Pelvic Venous Disease
According to data from the Center for Disease Control, over ten million women in the United States suffer from pelvic venous disease. The pelvic venous disease is also known as pelvic venous congestion syndrome or ovarian vein reflux.
The pelvic venous disease accounts for more than 40% of all chronic pelvic pain cases in women. This pain can best be described as lasting and will recur for six months or longer.
The pelvic venous syndrome can therefore be described as a painful condition usually caused by the dilation of the pelvic or ovarian veins.
The pelvic venous disease occurs when the varicose veins commonly found in the legs become less elastic. Consequently, the valves stop working, and the blood flows backward due to gravity. This results in blood pooling which causes the enlargement, bulging, and knotting of veins.
Additionally, this is more or less what happens to the pelvic vein in pelvic venous syndrome (PVCs). This can sometimes be visible from the varicose veins around the buttock, vagina, vulva, inner thigh, and down the leg.
What causes pelvic venous disease?
Admittedly, the causative agents behind ovarian or pelvic veins in PVCs are not yet fully understood. More research is still needed to definitely identify the causative agents and thereby curate an effective countermeasure.
The pelvic venous disease usually occurs in younger women or those with a few children from the data available. During pregnancy, the rapidly enlarging womb could compress the ovarian vein and constrict blood flow. The constriction of these veins then affects the functionality of the valves. When the valves stop working, the blood begins flowing backward, leading to pelvic venous disease.
What are the most common signs and symptoms of pelvic venous disease?
Symptoms of pelvic venous syndrome emanate from the dilation of the pelvic veins resulting from blood flowing backward.
In some cases, the varicose veins found in the pelvis area near the ovaries can also be pressured and push against the rectum and bladder. In such instances, the patient may exhibit signs such as;
- A painful or dragging sensation around the pelvic region
- Aches and pains near the lower abdomen
- Feeling like your legs are full and heavy
- Heightened sense of stress and anxiety
- Development or worsening of irritable bowel syndrome symptoms
In almost all pelvic venous syndrome cases, pain is the most common symptom. Some women complain of persistent pain for more than six months. The pain is usually concentrated on one side, but it can affect both sides concurrently.
This pain could often worsen when you stand for long, during or after intercourse, during pregnancy, and when lifting heavy objects. Additionally, it is noteworthy to mention the pain may also be affected by menstrual cycle hormones, meaning you could experience more pain and discomfort during menstruation. Luckily, lying down is one of the anecdotal measures known to reduce pain.
Not all women suffering from pelvic vein reflux will exhibit the symptoms. In fact, many women only start showing these symptoms during or after a pregnancy. This can be attributed to the dilation of the veins from the pregnancy.
How is pelvic venous disease diagnosed?
From the symptoms listed above, a healthcare professional can identify PVCs. Additionally, the doctor could also examine you for visible signs of varicose veins around the vulva and inner thigh. The inner thigh provides an ideal examination spot as a muscle-tendon extending through the thigh is visible and can be felt.
An ultrasound examination could also prove helpful in diagnosing pelvic venous syndrome. The ultrasound exam utilizes sound waves to identify and detect any abnormal veins. Ultrasound examinations are widely preferred as they effectively locate the irregular veins in a simple and non-invasive manner.
In some cases, however, the ultrasound may have difficulties seeing past the abdomen. A tiny probe is inserted through the vagina to make out the veins clearly in such an occurrence. This is called a transvaginal ultrasound examination.
If no definitive diagnosis is reached, the healthcare professional may opt for a computed tomography scan (CT scan) or a magnetic resonance imaging (MRI) examination. These tests help pinpoint where the varicose veins are emanating from, thereby curating an adequate remedy. While ovarian veins are largely responsible for varicose veins, other pelvic veins can also play a role, and MRI and CT scans help identify them.
The above mentioned tests are usually done at the initial stage. However, pelvic venography may still be used to diagnose pelvic venous disease and assess its impact and reach before seeking the right treatment option.
The pelvic venography examination can be done together with the pelvic vein treatment called an embolization. It can also be done as a separate procedure if there needs further consideration to the treatment options.
The pelvic venography test is relatively more invasive. However, it still remains an effective yet relatively simple way to diagnose pelvic venous disease.
The pelvic venography test involves a dye injected and then monitored through an x-ray machine with the help of a catheter. The catheter is inserted in the ovarian or pelvic veins, and the dye is injected. The catheter can also be placed at the neck if another medical perspective is needed. Images from the catheter are displayed on a fluoroscopic machine.
With a pelvic venography exam, doctors can map out the irregular veins. After that, the catheter is removed, and a little pressure may be applied on the spot to stop any slight bleeding. This whole operation takes less than a day. You can walk in the morning to get the procedure and leave by the afternoon.
What are the treatment options for pelvic venous diseases?
A pelvic vein embolization is the most common medical procedure used to treat pelvic venous syndrome. However, there are various medical drug treatments for those who don’t want to go through with the procedure.
For a long time, medroxyprogesterone acetate has been the medicine of choice. More recently, goserelin has also made its way as the medicine of choice. These medications have a more than 75% efficacy rate in reducing the size and pain of varicose veins.
As mentioned above, medicinal treatment is usually secondary to the pelvic vein embolization process. This minimally invasive treatment is pretty straightforward and will be through in one day. While the procedure will mainly focus on the ovarian vein, doctors may also investigate and treat other pelvic veins such as the internal pudendal vein, internal iliac vein, and obituary vein.
