Pelvic Congestion Syndrome
Pelvic Venous Disorders
What is Pelvic Venous disorder? ( PeVD)
Fifteen percent of all outpatient gynecologic visits and 30% of patients who present with pelvic pain are secondary to pelvic congestion syndrome (PCS). Unfortunately, this disease is often overlooked, with patients frequently undergoing an exhaustive evaluation before being diagnosed with PCS.
Nearly 15% of women aged 18 to 50 experience Chronic Pelvic Pain, will be of venous origin in approximately 16% to 31%. The typical symptoms of PeVD include noncyclical pelvic pain, often described as a dull ache or fullness that is worse with prolonged standing, coitus, menstruation, and pregnancy.
The combination of postcoital ache and tenderness over the ovarian point has been reported to be 94% sensitive and 77% specific for distinguishing a venous origin from other causes of pelvic pain.
What is cause of Pelvic venous disorder?
Pathophysiology And Clinical Presentation In Women
Although the etiology of PCS is poorly understood, the primary abnormality is the absence of functioning valves in the ovarian or internal iliac vein branches. This likely congenital absence of valves or hereditary predisposition is the most common explanation. The condition is worsened with each successive pregnancy due to increased blood flow and hormonal fluctuations.
It usually affects females more than males. As with varicose veins in the legs, if the valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside dilated varicose veins within the pelvis. This both stops the normal blood circulation to the pelvic organs and also causes these large varicose veins to push on the pelvic organs – the bladder, bowel, vagina, and also the pelvic floor.
Evaluation
Typically, multiparous(Multiple pregnancies) women present between the ages of 20 and 45 years with chronic pelvic pain of > 6 months’ duration, exacerbated by prolonged sitting or standing. Pain is described as dull, heavy, and aching, worsened with menses or sexual activity (dyspareunia). On physical exam, patients may present with visible labial, vulvar, or pudendal varices, often with extension of varices to the posterior medial thigh or gluteal regions. In addition, one in seven women with lower extremity varicose veins are found to have underlying Pelvic venous disorder.
Pelvic Venous disorder (PeVD)
Can present as
- Chronic Pelvic Pain is defined as pelvic pain lasting at least 6 months.
- Lower extremity varicose veins are found in up to 20% of women with varicose veins, which are derived from Pelvic veins.
While many gynecological conditions can mimic some of these symptoms, most women would have undergone extensive gynecological investigations and even treatment with little relief.
Imaging
Duplex ultrasound is first-line imaging for all patients presenting with signs or symptoms of pelvic venous insufficiency. Magnetic resonance imaging (MRI) and venography provide superior ability to detect retrograde gonadal vein flow, parauterine and labial varicosities, and venous anomalies.
The goal of intervention for venous-origin Chronic Pelvic Pain is to eliminate venous hypertension and varices in the periuterine and/or periovarian space.
Ovarian vein embolization
When the source of the high vein pressure in the pelvis is the veins draining the ovary, they can be stopped from transmitting that pressure by blocking them with coils using a key-hole technique. The procedure may need an overnight stay and can often be done under a local anesthetic with sedation. It is performed under the guidance of X-ray and special ultrasound catheters that can view the veins from inside the vessel (intra-vascular ultrasound).
Iliac vein stenting
This may be required when blockages in the veins draining the pelvis lead to venous hypertension and congestion in the veins around the uterus and in the pelvis. A metallic tube (stent) is placed within the blocked vein to relieve the blockage and allow venous drainage to take place normally. The procedure needs an overnight stay and usually a short general anesthetic. It is performed under the guidance of X-ray and special ultrasound catheters that can view the veins from inside the vessel (intra-vascular ultrasound).
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Treatments for Pelvic Congestion Syndrome
Pelvic Vascular Vein Treatment
- The treatments must be personalized for each unique patient. This ensures the doctor can provide the most effective care, tailored to individual needs, leading to the best possible outcomes for every patient.
Vein Check-up
- At the Vein and Foot Clinic, we offer an early detection service for the potential risk of developing thread veins, varicose veins, pelvic varicose veins, and deep vein thrombosis (DVT).
Conditions We Treat
- Varicose veins
- Superficial Venous Thrombosis Phlebitis
- Thread / spider veins
- Swollen leg
- Deep vein thrombosis (DVT)
- May turners syndrome
- Varicose veins in pregnancy
- Varicose veins in obese patients
- Restless leg syndrome
- Varicose veins of the testicles
- Recurrent Varicose Veins
- Hidden Varicose Veins
- Hemosiderin Brown Stains
- Lipo dermatosclerosis (LDS)
- Venous Eczema
- Leg Ulcers
- Vaginal and Vulval Varicose Veins
- Pelvic Congestion Syndrome (PCS)
