PELVIC CONGESTION SYNDROME

Pelvic Congestion Syndrome (PCS), also known as pelvic venous insufficiency, is one of the causes of chronic pelvic pain in women.

Symptoms of Pelvic Congestion Syndrome

PCS is characterised by worsening pelvic pain on sitting or standing for a long time but is relieved on lying flat. The pain can also be worse following urination or menstrual periods or intercourse.

Causes of Pelvic Congestion Syndrome

The typical age of women with this condition ranges from 20 to 45 years and in women with multiple pregnancies. The weight gain and anatomic changes in the pelvic structures during pregnancy may cause enlarged ovarian and/or pelvic veins.

Hormonal changes associated with pregnancy are also known to weaken the walls of the ovarian and/or pelvic veins. The dilated veins cause dysfunction of the vein valves leading to backward flow of blood that pools within the pelvis. This pressure results in pain in the pelvic region and may also cause visible abnormal veins.

Diagnosis of Pelvic Congestion Syndrome

PCS may go undiagnosed in many cases as the lying down position of the individual during the pelvic examination relieves the pressure over the ovarian veins and hence may not be noticed during the examination.

PCS is best diagnosed based on the report of the symptoms experienced by the patient and a physical examination. Dr Alexander may recommend imaging techniques to detect the presence of abnormal veins.

These include:

  • Pelvic Venography - is an invasive diagnostic procedure most commonly used to diagnose PCS. To conduct the venography, the patient lies on a tilting table. During the test, X-rays are used to visualise the abnormal veins. A contrast dye is injected through a catheter (small tube) placed in the veins of the pelvic region and the images are captured.

  • Pelvic ultrasound and Transvaginal ultrasound may also be performed to exclude other causes of chronic pelvic pain.

Treatment for Ovarian vein embolization

Ovarian vein embolization (OVE) is a minimally invasive treatment for PCS.

This can be performed as an outpatient procedure, with most patients going home after a few hours of observation and returning to normal activity within 24 hours.

Ovarian vein embolization OVE is an effective and safe procedure to block blood flow to the veins causing pelvic congestion. The procedure is performed using X-rays and a contrast dye to visualise the abnormal veins. Under the imaging-guidance, a catheter is placed in the blood vessel and advanced to the treatment site. A dye is then injected through the IV (intravenous) line and a series of X-rays are taken to locate the abnormal area.

An embolic agent (medication) is then introduced into the catheter and additional X-rays are taken to confirm all the abnormal veins are embolized. This blocks the blood flow in these veins and subsequent pooling of blood within the pelvis is prevented.

PELVIC PAIN DIAGNOSIS & LAPAROSCOPY

Pelvic pain is one of the common gynaecological problems which may be caused by various conditions.

What Pelvic Pain Could Mean?

Pelvic pain is a characteristic symptom of various gynaecological conditions. Assessing the exact cause for pain is essential to treat the condition.

Laparoscopy helps in assessing the exact cause of the pain such as:

  • presence of scar tissue,

  • infections,

  • ovarian cysts,

  • gastrointestinal problems,

  • urinary problems,

  • musculoskeletal problems and

  • other conditions.

 

Assessing the exact cause for pain is essential to treat the condition.

During the procedure, the surgeon makes a small incision in the abdomen, usually at or below the belly button, and inserts a tube through which the laparoscope is introduced into the abdomen. Laparoscope helps in examining the pelvis and the images can be viewed on the large screen.

A special contrast dye may also be injected before the procedure for better visualization of the fallopian tubes. After the procedure, the incisions are closed with stitches and covered with bandages.

About Laparoscopy Procedure

During the procedure, the surgeon makes a small incision in the abdomen, usually at or below the belly button, and inserts a tube through which the laparoscope is introduced into the abdomen.

The laparoscope helps in examining the pelvis and the images from the camera are projected onto a large screen for the surgeon to view.

A special contrast dye may also be injected before the procedure for better visualization of the fallopian tubes. After the procedure, the incisions are closed with stitches and covered with bandages.

Laparoscopy Complications

Like all surgical procedures, laparoscopic procedures may be associated with certain complications, which include:

  • Bleeding

  • Urinary tract infection

  • Injury to bladder or urethra

  • Injury to bowels

  • Irritation or inflammation at the opening of the vagina

The advantages of laparoscopic procedures when compared to open laparotomy include:

  • Reduced hospital stay

  • Smaller incisions and less scarring

  • Less postoperative pain

  • Faster recovery

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