The other treatment option used in the treatment of pelvic venous syndrome is laparoscopic or open surgery. This surgery is more invasive and includes opening up the affected area to tie the specific veins. This procedure is more invasive and requires general anesthesia and more time to recover.
How do you prepare for pelvic vein embolization?
So, let’s say you’ve visited the doctor’s, been diagnosed, and decided to have the pelvic vein embolization procedure done. What should you expect, and how do you prepare for the procedure?
- If you have a warfarin prescription, you’ll need to inform the doctor as this should be altered before the procedure.
- Carry an exhaustive list of all medications and prescriptions you’re on. Additionally, if you are using any herbal medicine, you’ll need to inform the healthcare provider.
- Also notify the doctor on cases of severe illness or provide clear medical history. If you’re pregnant, you should also let the doctor know as the procedure could expose the baby to x-ray radiation.
- Finally, wear loose and comfortable clothing on your way to the hospital. While you’ll receive a gown at the hospital, it’s always easier to slip in and out of the gown in loose clothing.
What does pelvic vein embolization look like?
The pelvic vein embolization procedure is performed by a specialist known as a radiologist. The surgery is performed in the x-ray department at the interventional radiology suite.
During the procedure, you’ll be laid on your back. A cannula will then be inserted either through the elbow or at the back of the hand. This will be used to administer any fluid or medication needed. You’ll also be connected to a monitoring machine measuring your blood pressure and heartbeat.
During the surgery, a local anesthetic similar to that of the dentist may be administered for the affected area, usually the groin or neck.
The materials used in pelvic vein embolization are safe and effective. These include;
- Liquid sclerosing agents – These are used to close up veins by speeding the clotting process.
- Coils – Usually made from safe materials such as platinum and stainless steel
- Liquid glue – This is used like the sclerosing agents and helps harden the veins at the incision.
The length of the procedure could take anywhere from 30 to 90 minutes. In a small number of the overall procedures, a follow-up or repeat procedure may be required to cover the affected areas comprehensively.
What are the benefits of getting a pelvic vein embolization?
- This simple and safe procedure has a high efficacy rate and remains effective in alleviating chronic pain.
- The procedure also works relatively quickly as most women report signs of relief barely two weeks after the procedure.
- Pelvic vein embolization is less invasive when compared to other treatment options such as open surgery
- You don’t need a surgical incision making the process fairly simple
Are there risks associated with pelvic vein embolization?
While few and rare, some of the complications of getting the embolization procedure include;
- There may be a slight risk of reaction to the dye
- There have also been few cases of infection occurring after the embolization procedure. This worry, however, can be alleviated by getting the procedure done in a professional healthcare setting.
- There’s also a 10 % risk the varicose vein may recur after the procedure is done.
- The procedure cannot be carried out if you’re pregnant as you can’t be exposed to radiation.
What happens after the embolization procedure?
After the procedure, you’ll have to remain in the hospital for a while so you can have blood pressure and heart rate monitored.
Some patients have reported experiencing mild discomfort and pain during the embolization procedure. After the procedure, you’ll also be required to observe bed rest for at least four hours.
Within a week’s time, you’ll be able to resume normal activities without any signs of pain. Should grain pain persist, you can go back for a follow-up examination.
The interventional radiologist can also recommend a follow-up visit and scan to monitor the progress of the procedure. The follow-up visit will also ensure you’re not having any adverse reactions from the procedure.
Following the operation, the pelvic varicose veins should shrink in a gradual manner over a few weeks. This will be the most evident sign that the procedure was successful and the varicose veins are gone.
How easy is it to diagnose pelvic vein syndrome?
Unfortunately, it’s true that most women understand little about pelvic vein disease. Medically, it can also be misdiagnosed for a number of other illnesses.
More education is needed to help women from all over the world understand more about the condition. These efforts will help increase awareness of pelvic vein syndrome and eliminate the shame in society. By doing so, more women suffering from pelvic vein disease will come forward for treatment and awareness.
Many women are initially hesitant to bring conversations around the vulvar varicosities and thus shy to seek medication. In fact, most cases are diagnosed while examining pelvic pain. This highlights the importance of awareness creation as the problem surpasses cosmetic concerns.
Ultimately, pelvic vein syndrome can leave you with severe pain. With medication, fortunately, you can alleviate most of this pain and lead a pain-free life. If you suspect you may be suffering from pelvic pain disease, contact a healthcare professional from Pedes Orange County and let them begin the process of your recovery. You don’t have to suffer from pelvic pain, seek treatment today and get back to your joyful self!
What to Expect from Your Visit to Pedes
Your treatment will begin with an ultrasound examination of your veins, arteries, or both, in your legs to diagnose the presence and extent of the disease. Your test results will be immediately available to review with the doctor.
Once we review the results of your diagnostic tests, our physicians will help you develop a plan to provide you with the best treatment for your disease.
Depending on the extent of disease in your arteries or veins, our specialists may recommend minimally invasive intervention and/or prescribe medications to help your symptoms.
It is important to make sure that you return for every scheduled follow-up appointment to ensure that your disease is appropriately monitored. If you ever have any questions or concerns, please call or schedule a follow-up appointment with our staff.