PELVIC CONGESTION SYNDROME
Pelvic congestion syndrome, aka pelvic venous insufficiency, is a condition that effects approximately 15-40% of women aged 20-50yo. This problem causes chronic pelvic pain due to varicose veins within the pelvis. This causes blood to pool within the bulging veins of the pelvis, causing pain. These abnormal veins can be secondary to abnormalities of the gonadal veins or a compression of a vein in the pelvis called, May-Thurner. Unfortunately, this is an underdiagnosed condition for women suffering with chronic pelvic pain.
Chronic pelvic pain is classified by pain in the lower abdomen/pelvis for more than 6 months. 60% of women who suffer from pelvic pain never get a proper diagnosis. The diagnosis for PCS is often not thought of as a diagnosis during evaluation and workup.
RISK FACTORS FOR PCS
2 OR MORE PREGNANCIES
- Worse pain with standing, sitting and physical activity
- Improved pain with lying down
- Abnormal menstrual bleeding
- Irritable bladder
- Vaginal discharge
- Varicose Veins
- PoTS syndrome
- Interstitial Cystitis
- Irritable bowel syndrome
ILIAC VENOUS STENTING
Pelvic congestion syndrome can be secondary to compression of the left common iliac vein, draining vein in the pelvis. This is due to an anatomical compression of the right iliac artery compressing the left common iliac vein. By limiting the drainage of blood out of the pelvis, blood finds alternative routes through veins in the pelvis and spine, causing them to dilate and potential cause pain.
Treatment involves placement of a stent within the compressed iliac vein, to regain its normal size and decompress venous pressure in the pelvis.
OVARIAN VEIN EMBOLIZATION
Dilation of the pelvic veins may also be secondary to a leaky gonadal vein, allowing blood to back up into the pelvis instead of moving forward to the heart. This is interrogated by performing a venogram, or dye test with X-ray, to watch blood flow within the gonadal vein. If reflux is noted, along with dilated varicose veins within the pelvis, the vein is shut down with coils, or embolized.