Pelvic Venus Insufficiency / Pelvic Congestion Syndrome

Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) in women is extremely common. So common that it accounts for up to 40% of visits to Gynecologists and 15% of Family Practitioners. CPP is defined as non-cyclic pain lasting more than six months in duration. The list of medical conditions associated with CPP is long, typically requiring a team of physicians to correctly determine which part of the body requires a more detailed evaluation and treatment. Many women have undergone medical and surgical treatment with little or no relief. One of the more commonly overlooked diagnoses is called Pelvic Venous Insufficiency or PVI.

PVI results when the veins that drains the ovaries begins to flow in the wrong direction. This type of venous insufficiency is common, affecting 10% of women. This is roughly 30,000 women in Wyoming alone! Up to sixty percent of women with these broken veins will experience the classic symptoms including, but not limited to: a dull pelvic ache, constant pelvic pain that worsens with standing, a heaviness or fullness in the pelvis that progressively worsens throughout the day, and deep pelvic pain following intercourse. Urinary urgency and bowel symptoms may also be associated with these findings.

A common question asked is, “Why do these veins break?” Unfortunately, there is no one simple answer. It is likely a combination of the ovarian vein being exposed to high concentrations of estrogen and progesterone over multiple menstrual cycles, dilation of the vein in response to pregnancy, and dysfunction of the vein valve - the support structure that makes the vein a one-way street.

Fortunately, the diagnosis can be verified by a painless and non-invasive imaging test called Magnetic Resonance Venography. This is simply a special type of an MRI. Once this diagnosis is confirmed, these veins can be treated with small metal coils (imagine the spring on the inside of a pen) that prevent the blood from flowing in the wrong direction. The procedure is performed in an outpatient setting with a rapid recovery.

Pelvic Venous Insufficiency, Symptoms:

  • Heavy cramping pelvic pain that increases after intercourse and towards the end of the day.
  • Lying down flat or elevating the pelvis with pillows improves the sensation of heaviness; the pain is virtually gone upon awakening in the morning following a night of restful restorative sleep.
  • Some women experience bowel and bladder symptoms due to venous congestion. 
  • Some women will have venous varices in the upper thighs, genital region, or buttocks. 

Pelvic Venous Insufficiency, Treatment, Technical Aspects:

The goal of eliminating gonadal venous reflux is aimed at re-routing the flow of venous blood away from the pelvis and eradicating the incompetent veins. 

 A small sterile catheter (imagine a very fine drinking straw) is inserted into the incompetent gonadal veins using X-ray guidance from a tiny incision in the groin or neck. Contrast dye is injected into the veins to document that the blood is indeed flowing in the wrong direction. Once confirmed, small coils (imagine the tiny spring in a ballpoint pen) are deployed into the vein, again using X-ray guidance to block the flow of blood. 

 Once the appropriate veins are blocked, the blood is re-routed to the central venous drainage. 

 This process stops the blood from flowing through the broken veins, thus alleviating the venous pooling in the pelvis thereby decreasing pain and discomfort. 

 Imagine that a waterfall was flowing rapidly with a large volume of water. Once there is an adequate dam in place, the water will find other natural ways to flow to the central system. Additionally, once the flow of water is stopped the pools below the waterfall will recede. I think that this analogy provides the best visual example to understanding venous reflux. 

Dr. Charles Bowkley has been treating this condition in Wyoming since 2010. If you have experienced the symptoms above or would like more information, please do not hesitate to contact Casper Medical Imaging.