1Pelvic pain

Pelvic pain

Pelvic pain is an extremly common syndrome amongst women.

Almost half women in their lives are going to experience pelvic pain, and for some of them it will constitute a chronic problem.

2What is Pelvic Congestion Syndrome?

The Pelvic Congestion Syndrome is characterized by dilated veins (varicose veins) around the pelvis which can be formed during pregnancy due to the dilation and insufficiency of the ovarian vein.

This insufficiency is due to the huge increase, almost 60%, of the blood circulating the veins during the pregnancy and the estrogen that are responsible for the thinness of the vein wall.

The pregnant uterus has also a significant role, due to its size and the significant increase of the blood circulation in it, which is funneled into it from the heart through the ovarian vein. Though after the pregnancy pelvic varicose veins and vulvar varicosities usually recide, and everything returns to their previous state (before the pregnancy), there are cases that the ovarian veins remain dilated and gradually develop the pelvic congestion syndrome.

Therefore there is a link of pregnancy and pelvic congestion syndrome, which appear always after a pregnancy and it is extremely rare amongst young women or women that have not yet reproduced.

The bigger the number of pregnancies of a woman, the bigger the possibility of developing pelvic congestion syndrome.

3What are the symptoms of pelvic congestion syndrome?

The pregnant woman might understand the changes of her body, from the appearance of vulvar varicosities, which can be extremely annoying. When varicose veins preexist on her lower extremities, they get significantly worse. The symptoms can affect a woman both physically and mentally, because they cause heaviness, pain, the risk of thromboses and they add an extra anxiety issue on an already highly emotional pregnant woman.

The pelvic congestion syndrome can be associated with pelvic pain that is caused from numerous situations, usually of a gynecological nature. The pain that gets worse when standing it is linked with vein insufficiency. Additionally, the pain is worse during the beginning of the menstrual cycle, and in some cases women have reported pain during or right after being sexually intimate.

Vulvar varicosities are another critical element that can read to the possibility of having pelvic congestion syndrome. Usually, vulvar varicosities feed the varicose veins of the lower extremities that start from the perineum and travel through the inner part of the thigh and end up in the Great Saphenous Vein causing it to reflux.

The typical woman with a pelvic congestion syndrome, has pelvic pain for a period of over six months and has visited her Obstetrician numerous times without having diagnosed any pathology during the obstetric examination.

4How do we diagnose Pelvic Congestion Syndrome?

The diagnosis include the combination of a vaginal and abdominal ultra sound, where the dilated pelvic veins are prominent and most specifically around the uterus ligament, and also the dilation of the ovarian vein and its blood reflux.

The MRI and the MRV can be useful for the diagnosis.

5What is the treatment for Pelvic Congestion Syndrome?

The treatment defers according each patients case.

When there are symptoms:

When we encounter symptoms from the pelvis, we are directed to treat the reflux on the ovarian vein. That treatment can be either surgical or minimal invasive, endovascular where they perform an embolism of the vein, thus preventing the blood from returning towards the pelvis. This leads to a dramatic improvement of the symptoms and does not effect the fertility of the patient.

When there are no symptoms:

A very significant percentage of the patients do not report pelvic pain. What is important in situations as these are the vulvar varicosities and the presence of varicose veins on the lower extremities.

For these women the required treatment is directed on the varicose veins and the vulvar varicosities. The treatment for vulvar varicosities is foam sclerotherapy.

The treatment is completed by dealing the varicose veins. The Great Saphenous Vein is treated through endovenous laser ablation and the varicose veins are treated through microphlebectomies or the use of foam sclerotherapy

The stratigic points of modern phlebology for the correct dealing of vein insufficiency is the thorough diagnosis and mapping of each patient's problem and, in continuance, the choice of the right techique or, if deemed necessary, the combination of two techniques.

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