Pelvic pain is among the top reasons for women to apply to “Gynecology and Obstetrics” specialists today. Chronic pelvic pain, which is seen with a frequency of approximately 20% in women in the society, has many causes such as natural pain caused by the menstrual cycle, endometriosis, ovarian cysts, urinary tract infections, fibromyalgia, and psychiatric problems. Although Pelvic Congestion Syndrome (PKS) is one of the important causes of chronic pelvic pain, it is a condition that is often overlooked because it is a little-known and relatively difficult condition to diagnose.
In women, the cause of this picture, which progresses with abdominal pains that cannot be explained by other pathologies, occult bleeding in the urine, and significant varicose veins in the genital area and groin, should be kept in mind in groin and lower abdominal pains whose cause cannot be found. pregnancy, obesity, previous vein thrombosis, etc. It is the varicose veins in the abdomen that collect the blood of the female genital organs for various reasons. In the presence of factors that play a role in the formation of varicose veins such as chronically increased intra-abdominal pressure and inactivity, the increase in pressure in the pelvic region veins and reversible enlargement at the beginning of the disease, deformity cause irreversible structural disorders in the later stages.
PKS patients generally have lower abdominal and groin pain that cannot be explained by other reasons, is not affected by the menstrual cycle, and can be exacerbated by sexual intercourse. Along with the pain, there is also a feeling of fullness in the groin and lower abdomen. In women with this disease, menstrual pain may be more severe than expected and normal. In some of the patients, varicose veins are noticed in the genital area, in the groin, on the inner side of the thighs and from the groin to the buttocks. Most of the patients have varicose veins that appeared during pregnancy. Frequent urination, fullness in the anus area, blood in the urine are other complaints that can be seen.
In these patients who do not have obvious physical examination findings, the first step for diagnosis should be Doppler ultrasonography. Both the pelvic regions and legs of the patients should be examined in detail with Doppler USG in terms of veins. After the Doppler USG examination, some of the patients require detailed examination and mapping of the veins related to MR venography, CT venography or conventional venography.
There are a number of drugs that can be used in treatment. A number of drugs that will restore the hormonal balance can reduce the rate of progression of the disease and sometimes stop the progression. However, various painkillers can be used to relieve pelvic pain.
Another technique used in the treatment of the disease is the embolization (closure) of problematic pelvic veins through a catheter. In these procedures performed through the inguinal or neck vein, enlarged, structurally impaired veins in the pelvic region are detected. These problematic vessels are first given a sclerosing (constricting) drug and then special plugs are placed inside. The procedures can be performed in any season of the year, and the patients can be discharged on the same day and resume their work and social life the next day. The timing of the procedure has nothing to do with the menstrual period. There is no change in fertility and menstrual pattern after the procedure.