Abstract
ObjectivesPelvic congestion syndrome is defined as chronic pelvic pain due to incompetent (dilated and refluxing) pelvic veins. The aim of this study was to investigate the prevalence of this condition by examining the prevalence of dilated ovarian and para-uterine veins in pre- and postmenopausal female patients, irrespective of their symptoms. We subsequently investigated how many women with dilated veins suffered from chronic pelvic pain. Additionally, we attempted to define diagnostic criteria that may allow for early identification of affected patients.MethodsWe reassessed 2384 abdomino-pelvic computed tomography scans performed on women at our institution. The maximal diameters of the ovarian and para-uterine veins were measured. Patients with a pathological process in the abdomen or pelvis affecting the veins were excluded. We considered ovarian vein dilation to be 6 mm or more in the axial plane. For patients that met these criteria, we performed a retrospective chart review to evaluate the clinical presentation and/or symptoms of these patients.ResultsDilated pelvic veins were present in 293/2384 (12%) patients, 118/559 premenopausal (21%) and 175/1825 postmenopausal (10%). Chronic pelvic pain of unclear etiology had been documented prior to the CT in 54/293 (18%) women with dilated veins—2% of the whole study collective (54/2384); 8% of all premenopausal (44/559) and 0.5% of all postmenopausal (10/1825). It was often accompanied by urological symptoms such as hematuria, dysuria, and urinary frequency, in the absence of infection (p<0.05). We identified a strong correlation between the presence of dilated ovarian veins and chronic pelvic pain in premenopausal parous patients with hematuria.ConclusionsPelvic congestion syndrome appears to be an underdiagnosed and undertreated disease. In our study, 8% of all premenopausal women had documented chronic pelvic pain of unclear etiology and dilated ovarian and pelvic veins on cross-sectional imaging studies. The features we identified in this study as most relevant should enable a faster identification of patients who could benefit from a specific treatment regimen for this condition.
Highlights
Chronic pelvic pain of unclear etiology had been documented prior to the computed tomography (CT) in 54/293 (18%) women with dilated veins—2% of the whole study collective (54/2384); 8% of all premenopausal (44/559) and 0.5% of all postmenopausal (10/1825). It was often accompanied by urological symptoms such as hematuria, dysuria, and urinary frequency, in the absence of infection (p
We identified a strong correlation between the presence of dilated ovarian veins and chronic pelvic pain in premenopausal parous patients with hematuria
Pelvic congestion syndrome (PCS) is a condition that results from incompetent pelvic veins, causing chronic pelvic pain (CPP) in women
Summary
Pelvic congestion syndrome (PCS) is a condition that results from incompetent pelvic veins, causing chronic pelvic pain (CPP) in women. The indicators of incompetent veins comprise dysfunctional dilatation of ovarian (OV) and para-uterine veins (PV), slow blood flow (congestion), retrograde flow and reflux [1]. PCS was first described in 1949 as symptoms of CPP related to dilated pelvic veins [2,3]. Women with PCS-derived CPP are mostly multiparous and describe the abdominal pain as dull and achy with sharp exacerbations, getting worse after long periods of standing and walking [1]. The pain can be accompanied by other symptoms such as post-coital pelvic aching and ovarian point tenderness on bimanual examination (94% sensitivity and 77% specificity) [4]. The etiology of PCS is still poorly understood but likely multifactorial, involving both mechanical and hormonal factors
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