Overview
Chronic pelvic pain is a common problem for women and has a number of causes. One cause of pelvic pain that has been identified in recent years is pelvic congestion syndrome. This condition is caused by varicose veins in the ovarian and pelvic veins, meaning that blood pools in the veins and affects the surrounding nerves, causing pain in the uterus, ovaries and vulva.
Pelvic congestion syndrome usually affects women between the ages of 20 and 50, and is unusual in women who have never been pregnant.
Symptoms
The main symptom is pain in the pelvis and lower back that lasts for more than 6 months. The pain usually becomes worse during menstrual periods, while standing, at the end of the day, after intercourse and during pregnancy.
Patients may also experience an irritable bladder, abnormal menstrual bleeding and vaginal discharge. Varicose veins may be present on the vulva, buttocks and thighs. Other symptoms include a lack of energy, depression, rectal discomfort and chronic lower back pain.
Diagnosis
If a woman is experiencing chronic pelvic pain, and other abnormalities have been excluded, a doctor must consider pelvic congestion syndrome as a possible cause. A doctor can use pelvic and transvaginal ultrasound to rule out other diagnoses, and Doppler ultrasound to obtain information about the patient’s venous blood flow.
The diagnosis can easily be missed during a regular pelvic exam, as the affected veins become less enlarged when the patient is lying down. An ultrasound carried out while the patient is in a standing position is helpful because it may reveal the dilated pelvic veins.
MR venography, which can depict the entire venous anatomy, is the best non-invasive method for diagnosing pelvic congestion syndrome and determining the extent of the condition.
The most accurate method for diagnosing the syndrome is by pelvic venography. To do this, an interventional radiologist, under fluoroscopic guidance, inserts a catheter into a vein in the groin area (the femoral vein), guides it to the dilated pelvic veins, and injects contrast dye to make the veins more clearly visible under X-ray.
Treatment
The doctor may prescribe painkillers to reduce the pain associated with pelvic congestion syndrome. Hormonal medications may also reduce congestion.
If these approaches fail, pelvic congestion syndrome can be treated using embolisation, a minimally invasive technique. An interventional radiologist first carries out a pelvic venography, described above, then inserts tiny coils in order to close the varicose veins. The specialist may also inject particular chemicals, called sclerotic agents, into the veins. The procedure does not require general anaesthesia, and is performed on an out-patient basis. Patients can return to normal activities immediately.
In increasingly rare cases, surgical treatment, such as a hysterectomy and vein removal, may be necessary.
Bibliography
1. Pelvic Congestion Syndrome – Chronic Pelvic Pain in Women Sirweb.com [http://www.sirweb.org/patients/chronic-pelvic-pain/]
2. Ignacio E, Dua R, Sarin S, Soltes Harper A, Yim D, Mathur V, Venbrux AC. “Pelvic Congestion Syndrome: Diagnosis and Treatment,” Semin Intervent Radiol. 2008 December; 25(4): 361–368.