Causes of Pelvic Congestion Pain
Pelvic pain could be from multiple cuases but pelvic venous congestion is resposible for up to 30% of pelvic pain. Most common cuases of pelvic congestion are
- Venous reflux due to absence of valves in gonadal veins- reported in up to 15% of women.
- Venous reflux due to malfunction of valves in gonadal veins -more common on left side.
- Venous reflux in ovarian vein is made worse by pregnancy related 6000% increase in vascular capacity.
- Venous obstruction like May Thurner Syndrome, Nutcracher syndrome and inferior vena cava obstruction.
Pelvic Congestion Syndrome Presentations
Pelvic congestion needs to be differentialed from other cuases of pelvic pain like uterine fibroids, adenomyosis, endometriosis, pelvic inflammatory disease, ovarian cyst and gastrointestinal cuases. Common symptoms of pelvic congestion are
- Non cyclical pain lasting for more than six months.
- Pelvic pain & discomfort, sometimes associated with generalized lethargy & depression.
- Pain worse by sitting, prolonged standing & towards end of the day or just before menses.
- Varicose veins perineum, buttock or lower extremities & hemorrhoids in selected women and men.
- Most common in pre-menopausal women
- Recurrence of varicose veins after initial successful treatment.
Pelvic Congestion Syndrome Treatment Options
Treatments for pelvic congestion has evolved over couple of decades
- Medical management included medroxyprogesterone acetate or the GnRH analogue Goserelin in an effort to suppress ovarian function and/or increase venous contraction.
- Surgical options started with extraperitoneal resection of the left ovarian vein.
- Laparoscopic ligation bilateral ovarian veins- this technique still needs general anesthesia.
- Newest & non surgical treatment of pelvic congestion is percutaneous pelvic vein embolization therapy.
- Significant improvement in up to 83% of women in their overall pain perception levels with a mean of 45 months of long-term follow up have been reported.