However, it often has complex underlying causes, making it difficult to diagnose and successfully treat. Many women suffer from chronic pelvic pain for years with no relief and little insight into what is causing their discomfort.
Fortunately, research in interventional radiology has provided new insight into a common cause of chronic pelvic pain: pelvic vein insufficiency.
When a patient experiences significant pain and discomfort due to malfunctioning pelvic veins, they may be diagnosed with a condition known as pelvic congestion syndrome.
Pelvic congestion syndrome can cause a number of painful symptoms.
Here are some frequently asked questions about this condition, its risk factors and its treatments.
Pelvic congestion syndrome (PCS) is a condition characterized by chronic pelvic pain.
The pain is closely associated with dilated veins in the pelvis and vein valves that do not function properly1. When the veins in the pelvic area don’t function properly, it is known as pelvic venous insufficiency. This can cause ovarian vein reflux, where the blood in the ovarian veins flows backwards into the pelvis instead of towards the heart.
Most pelvic varicose veins are not visible to the naked eye, which makes it difficult for individuals to know they have them. If the veins are visible, they can have a similar appearance to varicose veins in the legs. The veins may be visibly present on the lower abdomen, upper thighs, buttocks, vulva and perineum.
PCS causes pelvic pain that lasts 6 months or longer2. The pain is usually severe enough to interfere with daily life.
Pain from PCS is often described as a severe, dull ache that sometimes radiates throughout the pelvis. PCS can also cause feelings of heaviness or dragging in the pelvis that may get worse after sitting, standing, exercising or sexual intercourse. It may also get worse before or during a menstrual period.
Additionally, many individuals with PCS describe pain during urination and in the bowels, especially during bowel movements.
In normally functioning pelvic veins, blood flows from the legs into the pelvis and back towards the heart. During this process, blood flows through the ovarian veins to the inferior vena cava on the right and to the left renal vein on the left. Vein malfunction can cause this process to become sluggish, causing blood that should be flowing towards the heart to flow backward into the pelvis. As blood pools in the pelvic veins, the vein walls become distended and the veins become enlarged (varicosed).
There are several potential causes of vein malfunction or insufficiency in pelvic veins:
Pregnancy, especially multiple pregnancies, is thought to contribute to the development of varicose veins in the pelvis. This is because pelvic vein capacity increases by as much as 60% during pregnancy. This contributes to the pelvic veins becoming both dilated and to the valves not functioning efficiently.
Hormones. The hormone estrogen causes the veins to dilate. This can lead to pelvic pain during periods when estrogen levels are naturally high, such as during pregnancy or before a menstrual period.
Multicystic Ovaries. Women with polycystic ovary syndrome often have hormonal imbalances that increase their risk of developing pelvic venous insufficiency.
Pelvic or renal vein compression. Nutcracker syndrome--mesoaortic compression of the left renal vein--can cause chronic pelvic pain and may contribute to secondary pelvic congestion syndrome in some women3.
Women with retroverted uteruses may also be at higher risk of developing PCS.
While the conditions above have been associated with an increased risk for pelvic congestion syndrome, pelvic vein insufficiency and ovarian vein reflux can occur in people with none of these risk factors.
Chronic pelvic pain that has not been effectively treated should always be discussed with your doctor, even if you have none of the conditions or risk factors associated with PCS.
PCS is diagnosed through a combination of examinations and tests.
Women with undiagnosed pelvic pain typically undergo a pelvic exam, Pap smear, blood work and imaging tests to rule out other common conditions or pathologies.
After other pathologies have been eliminated, an interventional radiologist may request a pelvic ultrasound or CT scan to further eliminate pelvic comorbidities.
Currently, MRI/MRV (magnetic resonance venography) is the most effective method for finding dilated veins and venous insufficiency in the pelvic area.
There are several treatment options for women suffering from pelvic congestion syndrome.
Some women with PCS are prescribed hormonal therapies to reduce vein dilation and blood flow in the pelvic veins.
While hormonal therapy can be effective for some women, it doesn’t provide relief for everyone.
Some women with PCS may opt for a minimally invasive procedure known as ovarian vein embolization (OVE).
This procedure is performed in an outpatient setting by an interventional radiologist.
During the procedure, the IR uses x-ray guidance to insert a small catheter into the femoral artery. Once the catheter is successfully placed, he or she guides the catheter to the affected pelvic veins and injects coils or foam sclerosing agents to effectively block and seal the veins.
Ovarian vein embolization is a safe, effective procedure to treat pelvic congestion syndrome. Most women experience little-to-no downtime following the procedure and are completely healed after 1 to 2 weeks.
The majority of women who undergo OVE experience partial or complete relief of pelvic pain related to PCS4.
Georgia Vascular Institute is proud to provide treatments for PCS at our Stockbridge and Camp Creek, GA vein clinics.
"Pelvic Congestion Syndrome - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835435/.
"Women's Issues in Interventional Radiology: Pelvic ... - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/.
"Nutcracker Phenomenon and Nutcracker Syndrome - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878259/.
"Female Pelvic Vein Embolization: Indications, Techniques ...." 25 Mar. 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500858/.