Pelvic congestion syndrome

Last updated
Pelvic venous disease
Other namesPelvic congestion syndrome
9cmFibroidPelvicCongestionS.png
A very large (9 cm) fibroid of the uterus which is causing pelvic congestion syndrome as seen on X-ray computed tomography
Specialty [Interventional Radiology], gynecology
Symptoms Chronic pelvic pain [1]
Diagnostic method Ultrasound, CT scan, MRI, laparoscopy [1]
Medication Medroxyprogesterone, nonsteroidal anti-inflammatory drugs (NSAIDs) [1]
Frequency30% of women [2]

Pelvic congestion syndrome, also known as pelvic vein incompetence, is a long-term condition believed to be due to enlarged veins in the lower abdomen. [1] [3] The condition may cause chronic pain, such as a constant dull ache, which can be worsened by standing or sex. [1] Pain in the legs or lower back may also occur. [1]

Contents

While the condition is believed to be due to blood flowing back into pelvic veins as a result of faulty valves in the veins, this hypothesis is not certain. [3] The condition may occur or worsen during pregnancy. [1] The presence of estrogen is believed to be involved in the mechanism. [1] Diagnosis may be supported by ultrasound, CT scan, MRI, or laparoscopy. [1]

Early treatment options include medroxyprogesterone or nonsteroidal anti-inflammatory drugs (NSAIDs). [1] Surgery to block the varicose veins may also be done. [1] About 30% of women of reproductive age are affected. [2] It is believed to be the cause of about a third of chronic pelvic pain cases. [4] While pelvic venous insufficiency was identified in the 1850s it was only linked with pelvic pain in the 1940s. [4]

Signs and symptoms

Women with this condition experience a constant pain that may be dull and aching, but is occasionally more acute. The pain is worse at the end of the day and after long periods of standing, and those affected get relief when they lie down. The pain is worse during or after sexual intercourse, and can be worse just before the onset of the menstrual period. [5]

Women with pelvic congestion syndrome have a larger uterus and a thicker endometrium. 56% of women manifest cystic changes to the ovaries, [6] and many report other symptoms, such as dysmenorrhea, back pain, vaginal discharge, abdominal bloating, mood swings or depression, and fatigue. [5]

Causes

  1. Local pelvic hormonal milieu
  2. Venous outflow obstruction, such as May-Thurner syndrome, Nutcracker syndrome, Budd-Chiari syndrome, or left renal vein thrombosis
  3. External compression due to tumor (including fibroids, endometriosis), or scarring [7]

Diagnosis

A very large (9 cm) fibroid of the uterus which is causing pelvic congestion syndrome as seen on ultrasound 9cmFibroidUS.png
A very large (9 cm) fibroid of the uterus which is causing pelvic congestion syndrome as seen on ultrasound

Diagnosis can be made using ultrasound or laparoscopy testing. The condition can also be diagnosed with a venogram, CT scan, or an MRI. Ultrasound is the diagnostic tool most commonly used. [5] Some research has suggested that transvaginal duplex ultrasound is the best test for pelvic venous reflux. [8]

Treatment

Early treatment options include pain medication using nonsteroidal anti-inflammatory drugs, [5] and suppression of ovarian function. [6]

More advanced treatment includes a minimally invasive procedure performed by an Interventional Radiologist. This minimally invasive procedure involves stopping blood within the pelvic varicose veins using a minimally invasive procedure called a catheter directed embolization. The procedure rarely requires an overnight stay in hospital and is usually performed as an outpatient procedure, and is done using local anesthetic and moderate sedation. [9] Patients report an 80% success rate, as measured by the amount of pain reduction experienced. [9]

See also

Related Research Articles

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<span class="mw-page-title-main">Ovarian cyst</span> Fluid-filled sac in the ovary

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<span class="mw-page-title-main">Dysmenorrhea</span> Pain during menstruation

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<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

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<span class="mw-page-title-main">Gynecologic ultrasonography</span>

Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs as well as the bladder, the adnexa, and the recto-uterine pouch. The procedure may lead to other medically relevant findings in the pelvis.This technique is useful to detect myomas or mullerian malformations.

