CHRONIC PELVIC PAIN:Pelvic Venous Disorder or Pelvic Congestion Syndrome

For the past three years,K,35, had been suffering from lower abdominal discomfort and backache after the birth of her second child. The pain was worse on the first 2 days of menstruation. It was aggravated by prolonged standing and exercise but was relieved when she lay down especially in a prone position. The menstrual pain was accompanied by abdominal bloating, constipation and frequent urination occasionally. She also experienced pain during sexual intercourse.

She had been seen by many health professionals. Various investigations including endoscopic examinations of the gut (gastroscopy and colonoscopy), bladder (cystoscopy) and reproductive organs(laparoscopy) were normal. Eventually, an MRI of the pelvis revealed that K’s veins in the pelvis were abnormally engorged . K had been suffering from a medical condition called pelvic congestion syndrome or pelvic venous disorder (PVD) .

What is PVD?

PVD is a condition which is characterised by pelvic pain lasting more than 6 months. It is due to engorged varicose veins in the pelvis.

Varicose veins are veins with faulty valves. These valves direct blood flow towards the heart. When they are not functional, blood flows backwards and pools lower down in the veins. Extra blood will pool in the pelvis causing pressure, pain and heaviness in the lower abdomen.

PVD usually affects women of reproductive age. It is rare after menopause.

What causes PVD?

The cause of PVD is not well understood.

It is likely due to hormonal changes in the veins which expand about 50% in size during pregnancy. These changes may cause long-term damage to the walls of the blood vessels, causing veins to remain dilated.

As PVD is uncommon among menopausal women, it is also suggested that female hormone, estrogen, may play a role in making the valves of the vein more susceptible to defects.

What are the risk factors of PVD?

Risk factors include

· Women who have given birth