Center for Gynecology & Women’s Health
Most women experience pelvic pain of some type at some point in their lives, and a very long list of conditions can cause such pain. Many of these conditions, though, can cause severe or longer-term pelvic pain, including uterine fibroids; endometriosis; cancer ; menstrual conditions; ovarian cysts; gastrointestinal conditions, ectopic pregnancy, and urologic conditions, such as interstitial cystitis – to name just some.
Two other general terms refer to conditions that can also cause pelvic pain:
• Pelvic inflammatory disease. In this infectious condition, bacteria or other infectious organisms have crossed the cervical barrier and caused inflammation
in the uterus, fallopian tubes, or adjacent pelvic structures. Pelvic inflammatory disease can also encompass symptoms from sexually transmitted diseases, vaginal infections, or urinary infections.
• Adhesions. Abnormal physical connections between the surface of organs and structures in the pelvis, usually caused by connective tissue
such as scar tissue, can form after injury to tissue in the area due to surgery, infection, or chronic conditions such as
endometriosis. These connections can cause pulling, pressure, or stiffness that results in pelvic pain.
Pelvic Congestive Syndrome
Pelvic congestive syndrome is a diagnostic term and a condition that has received renewed attention in recent years, as understanding
of the phenomenon, and ability to diagnose it accurately and treat it properly, have improved. The syndrome is thought to
cause chronic pelvic pain as a result of varicosing of veins that drain blood from the ovaries. Indeed, pelvic congestive
syndrome occurs more often in women who have varicose veins of the legs as well. (Pregnancy, ovarian cysts, and hormonal
dysfunction may also be risk factors for this condition.) The valves that prevent the reverse flow of blood in the venous
system are defective in such veins. For this reason, blood pools in these vessels. The result is swollen, distorted, misshapen
veins that, in the pelvis, cause pressure and pain due to their enlargement. In the course of a day, the resulting discomfort
can be get worse, the longer the individual remains in the upright position.
The ovarian veins are susceptible to such expansion and congestion, due to their anatomy and their relatively unsupported
position along the pelvic sidewall. Varicose veins in the pelvis are a common condition, though they do not always cause
symptoms. Recent data, however, indicates that pelvic congestive syndrome may be a very common cause of chronic pelvic pain.
Thus, pelvic congestive syndrome is increasingly recognized as potential cause of otherwise unexplained, long-term pelvic
pain in women. Many specialists consider it significantly underdiagnosed and undertreated. The condition has been associated
with other symptoms such as menstrual irregularities; sexual problems; abdominal distension; irritable bladder; varicose veins
in the vulva, buttocks, or thigh; and sometimes serious discomfort before, during, and after menstruation.
Varicosities of one or more of the ovarian veins may be difficult to detect. If other conditions are ruled out, our staff
may order a venogram, to create an image of the vessels that may be varicosed. Or, they may perform a special type of laparoscopy using only local
anesthesia and minimal sedation, in which they touch different pelvic structures with a probe to identify the source of the
patient’s pain.
Drug treatment can be effective, using over-the-counter analgesics or prescription anti-inflammatories or through hormonal
suppression, including with birth control pills. Other options include surgical ligation of the vein, or surgical removal
of the uterus and ovaries. (Hysterectomy alone is not considered effective.) Frankford can also now offer a minimally invasive,
catheter-based approach to treating such varicosed ovarian veins, in the form of embolization procedures performed by interventional radiologists. This treatment plugs the blood vessels, causing them to shrink and disappear. |
Pelvic pain may be acute (sharp and with rapid onset), intermittent, or constant. Every woman’s tolerance for pelvic pain is different, but certainly when such pain begins to interfere with activities, to affect other aspects of physical health, or to cause distress, it should
be evaluated.
With so many potential causes of pelvic pain, isolating the basis of a woman’s discomfort may take time and patience. Our staff may use a variety of different steps to determine the cause of pelvic pain. These include:
• taking a medical history;
• physical examination (both standing and prone);
• and a number of different lab and imaging studies.
Ultrasound conducted externally on the pelvis or with a probe introduced through the vagina may be useful. In addition, our specialists may perform a diagnostic hysteroscopy to view the interior of the uterus or laparoscopy to view the interior of the pelvis. CT and MR imaging, as well as other radiologic, urologic, and gastroenterologic tests may also be employed.
Our center can offer treatment or refer for treatment for conditions underlying pelvic pain, including psychological factors
that may exacerbate the experience of pelvic pain. Treatment can include medications (including analgesics, anti-inflammatories, hormone therapy, muscle relaxants, or antidepressants),
heat therapy, nerve blocks, physical therapy (relaxation techniques), minimally invasive surgery using hysteroscopy or laparoscopy,
or major surgery (such as hysterectomy).
