According to the American Journal of Radiology, pelvic pain is a common condition, which affects millions of women worldwide. It occurs when the veins in the pelvis are not able to properly drain blood from the area. This can lead to a number of problems, including pain, swelling, and even fertility issues. PVI often leads to PCS, which is a chronic condition causing severe pain and tenderness in the lower abdomen, back, hips, and thighs. Learn more about PVI and what you can do to prevent and manage the symptoms.
What Is Pelvic Venous Insufficiency?
Pelvic venous insufficiency (PVI) is a condition that occurs when the veins in the pelvis are unable to adequately drain blood back to the heart. This can cause a build-up of blood in the pelvic region. Pelvic insufficiency results when circulation in the major pelvic veins is compromised.
Blood pools within the venous system causing pressure on the walls of the veins. Over time, the veins swell and dilate to accommodate blood flow. The one-way valves in the veins weaken allowing blood to flow backward and pool, causing further pressure on already weakened venous walls. The venous swelling and pressure on adjacent organs and tissues lead to pelvic congestion syndrome or PCS.
If left untreated, damage to the veins may become permanent and surgical procedures are needed to correct the problem. It accounts for 25% of all hysterectomies and 33% of all investigative laparoscopic procedures performed for pelvic pain. Leading causes of pelvic pain in women include pelvic congestion syndrome or PCS and pelvic venous insufficiency or PVI.
In some cases, PVI can also lead to pelvic varicosities, which are enlarged veins that are visible under the skin. While PVI is relatively common, it is often underdiagnosed due to the lack of awareness among both patients and medical professionals.
Am I at Risk for Pelvic Insufficiency?
Any woman can develop PVI, but there are certain factors that may increase your risk. Women of childbearing age, between 20 and 45 years of age are most at risk for PVI. Multiple pregnancies also increase the risk. PVI is also associated with obesity and rapid weight gain due to the increased weight of the fetus, uterus, and abdominal tissues pressing on pelvic veins. Other risk factors include blood clots and history of varicose veins.
These risk factors include:
- Being overweight or obese
- Use of birth control pills
- Hormonal changes during menopause
- Family history of venous insufficiency
- History of blood clots
- Sedentary lifestyle
What Are the Symptoms of Pelvic Insufficiency?
The symptoms of PVI can vary from woman to woman. They may be mild or severe and can come and go over time. The most common symptom is pelvic pain. This pain can be dull and aching or sharp and cramping. It is often worse during menstruation or after standing for long periods of time.
Other symptoms may include:
- Pelvic pain
- Chronic pelvic pain
- Heaviness or pressure in the pelvis
- Painful periods
- Pain with intercourse
- Lower back pain
- Leg pain or swelling
- Aching or throbbing in the legs
- Swelling in the legs or feet
- Abnormal bleeding
- Urinary incontinence
- Bloating or gas
- Varicose veins in the pelvis or legs
How do I know if I have Pelvic Venous Insufficiency?
PVI can have many symptoms that seem like other ailments. Like varicose veins, pelvic venous insufficiency can also have no symptoms. Most often, possible symptoms include severe, dull pain in the pelvic area, lower back, buttocks, and thighs.
Heaviness is often associated with the pain, and menstruation and prolonged standing tend to worsen the symptoms. Painful intercourse and urinary symptoms may also occur. Dilating venous tissues also release neuro-transmitting chemicals, leading to additional depression and anxiety in conjunction with the pain.
The only real way to know is to get checked by a doctor.
How Is Pelvic Insufficiency Diagnosed?
To diagnose PVI, your doctor will likely perform a pelvic ultrasound or other imaging of the tissue. An ultrasound is a painless test that uses sound waves to create an image of your pelvis. The doctor will look for dilated veins and abnormal blood flow.
Tests that may be performed include:
- Ultrasounds to visualize the venous structure around abdominal and reproductive organs. Doppler ultrasounds enable the physician to visualize venous circulation in real-time.
- CT Scans provide the opportunity for measuring the diameters of affected veins in order to diagnose the potential severity of the condition.
- MRIs with and without contrast provide an excellent diagnostic tool to examine the extent of blood pooling and congestion in affected areas.
- Venography is an invasive procedure performed when non-invasive imaging is not sufficient to provide a definite diagnosis. Contrast dye is injected via catheter directly into pelvic veins and measurements are taken to diagnose the severity of venous dilation.
- Doppler ultrasound: This test uses sound waves to measure the speed and direction of blood flow.
- Pelvic venography: This is an imaging test that uses X-rays to take pictures of the pelvic veins after a dye has been injected into them.
What Are the Treatment Options for Pelvic Insufficiency?
There are several treatment options available for PVI, ranging from conservative treatments to surgery. The type of treatment recommended will depend on the severity of your symptoms and how well you respond to conservative therapies.
Conservative treatments: These include wearing compression stockings, elevating your legs when possible, and avoiding prolonged standing or sitting. Weight loss, if you are overweight, can also help relieve symptoms.
Medicinal treatments: Non-surgical treatments of PVI and PCS are aimed at treating ovarian dysfunction. Hormonal management with progesterone-based birth control pills or treatments are used for their contracting effects on the veins. In some cases, estrogen-inhibiting implants are used in the management of PVI.
Interventional treatments: If conservative treatments do not relieve your symptoms, your doctor may recommend interventional treatments. Interventional options are aimed at correcting pelvic vein engorgement by blocking blood flow to the affected area by embolization. These include injections of sclerosing agents to close off the affected veins or surgery to remove the affected veins.
Surgical treatments: If other treatments have not worked or are not an option, your doctor may recommend a more major surgery to remove the affected veins. This includes ligation and stripping of the affected veins. In severe and debilitating cases not responding to medical or less invasive surgical treatments, full or partial hysterectomies may be required to prevent irreversible tissue damage.
Living With Pelvic Insufficiency
If you have been diagnosed with PVI, there are a few things you can do to help manage your symptoms and improve your quality of life.
- Wear compression stockings: Wearing compression stockings can help reduce pain and swelling by promoting circulation.
- Elevate your legs: Elevating your legs when possible will help reduce swelling.
- Avoid prolonged standing or sitting: Prolonged standing or sitting can worsen symptoms by increasing the pressure on your pelvis.
- Maintain a healthy weight: If you are overweight, losing weight can help reduce symptoms by reducing the pressure on your pelvis.
- Exercise: Exercise can help improve circulation and strengthen the muscles around your pelvis.
- Eat a healthy diet: Eating a healthy diet can help improve circulation and reduce symptoms.
- Manage stress: Stress can worsen symptoms, so it is important to find ways to manage stress. relaxation techniques, such as yoga or meditation, can be helpful.
Get Relief From PVI
Pelvic venous insufficiency (PVI) is a condition that affects millions of women and can lead to a number of debilitating symptoms. If you think you may have PVI, it is important to see a doctor so that you can get an accurate diagnosis and find the treatment option that is right for you. Your primary doctor or OBGYN may refer you to a venous specialist for further testing and management of your symptoms. Call the vein specialists at The Vein Centre in Belle Meade and Mt. Juliet, Tennessee at 615-269-9007! We will assist you in making the best possible decisions specific to your case.