Pelvic Congestion Syndrome

Pelvic congestion syndrome, which is also known as pelvic vein incompetence, is a chronic condition which cause pain in women caused due to varicose veins in the lower abdomen. The condition is usually associated with a constant dull ache, which can be aggravated by standing. Early treatment options include pain medication, alternative therapies such as acupuncture, and suppression of ovarian function. Surgery can be done using noninvasive transcatheter techniques to embolize the varicose veins. Up to 80% of women obtain relief using this method.

The condition can occur as a result of pregnancy or for unknown reasons. The presence of estrogen in the body causes vasodilation, which can result in the accumulation of blood in the veins in the pelvic area. Estrogen can weaken the vein walls, leading to the changes that cause varicosities. Up to 15% of all women have varicose veins in the abdominal area, but not all have symptoms.

Causes

Pelvic congestion syndrome is primarily thought to be due to the presence of varicosities in the lower abdomen and the inguinal area. In healthy veins, the blood usually circulates in a single direction and without any impediments. In certain instances in which the valves suddenly become damaged, the blood is then allowed to backflow. The valves are actually responsible for propelling blood only into a single direction because they act like flaps. The backflow of blood causes the vein to become engorged. The swelling of the vein then compresses surrounding nerves which then would elicit pain just like in pelvic congestion syndrome.

Symptoms

Female patients with this condition experience a constant pain that may be dull and aching, but is occasionally more acute. The pain is worse at the end of the day and after long periods of standing, and sufferers get relief when they lie down. The pain is worse during or after sexual intercourse, and can be worse just before the onset of the menstrual period.

Women with pelvic congestion syndrome have a larger uterus and a thicker endometrium. 56% of women manifest cystic changes to the ovaries, and many report other symptoms, such as dysmenorrhea, back pain, vaginal discharge, abdominal bloating, mood swings or depression, and fatigue.

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following:

Computed tomography scan (Also called a CT scan) - This is a imaging study that uses a combination of x-rays and computer technology to produce cross-sectional pictures, both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Magnetic resonance imaging (MRI) - This is a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Ultrasound - This study uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Venogram or angiogram - This is an x-ray imaging study of the blood vessels which utilizes contrast to evaluate blood vessel flow pattern. A dye, or contrast, will be injected through a thin flexible tube placed in the abdominal pelvic veins. This dye makes the blood vessels visible on x-ray.

Treatments

The majority of physicians often find it difficult to treat pelvic congestion syndrome. The exact treatment for each woman can be tough as the clinical manifestations and the severity of pain greatly vary. Not all possible treatments would work effectively for the rest. There’s actually a variety of treatments available for pelvic congestion syndrome ranging from certain medications to a possible surgical operation. The following are the commonly utilized treatments for pelvic congestion syndrome:

Medications

Painkillers

Ergotamine (which was found out to help narrow veins)

Hormones – The effectiveness of using hormones to treat this condition has not yet been established.

Surgery - Surgery is actually not a preferred way of dealing with pelvic congestion syndrome. This is not at all times indicated to patients and when it is, the operation is just minimally invasive which is primarily done to remove varicosities. Surgery is not also encouraged because patients may still remain symptomatic even after it. Surgery does not improve the condition of affected women. In fact, about 60 percent of those who underwent surgical operation reported dissatisfaction of the outcome.Potential treatment for an aortic aneurysm may include the following options:

Endovascular treatment with coil embolization - The most effective treatments however have been performed by a process called "embolization". Under x-ray control, a physician can pass a catheter into the veins from either the neck of groin. Once the catheter is positioned in the ovarian or internal iliac vein to be treated, an embolisation device is pushed out into the vein which causes the vein to permanently block.

At the current time, the best treatment is a metal coil, which coils up inside the vein blocking it and causing spasm. Other embolisation materials have been used such as foam sclerotherapy or other gels or glues. As research continues, it is likely that other embolization materials will be found to be effective but at the present time, metal coils are the optimal devices.

If you would like to see a physician at the University Vascular Associates, please check our physician information and call us for an appointment. We have offices throughout southern California. Our office locations and phone numbers are listed below.