Chronic Pelvic Pain Can Be Caused By Vascular Conditions
Chronic pelvic pain in women may account for 10-15% of all gynecologic visits. There may be several causes or contributing factors to chronic pelvic pain and vascular conditions that are often overlooked.
Vascular conditions that cause pelvic pain in women can be diagnosed easily and in a non-invasive manner. Once identified, they can be further evaluated by venography and treated successfully with outpatient-based endovascular techniques.
Causes For Pelvic Pain In Women
Pelvic pain is most often caused by a variety of non-vascular conditions
After these more common causes for pelvic pain have been ruled out, one should consider further vascular evaluation. This is very important because one may be suffering from
Pelvic Congestion Syndrome (PCS) – PCS is most commonly characterized by chronic pain in the pelvic region, caused by venous reflux and poor blood flow in the pelvic veins.
May-Thurner Syndrome (MTS) – MTS is caused by a compression of the iliac vein. MTS may or may not cause pelvic pain, but generally will cause varicose veins and/or swelling in one leg (typically the left leg).
Signs and Symptoms
Many patients with PCS and MTS may experience no symptoms. However, chronic pelvic pain is the most common. Because pelvic pain can present with other conditions, it is important to rule those out prior to the diagnosis and treatment of PCS and MTS.
The common symptoms include
Chronic pelvic pain, experienced for six or more months
Pain may be constant or intermittent
Usually a dull, achy pain in the lower abdomen, pelvic region or lower back
Pain generally worsens as the day progresses, particularly with prolonged sitting or standing
Pain is often on the left side, though it may be generalized throughout the pelvic region
With MTS, there are usually varicose veins and/or swelling of the left leg
Both PCS and MTS are more common in women who have had multiple births.
How Is Pelvic Pain Diagnosed?
Diagnostic testing is minimally invasive and generally pain free.
Several techniques may be used
Venography (x-ray of the veins)
Intravascular ultrasound (IVUS)
Chronic Pelvic Pain
The most conservative and least invasive treatments are most desirable to restore optimal blood flow and relieve pelvic pain. There is no “one-size-fits-all” solution. Treatment options may include
Embolization Therapy generally involves injecting a sclerosing agent into the vein. This results in the closing of the affected vein, with blood flow being naturally rerouted into healthier veins. Treatment is very similar to sclerotherapy in the legs.
Venoplasty and Stenting a majority of women diagnosed with MTS will undergo a minimally invasive procedure to place a stent in the compressed iliac vein. Using intravascular ultrasound, the physician will guide a catheter through the vein in the leg and into the pelvic region allowing precise measurement. If necessary, a balloon and stent may be placed into the vein to keep the vein open.
Bypass Surgery in very rare cases, a bypass surgery may be the best option to restore proper blood flow in the pelvic region.
Chronic pelvic pain of vascular origin is often under recognized. When left untreated, it can be extremely limiting. Fortunately, there are minimally invasive measures to help affected women in the outpatient setting.