Pelvic Congestion Syndrome (Varicosities) and Pelvic Pain
Varicose veins, similar to those in the legs, can affect the pelvis, causing persistent pain in the lower abdomen. This often feels like a dull, deep ache within the pelvis, made worse by standing and some activities and may feel better when lying down.
Veins are designed to allow blood to flow back to the heart. They do this by a series of one-way valves which keep blood flowing upward against gravity. If these valves are affected, veins become distended with blood which doesn’t flow normally and the enlarged veins leads to pain. This is true of varicose veins in the legs, which most people are familiar with. In the pelvis, the same problem can occur but is not visible to the naked eye. Such varicose veins in the pelvis normally affect women who have given birth because these veins had to widen during pregnancy to accomodate the increased blood flow to the uterus during pregnancy.
If you suffer from pelvic pain, there are a number of problems that can be behind it and some minimally-invasive tests can help to identify if varicose veins are responsible in your case and exclude other causes. These include:
- pelvic and transvaginal ultrasound
- abdominal CT scan
- pelvic MRI scan
- pelvic venogram
You may need to see a gynaecologist to exclude other common causes of pain. For those with pelvic congestion syndrome, just like with varicose veins, there is a minimally invasive, image-guided procedure which can treat the affected veins. This is called Ovarian Vein Embolisation.
So what is Ovarian Vein Embolisation?
Ovarian Vein Embolisation uses pinhole access to your veins and image-guidance to locate and treat the offending veins. It is performed as a day procedure under twilight sedation, which means patients generally feel peaceful but are awake and aware of your surroundings and the doctor will talk to you during the procedure, asking you to hold your breath every now and then while images are taken and answering any questions you have.
A fine needle is used to numb an area near the vein in your upper thigh, and this pinprick is generally the only discomfort during the procedure. Once the vein is numb, a thin plastic tube called a catheter (similar size to a piece of spaghetti) is threaded into the vein and then directed under x-ray guidance to the pelvic veins. Images are taken to show whether the vein valves are malfunctioning or not.
The pelvic varicose veins are then treated to stop the abnormal flow. Normally platinum metallic coils are placed into the ovarian veins to block any abnormal flows and the varicose veins themselves are then treated with a chemical designed to shut down veins (Fibrovein), the same as for varicose veins in the legs. Sometimes additional malfunctioning veins will need to be located and closed. All up the procedure generally takes between 1-2 hours. After the procedure, you will be observed in hospital and resting in bed for a few hours, and able to go home later that day.
What are the risks of ovarian vein embolisation?
The main risks are a bruise in the groin, backache and pelvic ache which are passing.
Uncommon risks include a drug allergies and a vascular injury.
Very rarely, the blocking coils can float from the ovarian vein to the lung, where in the few cases where they cannot be retrieved, they may cause transient cough or chest pain. Such coils are often placed in the lungs and even the brain deliberately to treat other conditions so serious harm doesn’t result.
What are the results of the treatment?
Ovarian vein embolisation is successful in treating pelvic congestion syndrome in 83% of women affected. This success rate is the same as surgery where the ovarian veins are tied off, but surgery is a major operation with additional pain, risks and recovery time needed.
The key to achieving these good results is in making sure that the varicose veins are the only cause of pelvic pain and that other problems, like infection or endometriosis are not the problem.
What is the recovery like?
You will be allowed to go home that afternoon. You cannot drive for 24 hrs. It’s best to avoid strenuous exercise and activity for 2 days after the procedure.
The dressing can be removed at this time, as there is only a pinhole access in the upper thigh.
You may experience a temporary flare up of the pelvic pain in the days following the procedure, whilst the veins are reacting to the treatment and eventually shrinking away. Any discomfort is normally managed with over the counter painkillers like panadol or anti-inflammatories like Neurofen are would normally resolve within 10 days.