Pelvic pain? No one can find the cause?
There are many different causes of recurrent pelvic pain in women, and it can be a challenge to figure out which one might be affecting a particular woman. A common and frequently overlooked cause, especially in women who have one or more children, is Pelvic Venous Insufficiency (PVI); also know as Pelvic Congestion Syndrome.
PVI occurs through the ovarian veins. These veins are supposed to drain the blood from your ovaries. But in women with PVI the blood flows the wrong way, back down to the ovaries. The tissues get congested from the elevated pressures in the veins. This in turn can cause severe, sometimes debilitating pain.
But these veins are not visible on physical exam because they are deep in your abdomen and pelvis. In fact the routine physical exam does not even check for PVI. Even if your doctor suspects PVI, there are very few findings on a targeted physical exam.
So women with this problem are often given the diagnosis of "chronic pelvic pain, NEC (not elsewhere classifiable)" which means the cause of the pain remains uncertain. Or worse, incorrectly diagnosed with one of the many other causes of pelvic pain or the doctor begins to think the problem is in your head since a cause has not been found.
An episode of the serial documentary Without A Scalpel is all about PCS/PVI. It is episode #3 "HYSTERical" that you want to watch (The link takes you to the show on Amazon, and you have to pay ~$1 to buy it. It is worth the small investment, and on request I am happy to reimburse you your $1 when we meet in clinic) Take the time to watch it! It is well done, and I am betting what the women discuss during the show will ring true for you.
PVI occurs through the ovarian veins. These veins are supposed to drain the blood from your ovaries. But in women with PVI the blood flows the wrong way, back down to the ovaries. The tissues get congested from the elevated pressures in the veins. This in turn can cause severe, sometimes debilitating pain.
But these veins are not visible on physical exam because they are deep in your abdomen and pelvis. In fact the routine physical exam does not even check for PVI. Even if your doctor suspects PVI, there are very few findings on a targeted physical exam.
So women with this problem are often given the diagnosis of "chronic pelvic pain, NEC (not elsewhere classifiable)" which means the cause of the pain remains uncertain. Or worse, incorrectly diagnosed with one of the many other causes of pelvic pain or the doctor begins to think the problem is in your head since a cause has not been found.
An episode of the serial documentary Without A Scalpel is all about PCS/PVI. It is episode #3 "HYSTERical" that you want to watch (The link takes you to the show on Amazon, and you have to pay ~$1 to buy it. It is worth the small investment, and on request I am happy to reimburse you your $1 when we meet in clinic) Take the time to watch it! It is well done, and I am betting what the women discuss during the show will ring true for you.
CT scan of abdomen and pelvis. The structures involved in PVI are labelled.
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Circuit of abnormal blood flow. Arrows indicate direction blood is moving
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The abnormal flow of blood in PVI (aka Pelvic Congestion Syndrome)
This video gives you a sense for how the flow is abnormal. And this woman is on her back on a table; imagine how much worse it must be when she stands up!
This video was captured during the procedure to correct this abnormal flow.
The dark tube at the upper right side of the video is a small catheter that was placed into the vein at the base of the neck and maneuvered into the top of the left ovarian vein (in Radiology we show the left side of the body on the right side of the image; just as if you were looking at the person). The dark gray material you see flowing down to the pelvis is X-ray dye, or contrast, that I inject to see where the vessels are and how blood flows through them. In this case, the flow should be up toward the chest, not down to the pelvis)
But there is a real cause, and a safe solution
If you have this abnormal blood flow it can usually be seen with pelvic ultrasound, CT scan, or MRI.
Also, if you have surgery on your pelvis (for example, if your gynecologist is looking to see if you have endometriosis) the surgeon may have noticed the abnormal dilated veins.
Many women with these abnormal veins have no symptoms; it only makes sense to treat the veins if they hurt you. This is why our visit in my clinic is so important. I will listen to you and we will determine if the therapy is right for you.
Also, if you have surgery on your pelvis (for example, if your gynecologist is looking to see if you have endometriosis) the surgeon may have noticed the abnormal dilated veins.
Many women with these abnormal veins have no symptoms; it only makes sense to treat the veins if they hurt you. This is why our visit in my clinic is so important. I will listen to you and we will determine if the therapy is right for you.
"Before I had the surgery I had wound up in the E.R. I was in so much pain. It felt almost as bad as labor
pains. I was nervous going into the procedure because any surgery is scary but Dr.Thomas and his
nurses were very comforting and had a great bedside manner which helped me to relax. The recovery
time was short. Now my pain is non-existent most of the time and when I do have some pain it is very
minimal."
-Meghan
What is the treatment?
The ovarian vein is no longer working to drain your ovary, it is flowing backwards draining the blood from your kidney into your pelvis. So it is not helping you at at all, anymore. You would be better off if the vein could just be removed or tied off...but that would be a huge surgery to go through.
Fortunately, there is a much less invasive way of making the vein go away and stopping the abnormal blood flow. It is called ovarian vein embolization (OVE). Meghan called this a surgery but is actually a non-surgical procedure (because there is no incision) I perform this procedure at Methodist Hospital. It is an outpatient procedure, meaning you will go home the same day. There is no incision, stitches or staples; just a band-aid placed over the site where I was working.
Using our very sophisticated imaging equipment I guide a tiny tube into the ovarian vein and block it off from the inside using coils that open to the size of your vein. This blocks the vein permanently.
We do this procedure using sedation, so you are very relaxed and might fall asleep. The procedure is painless, though afterwards you might have some aches in your pelvis that lasts for a couple of days. If you work M-F it is a good procedure to have on a Friday as you should be able to get back to work on Monday.
Fortunately, there is a much less invasive way of making the vein go away and stopping the abnormal blood flow. It is called ovarian vein embolization (OVE). Meghan called this a surgery but is actually a non-surgical procedure (because there is no incision) I perform this procedure at Methodist Hospital. It is an outpatient procedure, meaning you will go home the same day. There is no incision, stitches or staples; just a band-aid placed over the site where I was working.
Using our very sophisticated imaging equipment I guide a tiny tube into the ovarian vein and block it off from the inside using coils that open to the size of your vein. This blocks the vein permanently.
We do this procedure using sedation, so you are very relaxed and might fall asleep. The procedure is painless, though afterwards you might have some aches in your pelvis that lasts for a couple of days. If you work M-F it is a good procedure to have on a Friday as you should be able to get back to work on Monday.
