I think the hardest part of being a woman with some struggle (fibroids, PCOS, PMS, Endometriosis etc) is trying to understand all the things you are going through. Even after you have done surgery to aid, some times you still struggle and there are times new issues to deal with.
My PMS tends to be different each month. One month it may be serious headaches, others mood swings, but the main problem that I had is lower back pain. This tend to occur monthly and some months worse than others. It starts somewhere deep in my left pelvic, around the hip and into the lower back. I often find it difficult to describe it to the doctor. While there are times it feels like serious pain, most times it is a dull ache and the only thing that seems to sooth it is deep tissue massage which I just want someone to do until I fall asleep.
I have seen many different doctors with my back pain and did several x-rays where nothing abnormal was revealed. I also went through Physiotherapy, but stopped after I was not showing any improvements and they felt that it was a gynecological issue. So I went back to my Gynae and he said, it is pelvic congestion. What is Pelvic Congestion? Here is what I found out:
Pelvic Pain (Pelvic Congestion Syndrome)Ovarian Vein and Pelvic Varices
What is it?
It is estimated that a third of all women will experience chronic pelvic pain during their lifetime. Chronic pelvic pain is defined as “non-cyclic” pain lasting greater than six months. A multidisciplinary team approach is needed to treat this often complex medical condition. After a physical examination, a Pap test to rule out cervical cancer, and routine laboratory bloodwork, a cross-sectional imaging study is obtained to be certain that there is not a pelvic tumor. If the clinical symptoms are those of chronic pelvic pain, worse when sitting or standing, and sometimes also associated with varicose veins in the thigh, buttock regions, or vaginal area, the possibility of ovarian vein and pelvic varices must be considered.
Source: http://www.hopkinsmedicine.org/interventional-radiology/conditions/pelvic/
Prevalence
- Women with pelvic congestion syndrome are typically less than 45 years old and in their child-bearing years.
- Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
- Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
- Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15 percent have PCS along with another pelvic pathology.
Risk Factors
- Two or more pregnancies and hormonal increases
- Fullness of leg veins
- Polycystic ovaries
- Hormonal dysfunction
Symptoms
The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:
- Following intercourse
- Menstrual periods
- When tired or when standing (worse at end of day)
- Pregnancy
Other symptoms include:
- Irritable bladder
- Abnormal menstrual bleeding
- Vaginal discharge
- Varicose veins on vulva, buttocks or thigh.
Diagnosis and Assessment
Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use the following imaging techniques to confirm pelvic varicose veins that could be causing chronic pain.
Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, interventional radiologists examine patients on an incline, because the veins decrease in size when a woman is lying flat.
MRI: May be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.
Pelvic ultrasound: Usually not very helpful in diagnosing pelvic congestion syndrome unless done is an very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.
Transvaginal ultrasound: This technique is used to see better inside the pelvic cavity. As with a pelvic ultrasound it is not very good at visualizing the pelvic veins unless the woman is standing. However it may be used to exclude other problems.
Treatment Options
Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.
Additional treatments are available depending on the severity of the woman's symptoms. Analgesics may be prescribed to reduce the pain. Hormones such birth control pills decrease a woman's hormone level causing menstruation to stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.
Source: http://www.sirweb.org/patients/chronic-pelvic-pain/
