According to the American Journal of Radiology, pelvic pain is a common condition, which affects millions of women worldwide. 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. PVI often leads to PCS, which is a chronic condition causing severe pain and tenderness in the lower abdomen, back, hips, and thighs.
What Is Pelvic Venous Insufficiency?
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 backwards 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.
Am I at Risk for Pelvic Insufficiency?
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 a history of varicose veins.
How do I know if I have Pelvic Venous Insufficiency?
Like varicose veins, pelvic venous insufficiency can 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.
Tests for PVI include soft tissue imaging with and without dye. The most common 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.
• MRI’s 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.
How is PVI Treated?
Non-surgical treatment 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 and surgical options are aimed at correcting pelvic vein engorgement and include ligating affected veins or blocking blood flow to the affected area by embolization. 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.
If you are experiencing any of the symptoms indicative of PVI, your primary doctor or OBGYN may refer you to a venous specialist for further testing and management of your symptoms. The vein specialists at The Vein Centre will assist you in making the best possible decisions specific to your case. Call us today at 615-269-9007!