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 your doctors begin 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. (That link takes you, in 2022, to the show on Amazon, and you have to pay $1 to buy it. It is worth the 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 your doctors begin 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. (That link takes you, in 2022, to the show on Amazon, and you have to pay $1 to buy it. It is worth the 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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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 our clinic is so important. We 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 our clinic is so important. We 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
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 it is actually a non-surgical procedure (because there is no incision) We perform this procedure at the 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 we were working.
Using our very sophisticated imaging equipment we guide a tiny tube into the ovarian vein and block it off from the inside using special fibered coils that open to fill 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.
If you have pelvic pain and wish to be evaluated for Pelvic Venous Insufficiency please call for an appointment with one of our IR doctors (210-617-9071) or submit this form and we will contact you.
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 it is actually a non-surgical procedure (because there is no incision) We perform this procedure at the 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 we were working.
Using our very sophisticated imaging equipment we guide a tiny tube into the ovarian vein and block it off from the inside using special fibered coils that open to fill 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.
If you have pelvic pain and wish to be evaluated for Pelvic Venous Insufficiency please call for an appointment with one of our IR doctors (210-617-9071) or submit this form and we will contact you.