Approximately 13-40% women suffer from chronic pelvic pain (pain lasting more than 6 months) caused by reflux in ovarian veins also known as pelvic venous congestion syndrome.
The underlying cause is defective valves in ovarian veins causing the blood to flow in reverse direction. This reversal of blood flow in ovarian veins leads to pooling of blood in pelvis leading to classical symptoms of pelvic heaviness and dull aching pain. Pain is usually worse during menstrual cycle.
Pelvic venous congestion is equivalent of varicose veins in the legs, where the incompetent veins cause veins on legs to become dilated and bulging on the skin surface. Similarly in pelvic venous congestion veins in pelvis become dilated and as the condition progresses, veins around vagina, vulva and upper thighs may also become visibly dilated and painful.
Who gets pelvic venous congestion?
Typically women who have been pregnant and who may have 2-3 children. It can also occur in younger women without pregnancy if they have varicose veins of the legs. Occasionally it will be seen in women with polycystic ovaries. Common symptoms of pelvic venous congestion are as following. The varicose veins in the pelvis surround the ovary and can also push on the bladder and rectum. This can cause the following symptoms:
- Pelvic pain or aching around the pelvis and lower abdomen
- Dragging sensation or pain in the pelvis
- Feeling of fullness in the legs
- Worsening of stress incontinence
- Worsening in the symptoms associated with irritable bowel syndrome
Pain is usually commonest symptom and present for over 6 months duration. The pain is usually on one side but can affect both sides. The pain is worse on standing, lifting, when you are tired, during pregnancy and during or after sexual intercourse. The veins are also affected by the menstrual cycle/hormones and therefore the pain can increase during the time of menstruation. The pain usually is improved by lying down.
How is it diagnosed?
Ultrasound may be a good starting point. This may be initially diagnosed with CT scan or MRI scan of the abdomen. Venography remains the gold standard of diagnosis for pelvic venous congestion. Using femoral or jugular vein access, a small tube or catheter is placed in the ovarian veins and dye is injected under x-ray fluoroscopy. This clearly shows the dilated ovarian veins and varicosities in pelvis.
What is the treatment of pelvic venous congestion syndrome?
Treatment is performed in our office cath lab and involves venography followed by placement of catheter into lower part of ovarian vein. injection of sclerosants into ovarian veins as well as placement of small metal coils is performed to stop these veins from refluxing. In most cases you can go home after an hour of the procedure.