, which in certain individuals involve the pelvic veins.  A comprehensive evaluation by a vascular surgeon with experience in pelvic venous disease is recommended.   Smaller pudendal veins that are without symptoms can be treated without further investigation using sclerotherapy.   

Learn More About Pelvic Congestion Syndrome

Abnormal Veins on the Buttocks

In simple instances, this can be small thread veins or spider veins visible on the buttock region.  Other than being cosmetically displeasing, there is no cause for concern.  These spider veins are similar to the ones that we are more familiar with on the legs and respond well to sclerotherapy.  

Spider veins and even larger varicose veins in the buttock region are often secondary to incompetent veins.  As blood pools in the veins around the buttocks, the increased pressure results in spider veins and varicose veins.  

Hemorrhoids are another type of dilated vein that can appear on the buttock region.  For the majority of patients, this is not likely to be significant.  However, individuals who have symptoms including pain, itching, or bleeding, effective treatments are available.

Facial Veins

We are commonly asked to treat what appear to be broken capillaries on the face.  These spider veins must be distinguished from Rosacea, a skin condition treated under the care of a dermatologist.  Spider veins on the face tend to cluster around the nose and have an association with aging, genetics, hormones, sun exposure and certain medications.   Because these veins are so close to the skin, they can be easily visible in some affected individuals. 

Facial spider veins are best treated with laser vein removal.  The location and tiny nature of these veins are not often suitable for sclerotherapy.  For patients with larger veins near the forehead, temples  or eyes, sclerotherapy can be effective.

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