That Chronic Pelvic Pain May be Due to Pelvic Congestion Syndrome

• 1 September 2019
• Dr. Obinna Nwobi

If you’re a woman and you have ongoing pelvic pain, you’re going to do what makes sense: Schedule an appointment with your gynecologist. But then what do you do if your gynecologist gives you a clean bill of health, but you still suffer from chronic pelvic pain? That’s when it’s time to call us at Vein Health Clinics, where Dr. Nwobi is an expert in pelvic congestion syndrome.

Pelvic congestion syndrome is a vascular problem that’s responsible for 30-40% of all cases of pelvic pain. It frequently causes severe pain and negatively affects your quality of life, but once you have an accurate diagnosis, you can get effective treatment.

Vein problems cause pelvic congestion syndrome

Pelvic congestion syndrome is like varicose veins, except that the enlarged — or congested — veins are deep in your abdomen. In this condition, the ovarian veins develop varicosities, primarily due to dysfunctional valves.

Like other veins in your body, ovarian veins transport blood to your heart. Since they’re in the abdomen, the veins work against pressure from your body and gravity, so they get help from one-way valves. These valves open to let blood flow in the proper direction and close to stop it from going backward.

When a one-way valve doesn’t work properly, blood goes in the wrong direction, but it stops when it reaches the next healthy valve. Over time, blood accumulates in that part of the vein, causing an enlarged, twisted, and painful vein.

A second problem also contributes to pelvic congestion syndrome. Most women with ovarian vein problems also have a narrowed iliac vein. This vein is in your abdomen, where it receives blood from organs and carries it to your heart. The narrowed iliac vein increases pressure in the veins, which contributes to ovarian vein varicosities.

Risk factors for pelvic congestion syndrome

Women who have had several pregnancies have the highest risk of pelvic congestion syndrome. Your vein capacity can increase by 60% during pregnancy to accommodate the extra blood volume during pregnancy. This extreme vein distension stretches the valves, making them dysfunctional.

The weight of your baby during pregnancy also adds to your risk as the increased weight may press on the veins and occasionally disrupt blood flow. When blood flow is blocked, it backs up in the vein, causing further engorgement and stretching. And finally, increasing estrogen levels during pregnancy may contribute to the problem because estrogen weakens vein walls.

Pain is the hallmark symptom of pelvic congestion syndrome

Because the affected veins are in and around your ovaries, you develop chronic pelvic pain. When you have pelvic congestion syndrome, you’ll have one or more of the following symptoms:

• Pain that’s sharp or achy in your pelvic region
• Pain during or after intercourse
• Pain that’s worse when standing
• Pain that feels better when lying down
• Pain that gets worse around your period (but it’s not menstrual cramps)
• Pain in your lower back
• Pain or aching in your legs

The venous pressure caused by pelvic congestion syndrome may result in varicose veins in your vagina and vulvar area. Some women also develop problems like abnormal vaginal bleeding, headaches, urinary urgency, and abdominal bloating.

The best treatment for pelvic congestion syndrome

Hormonal medications may temporarily relieve your pain, but the only way to get long-term results is with a minimally invasive procedure that directly treats the veins: transcatheter embolization or ovarian vein embolization. Ovarian embolization provides long-lasting pain relief in 99% of women who have the procedure.

Your uterine embolization is an outpatient procedure in that we do use real-time imaging, so we can see your veins and guide a slender catheter to the varicose veins. When the catheter is in place, we close the vein using one of several techniques. We may inject a medication that collapses the vein or insert coils or a sponge to seal the vein. If we need to block small veins, we can use a specialized foaming agent.

We have the expertise to accurately diagnose pelvic congestion syndrome and provide safe, effective treatment. So if you have ongoing pelvic pain, schedule an appointment at Vein Health Clinics, by calling one of our offices in Oviedo, Apopka, and Winter Haven, Florida. Or you can use the online scheduling tool while you’re here on the website.