What is Pelvic Congestion Syndrome
Pelvic congestion syndrome or pelvic venous insufficiency is a lesser-known cause of pelvic pain affecting women, typically of childbearing age. In this condition, the veins draining blood from the pelvis become dysfunctional, and blood starts pooling in the pelvic veins. The veins enlarge because of the high pressure and are called varices. The subsequent stretching of the walls of the veins causes chronic pelvic pain. There are many risk factors for developing pelvic congestion, such as the history of pregnancy, certain anatomic configurations, prior pelvic surgery, hormone replacement therapy or polycystic ovarian syndrome, PCOS.
What are the symptoms
Patient’s description of the pain varies, but most often, it is worse just before and in the first days of menstruation, after prolonged standing or walking, and intercourse. Other symptoms include lower back pain, irritable bladder, and varicose veins of the upper thighs, buttocks or pelvic area. Because of the many potential causes of pelvic pain and symptom overlap, patients are often seen by multiple specialists before learning this may be the cause of their problems.
Embolization Treatment is an option for Pelvic Congestion Syndrome
Today, embolization of the ovarian vein with sclerotherapy of the pelvic varices is the most widely accepted treatment for this condition once conservative management with medication fails. Ovarian vein embolization is a minimally invasive outpatient endovascular procedure. First, an interventional radiologist (IR) will perform an x-ray dye study of the veins in the pelvis called a venogram. This will confirm the diagnosis of malfunctioning veins draining the pelvis. Next, the malfunctioning veins, almost always ovarian veins, will be blocked off (also known as embolized) by small metallic fibers. A liquid substance to treat smaller diseased veins will be injected at the same time, which is called sclerotherapy. The patient is able to go home after an hour of bed rest and resume normal activities in one day. The rate of sustained symptom improvement in women is around 80%.
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