Varicose Veins or Vein Engorgement
When blood pools in the pelvic vein or ovarian vein, it may result in enlarged veins, causing pain, tenderness, and redness. Varicose veins usually develop in the legs, calves, and feet, but can also occur in the pelvic region, leading to pelvic congestion syndrome.
Deep Vein Thrombosis (DVT)
DVT occurs when a blood clot forms in a deep vein, and this can occur in the pelvis. The clot then restricts blood flow, which in turn causes pain, swelling, and often varicose veins, such as in the left ovarian vein.
Hydro-nephrosis
Compression on the renal vein can affect urine flow and backing up of urine into the left kidney, causing pelvic congestion syndrome symptom. As a result, affected individuals may report chronic pain and frequent urination.
Peripheral Artery Disease (PAD)
Cholesterol and fat can build up in the arteries forming plaque that blocks blood flow. This leads to peripheral artery disease, wherein the reduction of blood flow affects the iliac arteries in the pelvis. Those affected may suffer from pain and cramps. Men may also experience erectile dysfunction.
Who is at Risk for Pelvic Congestion Syndrome?
Since studies have shown a link between pregnancy and pelvic congestion syndrome, women who have given birth are at risk for developing this condition. Women who have had multiple pregnancies (carrying more than one baby, e.g. twins) are even more at risk than those who have had a singleton pregnancy (carrying one baby), as they are more likely to develop pelvic varices or enlarged veins in the pelvic region.
In addition, those who have a history of pelvic congestion syndrome in the family are also at risk. If you are suffering from chronic pelvic pain and believe you might have this condition, get in touch with a qualified healthcare provider like AZCCPP.
Can I manage Pelvic Congestion Syndrome on my own?
While this condition is not fatal, if left undiagnosed or untreated, pelvic congestion syndrome can lead to further health complications like chronic pelvic pain and permanently damaged vein. Only qualified healthcare professionals like our team at AZCCPP can help you manage it properly through treatments such as interventional radiology and ovarian vein embolization.
We strongly advise you to get in touch with us so we can make the right diagnosis and provide the best pelvic congestion syndrome treatment option for your case.
What are Pelvic Varicosities?
Pelvic congestion syndrome is a condition where pelvic veins become engorged and form pelvic varicosities. Pelvic varicosities usually occur during pregnancy and disappear after. In some patients, they remain, causing pelvic congestion syndrome. It may occur after a full-term pregnancy, but also after preterm birth, miscarriage, or even after ectopic pregnancy. The mechanism in which varicosities cause pain is not well understood, but it may be due to stretching of the vein wall, pressure on the surrounding nerves, or changes in tissue pH. Some varicosities occur in the ovarian veins and veins around the uterus but some patients have varicosities in the vulvar area pressing against the nerves innervating the clitoris, urethra, and labia.
Depending on the location of congested veins patients will experience different symptoms. Congestion of ovarian and uterine veins leads to the sensation of heaviness in the pelvis which is worse with sitting and standing for a prolonged time and better with laying down. On top of the sensation of heaviness, there is occasional sharp shooting pain in the lower abdomen usually on the left side lasting several seconds at a time which may occur a few times a day to a few times per week.
Pelvic congestion may be diagnosed on pelvic MRI or ultrasound but the gold standard test for diagnosis is transfundal venogram.
Typical appearance of pelvic congestion syndrome on transfundal venography
Treatment of pelvic congestion may be done by an interventional radiologist who obliterates the congested veins in an attempt to decrease pain. Congested veins may also be closed off surgically by isolating them from the surrounding structures such as nerves and arteries and sealing with a vessel sealing device. An additional benefit of surgical treatment using da Vinci robot over radiological treatment is that surgical treatment of pelvic congestion allows to precisely survey the pelvis and address any other cause of pelvic pain.
Congestion of the veins around the clitoral or perineal branch of the pudendal nerve can only be seen during a special ultrasound examination. This congestion will lead to pain in the clitoris, urethra, and labia and it is worse with sitting and standing. Patients may also experience the sensation of persistent sexual arousal. This type of congestion may be treated by injecting a sclerosing agent into the congested vein in a similar manner as it is done into varicosities in the legs.
