Vein Practice
PELVIC CONGESTION SYNDROME
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is "all in their head" but recent advancements show the pain may be due to hard to detect varicose veins in the pelvis, known as pelvic congestion syndrome.
Many women with pelvic congestion syndrome, spend years trying to get an answer to why they have this chronic pelvic pain. The diagnosis is often missed because 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.
SYMPTOMS
The chronic pain that is associated with this condition is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases following sexual intercourse, menstruation, when tired or standing, usually at the end of the day. Other symptoms include irritable bladder, irritable bowel and varicose veins on vulva, buttocks or thigh.
This image shows a leash of bilateral ovarian varices
DIAGNOSIS
High clinical suspicion is required and once other causes of pelvic pain have been excluded pelvic congestion syndrome could be diagnosed through non-invasive examinations. MR venography of the pelvis is the most accurate examination for the diagnosis of ovarian and pelvic varices that cause the pelvic congestion syndrome. Pelvic and transvaginal ultrasound could be sometimes misleading but can easily exclude other causes of chronic pelvic pain.
TREATMENT
Pelvic varicosities are treated with a procedure called percutaneous embolisation. This involves the insertion of small catheter, about the size of a strand of spaghetti through the femoral or jugular vein and guides it inside the dilated pelvic and ovarian varices. Tiny coils are placed in the dilated veins which cause them to seal off. The procedure is successful in 95% of cases and causes symptomatic improvement in 90% of the women. Occasionally in more complex cases a two stage or a repeat procedure may be required.
