Pelvic venous disorders refers to long-lasting (chronic) pain in the lowest part of the abdomen (pelvis) caused by accumulation of blood in veins of the pelvis, which have widened (dilated) and become convoluted.
Pelvic venous disorders seem to be a common cause of chronic pelvic pain (pelvic pain lasting more than 6 months). Pain occurs because blood accumulates in veins of the pelvis, which have dilated and become convoluted (called varicose veins). The resulting pain is sometimes debilitating. Estrogen may contribute to the development of these veins.
Many women in the reproductive years have varicose veins in their pelvis, but not all of them have symptoms. Why some women develop symptoms is unknown.
Most women with pelvic venous disorders are premenopausal. Symptoms usually resolve after menopause.
Symptoms of Pelvic Venous Disorders
Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse.
Other symptoms include pelvic heaviness or pressure, painful menstrual periods, and increased vaginal discharge.
The pain tends to occur only on one side.
Diagnosis of Pelvic Venous Disorders
Ultrasound or another imaging test
Doctors may suspect pelvic venous disorders when women have pelvic pain but a pelvic examination does not detect inflammation or another abnormality. For doctors to diagnose pelvic venous disorders, pain must have been present for more than 6 months and the ovaries must be tender when they are examined.
Ultrasound to check for varicose veins in the pelvis can help doctors confirm the diagnosis of pelvic venous disorders. However, another imaging test may be needed to confirm the diagnosis. These tests may include venography (x-rays of veins taken after a radiopaque contrast agent is injected into a vein in the groin), computed tomography (CT), and magnetic resonance imaging (MRI).
If the pain is bothersome and persistent and the cause has not been identified, laparoscopy may be done. In this procedure, doctors make a small incision just below the navel and insert a viewing tube to directly view the structures of the pelvis.
Treatment of Pelvic Venous Disorders
Usually nonsteroidal anti-inflammatory drugs
Compression shorts
Nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve the pain.
Compression shorts may be helpful, but not compression stockings.
If these measures are ineffective and the pain is persistent and severe, doctors may try minimally invasive procedures to block blood flow to the varicose veins and thus prevent blood from accumulating there. For example, doctors may embolize the varicose veins by using an anesthetic to numb a small area of the thigh before making a small incision. Then, doctors insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils or gluelike liquids through the catheter into the veins to block the veins.
When blood can no longer flow to the varicose veins in the pelvis, pain usually lessens.
Surgery to remove varicose veins may be considered if minimally invasive procedures are unsuccessful.
