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Do You Have Chronic Pelvic Pain?

Posted: April 5, 2019   |   Revised: April 8, 2019

Chronic pelvic pain can be disabling to the patient and it often is difficult to diagnose the reasons for the symptoms. Recent technological improvements allow for dramatic improvements in QUALITY OF LIFE for approximately 30% of patients with chronic pelvic pain.

Chronic pelvic pain is defined as pain in the pelvis which lasts more than six months. The pain may be constant or intermittent and often is worse with hormonal changes especially before or during menstrual bleeding.

Causes of chronic pelvic pain

Gynecologic conditions which may cause chronic pelvic pain are numerous and include:

  • Uterine enlargement due to fibroids, adenomyosis, or rare cancers
  • Ovarian cysts (though these usually do not cause pain lasting over six months)
  • Endometriosis (implants of cells similar to those inside the uterus within the abdominal cavity which may cause pain during menstruation)
  • Pelvic floor disorders involving muscle spasm or nerve pain

Non-gynecologic conditions which may cause chronic pelvic pain include intestinal or urinary tract abnormalities. Each of the conditions require specific different treatments to relieve the patient of pain and to avoid potential other complications.

Some of these conditions can be treated with hormone therapy while others require surgery, physical therapy, or injections for pain control. Unfortunately, one or more of the disorders listed above may be blamed for the pelvic pain even though there is little evidence to support such a diagnosis as the cause for the pain.

We are experts in diagnosing and treating pelvic venous disorders

We wrote the first report in the peer-reviewed medical literature of a series of patients treated with angioplasty and stenting (through tiny 1/8″ incisions) for obstruction of pelvic veins due to compression causing chronic pelvic pain (Journal of Vascular Surgery: Venous and Lymphatic Disorders, July, 2015).

Dr. Daugherty was one of the early surgeons placing stents in pelvic veins for obstruction more than 20 years ago and he was one of the early users of IVUS for venous diagnosis nearly 20 years ago. He speaks regularly as an invited speaker at national medical meetings regarding pelvic venous disorders. Physicians, vascular technologists, and other clinical specialists come to Clarksville, Tennessee to learn from us.

The clinical staff at VeinCare Centers of Tennessee include Registered Nurses and Registered Vascular Technologists with special expertise in evaluating, treating, and follow-up for patients with pelvic venous disorders. Sandra French, RN, ANP-BC, is an expert in evaluation of pelvic venous disorders and in teaching other clinicians to recognize pelvic venous disorders.

Sandra French

VeinCare Centers of Tennessee is a specialty clinic and is a part of Advanced Health, the largest physician owned medical practice in Tennessee with over 450 physicians and advanced practice clinicians. We participate in most of the major insurance plans available in Tennessee and surrounding states.

Diagnostic testing

A detailed clinical history sheds much light on the nature of the problems and a physical exam helps to differentiate the possible causes of a problem. Diagnostic testing is essential to further identify the likely causes of the symptoms. Few patients require the entire list of available diagnostic tests, but each available test may help to answer specific clinical questions based upon unique circumstances for each patient. These tests may include:

  • Pelvic soft tissue ultrasound
  • CT or MRI scan to evaluate soft tissues or blood vessels
  • Colonoscopy to look inside the intestine for causes of pain
  • Laparoscopy to look inside the abdominal/pelvic cavity through small incisions

Pelvic venous testing

One of the most important tests to obtain early in the evaluation of chronic pelvic pain is VENOUS COLOR DUPLEX ULTRASOUND (CDU) of the abdomen and pelvis. A common cause of chronic pelvic pain is obstruction of veins in the pelvis or failure of one-way valves in veins of the abdomen and pelvis which result in high pressures in the veins of the pelvis.

These high venous pressures may get worse with exercise, intercourse, or with prolonged sitting or standing. High pressure in the veins of the pelvis causes pain due to stretching and swelling and due to inflammatory changes in the tissues associated with blood components leaking into the tissues of the pelvis and lower extremities.

Who should have pelvic venous color duplex ultrasound studies?

Women with pelvic pain significantly interfering with quality of life for a period of over 6 months with one or more of the following:

  • Pelvic pain at rest, after exercise, or with prolonged sitting or standing
  • Pelvic pain deep in the pelvis with sexual intercourse (dyspareunia)
  • Unexplained chronic low back pain
  • Chronic urinary bladder discomfort
  • Leg swelling
  • Pain in the soft tissues of either leg
  • Varicose veins of the external genitalia (labia) or extending from the labia into either leg

Definitive diagnosis—the “Gold Standard” test

If clinical symptoms and physical exam strongly suggest that a pelvic venous disorder may be the underlying problem, the venous CDU often suggests a venous cause as well. The “Gold Standard” diagnostic test now is a combination of VENOGRAPHY (imaging of the veins with X-ray while injecting a drug into the veins) and INTRAVASCULAR ULTRASOUND (IVUS).

Venography allows imaging of the inside of the veins and flow of blood through the veins which may show areas of obstruction or enlargement of veins carrying blood around areas of blockage or in areas of valve failure. IVUS allows very precise measurements of the diameter, length, and shape of an abnormality in the veins which may limit blood flow back to the heart. This information in addition to the venous color duplex ultrasound findings allows assessment of the severity of the condition and facilitates decisions regarding treatment.

For most patients, venography and IVUS are performed with light intravenous sedation and monitoring in the office-based diagnostic vascular laboratory similar to a cardiac catheterization laboratory. Most patients undergo treatment of the venous problem during the same session as the diagnostic venography and IVUS procedure if the suspected problem is confirmed. Typically, patients are discharged home in 2-3 hours after completion of the procedure.

If pelvic venous obstruction or valve failure are confirmed and treated, the vast majority experience dramatic improvement in pelvic symptoms. Some patients report complete resolution of their low back pain; others experience partial improvement or no improvement in low back pain since low back pain can result from a number of different problems which may be present as well. The degree of improvement of leg symptoms varies depending on the severity of other leg problems such as varicose veins or prior clotting injury to leg veins.

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