<span class="mw-page-title-main">Sclerotherapy</span> Shrinking of the varicose blood vessels by the injection of medicine

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<span class="mw-page-title-main">May–Thurner syndrome</span> Medical condition

May–Thurner syndrome (MTS), also known as the iliac vein compression syndrome, is a condition in which compression of the common venous outflow tract of the left lower extremity may cause discomfort, swelling, pain or iliofemoral deep vein thrombosis.

<span class="mw-page-title-main">Nutcracker syndrome</span> Medical condition

The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA appear to be a nutcracker crushing a nut.

<span class="mw-page-title-main">Pelvic pain</span> Medical condition

Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis.

<span class="mw-page-title-main">Pampiniform plexus</span>

The pampiniform plexus is a venous plexus – a network of many small veins found in the human male spermatic cord, and the suspensory ligament of the ovary. In the male, it is formed by the union of multiple testicular veins from the back of the testis and tributaries from the epididymis.

<span class="mw-page-title-main">Chronic venous insufficiency</span> Medical condition

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

<span class="mw-page-title-main">Ovarian vein syndrome</span> Medical condition

In medicine, ovarian vein syndrome is a rare condition in which a dilated ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.

<span class="mw-page-title-main">Ovarian torsion</span> Medical condition

Ovarian torsion (OT) or adnexal torsion is an abnormal condition where an ovary twists on its attachment to other structures, such that blood flow is decreased. Symptoms typically include pelvic pain on one side. While classically the pain is sudden in onset, this is not always the case. Other symptoms may include nausea. Complications may include infection, bleeding, or infertility.

<span class="mw-page-title-main">Superficial vein thrombosis</span> Medical condition

Superficial vein thrombosis (SVT) is a blood clot formed in a superficial vein, a vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration with redness. SVT itself has limited significance when compared to a deep vein thrombosis (DVT), which occurs deeper in the body at the deep venous system level. However, SVT can lead to serious complications, and is therefore no longer regarded as a benign condition. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.

<span class="mw-page-title-main">Perforator vein</span>

Perforator veins are so called because they perforate the deep fascia of muscles, to connect the superficial veins to the deep veins where they drain.

Ovarian remnant syndrome is a condition that occurs when ovarian tissue is left behind following oophorectomy, causing development of a pelvic mass, pelvic pain, and occasionally dyspareunia. Ovarian remnant syndrome (ORS) is characterized by the presence of residual ovarian tissue after a woman has had surgery to remove one ovary or both ovaries (oophorectomy).

References

  1. 1 2 3 4 5 6 7 8 9 10 11 "Pelvic Congestion Syndrome - Women's Health Issues". Merck Manuals Consumer Version. Retrieved 27 September 2019.
  2. 1 2 Cheema, Omer Saadat; Singh, Pramvir (2020). "Pelvic Congeston Syndrome". Statpearls. PMID   32809625. CC-BY icon.svg Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
  3. 1 2 Champaneria, R; Shah, L; Moss, J; Gupta, JK; Birch, J; Middleton, LJ; Daniels, JP (January 2016). "The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness". Health Technology Assessment . 20 (5): 1–108. doi: 10.3310/hta20050 . PMC   4781546 . PMID   26789334.
  4. 1 2 Brown, CL; Rizer, M; Alexander, R; Sharpe EE, 3rd; Rochon, PJ (March 2018). "Pelvic Congestion Syndrome: Systematic Review of Treatment Success". Seminars in Interventional Radiology. 35 (1): 35–40. doi:10.1055/s-0038-1636519. PMC   5886772 . PMID   29628614.
  5. 1 2 3 4 "Dysmenorrhea". Merck Online Medical Manual. December 2008. Retrieved December 23, 2010.
  6. 1 2 Phillip Reginald, MD. "Pelvic Congestion". The International Pelvic Pain Society. Archived from the original (PDF) on September 16, 2014. Retrieved December 23, 2010.
  7. Rutherford's vascular surgery references. [S.l.]: Elsevier Saunders. 2014. ISBN   978-0323243056.
  8. Whiteley M, Dos Santos S, Harrison C, Holdstock J, Lopez A (Oct 2014). "Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women". Phlebology. 30 (10): 706–13. doi:10.1177/0268355514554638. PMID   25324278. S2CID   25053851.
  9. 1 2 "Pelvic Pain (Pelvic Congestion Syndrome)". Johns Hopkins. Retrieved December 23, 2010.