Chronic Abdominal Pain

Pelvic Congestion Syndrome - Chronic Pelvic Pain in Women

It is estimated that one in three women will experience chronic pelvic pain at some point in their life. One of the important causes of chronic pelvic pain is in the pelvis, known as pelvic congestion syndrome. There may be enlarged veins. The causes of chronic pelvic pain vary, but are often related to the presence of enlarged veins around the ovaries and in the abdomen. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that carry blood back to the heart are weakened and do not close properly. This causes blood to flow backwards, causing pressure to build up as the veins dilate and pool blood. Dilated veins cause abdominal pain and affect the uterus, ovaries and vulva. Approximately 15% of women between the ages of 20 and 50 have dilated veins in the abdomen, but it does not cause pain in everyone. Diagnosis is often difficult because patients lie down for examination and the pressure in the veins in the abdomen decreases, and the veins do not dilate as much as they do when standing. Many women with pelvic congestion syndrome struggle for many years to find out why they have abdominal pain.

It is difficult to live with constant abdominal pain. This is not a condition that only affects women. It affects the patient's  relationships with family and friends and their general outlook on life. Since the cause of the pain cannot be found, patients are not treated even though treatment is possible.

If you have pelvic pain that increases while standing during the day, you can get an opinion from an interventional radiologist.

Prevalence

• Women with pelvic congestion syndrome are usually younger than 45 years of age and are of childbearing age.
• There is an increase in the size of the ovarian vessels due to previous pregnancies. It is not normal for pelvic congestion syndrome to occur in a woman who has never been pregnant.
• Chronic pelvic pain accounts for 15% of gynecological outpatient clinic visits.
• Research shows that 30% of patients with chronic pelvic pain are due to pelvic congestion syndrome. (PCS), in addition, 15% of them have different pelvic pathologies. It indicates that they have multiple PCS.

Risk Factors

• Two or more pregnancies and hormonal increase
• Occlusion of leg veins
• Polycystic ovaries
• Hormonal dysfunction

Symptoms

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Chronic pain resulting from this disease is usually dull and painful. Pain is usually felt in the lower abdomen and waist. Pain usually increases in the following periods;

-Following intercourse

-Menstrual periods

-When tired (especially at the end of the day )

-Pregnancy

• Irritable bladder (!)
• Abnormal menstrual bleeding
• Vaginal inflammation
• Varicose veins in the vulva, buttocks, and thighs

Diagnosis and Evaluation

Once other abnormalities or inflammation have been ruled out by a complete pelvic examination, pelvic Congestion syndrome can be diagnosed using several minimally invasive methods. An interventional radiologist (a doctor specifically trained to perform minimally invasive treatment using imaging for guidance) uses the following imaging techniques to confirm pelvic varicose veins, which can cause chronic pain:

• Pelvic Venography:Venogram, which is thought to be the most accurate method for diagnosis, is performed by injecting contrast dye to make the pelvic organ vessels visible during X-ray. To aid in the accuracy of the diagnosis, the interventional radiologist examines the patient in a horizontal position; because the size of varicose veins decreases when the woman lies down.
• MRI: It may be the best non-invasive method in the diagnosis of pelvic congestion syndrome. The examination needs to be performed specifically adapted to look at the pelvic blood vessels. Standard MRI may not show the abnormality.
• Pelvic Ultrasound: It is a special application that is not very useful in the diagnosis of pelvic congestion syndrome unless the patient is standing. Ultrasound can be used to reveal other problems that may be causing pelvic pain.
• Transvaginal Ultrasound: This technique is used to get a better look inside the pelvic cavity. Pelvic ultrasound is not a good way to visualize the pelvic vessels unless the woman is standing. However, it can be used to reveal other problems.

Treatment Options

Once the diagnosis is made and the patient becomes symptomatic, embolization should be performed. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging methods. During outpatient procedures, the interventional radiologist inserts a thin, spaghetti-sized catheter into the affected vein through the femoral vein and applies a sclerosing agent (the same substance used to treat varicose veins) to close the enlarged damaged vein and relieve painful pressure. After treatment, the patient can immediately resume normal activity. There are also additional treatments available depending on the severity of the woman's symptoms. Medications that induce menstruation and reduce hormone levels, such as birth control pills, can help control symptoms. There are also surgical options such as histelectomy and ligation or removal of veins along with the ovaries.

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