Many young women complain of chronic lower abdominal (pelvic) or belly pain. Such pain can be reported in many conditions, which makes it difficult to evaluate and arrive at a diagnosis. Pelvic congestion syndrome (PCS) is one such condition which causes chronic pelvic pain and is commonly underdiagnosed or misdiagnosed.
Most women who suffer from this condition are young and have more than one child. Typically, patients complain of dull aching pain in the lower abdomen, which is aggravated by prolonged periods of standing or sitting. The pain can be more before or during the menstrual period. The intensity of pain is often worse at the end of the day. Few women feel pain while passing urine, similar to what happens during a urinary tract infection. Dyspareunia or pain during sexual intercourse is another symptom which is often under-reported by women suffering from pelvic congestion syndrome, and can result in avoidance of intercourse and relationship problems.
The pelvic congestion syndrome is caused due to the dilated tortuous veins in the pelvis. These veins become bigger in size due to reflux of blood across the malfunctioning valves in the ovarian veins or internal iliac veins. Oestrogen, a hormone, is also thought to be responsible for dilation of these veins and causing pain.
A physician may notice dilated bluish veins in the vulvar region and along the medial aspect of the thigh. On deep palpation at certain points in the lower abdomen, patients complain of severe pain. Various non-invasive imaging modalities such as ultrasound, CT scan and MRI help in diagnosing pelvic congestion syndrome, and exclude the alternative causes of pelvic pain.
Traditionally, patients with pelvic congestion syndrome are offered supportive treatment in the form of pain relieving medicines or hormonal therapies. The medicines often fail to give adequate relief. These patients are then generally offered a surgery, which involves removal of the uterus and ovaries (hysterectomy and oophorectomy). This is a major surgery which involves anaesthesia, longer recovery period and chances of complications. Moreover, removal of the uterus in a young female causes an adverse psychological impact.
Ovarian vein embolization is a novel, minimally-invasive non-surgical procedure that treats the pelvic congestion syndrome and relieves the various symptoms associated with it. The procedure is performed by a specially trained vascular interventional radiologist doctor. In this procedure, a tiny plastic tube called a catheter is inserted through a pinhole opening at the groin or neck. The catheter is then navigated to the ovarian vein and dilated veins in the pelvis. The blood flow in these abnormal veins is then blocked using special metallic coils or sclerotherapy agents.
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The procedure does not require any anaesthesia and can be done as a day care procedure. The patients typically stay in the hospital for six hours and are discharged on the same day. Patients can resume their routine and daily activities almost on the same day, and completely recover within a few days. The procedure is less invasive, safer than surgery, has minimal complications and causes no scarring. Embolization allows women to return to life sooner and in better health.
It is not uncommon to see many women suffering silently from lower abdominal pain for years, because they are often misdiagnosed and are offered non-specific treatments without real benefit. These women are not willing to undergo surgery and lose their uterus/ovaries. For all these women, there is a choice available now, which is called ovarian vein embolization.
It is highly effective, completely non-surgical and saves the women from the trauma of undergoing major surgical procedures. It is truly a major advance in women’s health, and is bound to revolutionize the treatment of chronic pelvic pain amongst women.
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