Chronic Pelvic Pain


Pelvic Congestion Syndrome (PCS)

Also called Painful Ovarian Varicose Veins and the very Effective Treatment is by technique called embolization

Chronic pelvic pain is a common condition and about 1/3 of all women experience this in their lifetime. Many of these women are told the problem is “all in their head” but recent advancements now show that the pain may be due to varicose veins in the pelvis which are hard to detect and causes pelvic congestion syndrome.

Due to defective valves, blood pool in the vein causing pressure and bulging veins.which can cause pain. The diagnosis if often missed because when women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.

Living with chronic pelvic pain is difficult and affects not only the woman directly, but also her interactions with her family, friends, and her general outlook on life.

If you have pelvic pain that worsens throughout the day when standing, you may want to seek a second opinion with an interventional radiologist, who can work with your gynecologist. You can ask for a referral from your doctor, call interventional radiologist or visit the doctor.

Prevalence and Symptoms

  • Women with pelvic congestion syndrome are generally in their childbearing years and  less than 45 years old
  • The commonest cause is previous pregnancy that causes incompetency of pelvic veins.
  • The pains are usually dull aching and felt in the lower abdomen and lower back.
  • The pain often increases during following intercourse, menstrual periods, when tired or when standing (worse at end of day).

Associated other symptoms include:

  • Irritable bladder
  • Abnormal menstrual bleeding
  • Excessive Vaginal discharge
  • Varicose veins on vulva, buttocks or thigh.

Diagnosis and Assessment

Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed by an interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, He may order  following investigations  to confirm pelvic varicose

Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contrast dye in the veins of the pelvic organs to make them visible during an X-ray. Varicose veins will appear very prominent and dilated.

          

Picture: – 1. USG Doppler study of pelvis shows prominent ovarian veins.
Picture: – 2. Ovarian vein venography shows dilated veins in pelvis cause of chronic pelvic pain.
Picture: – 3. Shows blocking of dilated ovarian vein by multiple coils.

MRI:  May be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a modified way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.

Pelvic /Transvaginalultrasound: Usually not very helpful in diagnosing pelvic congestion syndrome unless done with the patient standing. Ultrasound may be used to exclude other problems that might be causing pelvic pain.

Treatment Options

Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.

Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.

How effective embolization treatment

In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal. The procedure is very commonly successful in blocking the abnormal blood flow.

For more in-depth information on various non-surgical treatments:-

Call on mobile 91-9810492778 or E-mail muleypradeep@hotmail.com