Pelvic Venous Congestion as a Cause of Pelvic Pain
Most of the patients who come to Artemis Colorado – Vein and Cosmetic Center are seeking treatment for venous insufficiency, a condition related to several disorders of the venous system. Venous insufficiency typically causes symptoms in the legs such as swelling, aching, feelings of heaviness, tiredness or pain. Visible symptoms include spider and varicose veins. However, venous insufficiency isn’t confined to the legs, and may be the culprit behind similar problems in other areas of the body.
Consider this hypothetical patient: Catherine is a 37-year-old mother of three. She suffers from frequent pain and tiredness in her legs, and has visible varicose veins in her calves. These symptoms began after her first pregnancy and gradually worsened after her second and third pregnancies. After delivering her third child, she noticed swollen and painful veins in her groin, and feels a chronic ache in her pelvic area that intensifies when she stands up. Sometimes Catherine has painful menstruation. She assumes that her pelvic discomfort and the changes in the veins in her groin are just natural effects of childbirth, but decides that she wants to visit a vein clinic to address the pain and varicose veins in her legs. She’s heard about a friend who underwent a procedure to correct her varicose veins and is now enjoying relief from similar symptoms. While discussing her medical history with the vein specialist, Catherine is surprised to learn that the discomfort she is experiencing in her legs and her pelvic area may stem from similar causes, and is delighted to hear that treatment is available for both issues.
In this scenario, Catherine’s pelvic pain is a symptom of “pelvic venous congestion syndrome,” or PVCS, which is a malfunction of veins in the pelvic region. While PVCS does afflict men, it afflicts women more frequently; in these cases, it may also be referred to as “ovarian vein reflux.” Between 13-40% of women are impacted by this condition.
Normally, the body pumps blood up the legs, through the veins in the pelvis and abdomen, and back to the heart, but in patients suffering from PVCS, the blood slides back down and pools in the pelvic veins. The increased volume of blood stretches the vein walls and compromises the integrity of the venous valves, leading to a host of problems including pain and visible veins. These issues develop frequently in the legs as well, and it’s possible for a patient to experience symptoms simultaneously in more than one area of the body.
PVCS is more common in women who have had multiple pregnancies. This may be due to hormonal changes that increase venous blood flow. In some cases, the baby in the uterus compresses the pelvic veins, thereby increasing pressure in the venous network.
Pain is the most common symptom of PVCS, which is diagnosed most accurately when the pain has been present for over 6 months. It may be constant or intermittent, affect one or both sides of the pelvis, and can worsen with standing or lifting, during pregnancy, or during intercourse. Because veins can dilate and react to hormonal changes, the pain may also increase during menstruation. Other symptoms include a feeling of fullness in the legs, flank pain, worsening of stress incontinence, and a worsening in the symptoms associated with irritable bowel syndrome.
When someone like Catherine comes to Artemis Colorado, we examine the patient for varicosities and then conduct a diagnostic ultrasound that enables us to identify venous insufficiency in the legs. While vein problems discovered in the legs certainly need to be addressed, when a patient is feeling discomfort elsewhere in the body it is important to postpone treatment until we have a full picture of the patient’s condition. Doing so ensures that we can address the deepest source of the problems. In Catherine’s case, we would request that she have her pelvic veins evaluated before we begin treating the veins in her legs.
When it is necessary for patients to receive an assessment of their pelvic veins, we send them to an MD specializing in treatment of PVCS. After a patient is diagnosed with PVCS, the doctor performs a procedure called pelvic embolization. This minimally invasive treatment shuts down diseased veins, which reroutes blood through healthy veins. As a result, the pressure in the pelvic veins is eased, ultimately relieving the patient’s symptoms. Pelvic embolization only requires local anesthesia and takes 30-90 minutes, depending on the complexity of the circumstances.
The great news for patients with PVCS is that they can expect improvements in pelvic symptoms within two weeks. Pelvic embolization is over 80% successful, and recovery is quick, with patients resuming normal activities within a few days. After issues with the pelvic veins are resolved, patients can return to Artemis the following week to receive treatment for the veins in their legs.
If you are experiencing symptoms similar to Catherine’s, speak with a vein specialist. At Artemis our medical staff is very experienced at diagnosing and treating venous disease. We know when it’s necessary to collaborate with other experts to identify what is troubling a patient, and always recommend the course of treatment that will result in the safest and best long-term outcome for each individual. Call our office or email us and we will be glad to discuss your symptoms with you. There’s no need to continue suffering when effective treatment is available.