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Pelvic Pain and Pelvic Venous Obstruction

Posted: February 13, 2019

Deep pelvic pain, leg pain and swelling, low back pain; what do they have in common? Although each of these symptoms may be caused by a number of medical problems, one often overlooked cause may be blockage of veins in the pelvis.

Understanding Pelvic Pain

Deep pelvic pain in women with intercourse often is due to obstruction of veins in the pelvis called iliac veins that carry blood flow from the legs and pelvic organs back toward the heart. The venous blood builds up pressure in the pelvis and legs resulting in pelvic pain and, frequently, leg pain and/or swelling. The pain often occurs or increases in intensity with exercise of the legs or with intercourse as venous blood flow back to the heart must increase during physical activity.

Pain with intercourse (dyspareunia) occurring low in the vaginal area often is due to loss of estrogens with menopause and it not due to venous problems. Sometimes, pain low in the vagina or in the external female parts (labia) may be associated with varicose veins on those tissues, many of which can be treated with injections of a foam which seals the varicose veins shut, causing them to shrink. Sometimes, the labial varicose veins are present because of obstruction of the pelvic veins (iliac veins) which must be addressed before treating the labial varicose veins.

Pain deep in the pelvis with intercourse more often is due to tender and painful varicose veins in the pelvis which carry venous blood flow around the obstructed iliac veins. Some patients experience continued deep pelvic pain after intercourse which may be brief or may last a week or more. Many patients with this problem have stopped having intercourse because of this problem. Often, they have undergone multiple pelvic imaging studies such as ultrasound or CT scanning and may have undergone colonoscopy or laparoscopy looking unsuccessfully for the source of the pain.

Other Signs of Pelvic Venous Obstruction

Obstruction of the veins of the pelvis may also cause low back pain and must be considered among the possible causes of low back pain. If there is no deep pelvic pain, it is unlikely that pelvic venous obstruction is the culprit, but chronic low back pain without radiation to the legs (sciatica) in the presence of deep pelvic pain with intercourse may well be due to high pressure in veins carrying blood around the obstructed iliac vein.

Leg pain and swelling may occur for many, many reasons and pelvic venous obstruction is one of the long list of possibilities. Evaluation of soft tissue leg swelling and pain is best performed in a clinic specializing in venous and lymphatic disorders which may cause these symptoms.

Diagnosing Chronic or Deep Pelvic Pain

Patients who have chronic pelvic pain lasting more than 6 months and/or deep pelvic pain with intercourse which severely impact their quality of life and who have not had a definite cause for the symptoms found by their physicians are best evaluated in a clinic specializing in evaluation and treatment of pelvic venous disorders. Routine pelvic ultrasound, CT, or MR scanning often miss the problem since special techniques and specialized interpretation are essential to identify the problem. Very specialized abdominal and pelvic venous ultrasound imaging is our first choice in diagnostic testing because ultrasound usually will identify the problem and it can show changes in venous flow to help sort out the significance of narrowing in the pelvic veins.

Most of the time, pelvic venous obstruction is due to compression of the iliac vein between the bone of the spine and the iliac artery, but scarring in the veins from previous clotting (deep vein thrombosis) also may be found.

Treating Pelvic Venous Obstruction

Treatment of most pelvic venous obstruction is done with placement of a stent across the blockage to allow blood to flow through the normal pathway back to the heart. This usually can be performed on an outpatient basis and most of these are performed in our new state-of-the-art office-based catheterization laboratory. The initial portion of the procedure is to inject a drug into the veins at the groin which is followed with X-ray as it flows back to the heart (venography) and then ultrasound imaging of the abnormality with a catheter inside the veins. These diagnostic steps are performed to confirm the initial ultrasound findings, to look for other potential problems, and then to measure the vein for placement of the stent which holds the vein open for blood flow. This is all done through an incision in the upper thighs measuring about 1/8 inch in length.

Tennessee’s Leading Vein Center ℠

VeinCare Centers of Tennessee is one of a very small number of medical practices with special expertise in evaluation of pelvic venous disorders. Stephen F. Daugherty, MD, FACS, FAVLM, authored the first report in the Journal of Vascular Surgery: Venous and Lymphatic Disorders of treatment of a series of patients for pelvic pain and dyspareunia with venous stenting in 2015. Daugherty teaches regularly at major national meetings of vein specialists on this subject. He attributes much of the successful treatment to his experienced professional staff of nurses and imaging specialists who are critical to assess the unique needs and problems of each patient.

Patients with unexplained chronic pelvic pain or deep pelvic pain with intercourse which severely affect their quality of life who have had recent medical pelvic evaluation without a diagnosis for the pain may contact VeinCare Centers of Tennessee for a specialized evaluation by calling 931-551-8991. Patients with soft tissue leg pain and/or swelling may contact us for an appointment to evaluate their problem as well. The website for VeinCare Centers of Tennessee is www.TennesseeVeinCare.com.

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