Chronic pelvic pain treatment

Chronic pelvic pain syndrome

Chronic pelvic pain syndrome occurs mainly in women between the ages of 20 and 45 who have had multiple pregnancies. It is the dilatation of the veins in the vaginal area due to valve deficiency in the ovarian (over) veins. That is, these veins become varicose (varicosis means expansion of the veins). These varices cause burning and soreness. An increase in soreness is an indicator of the progression of the disease.

How does chronic pelvic pain syndrome cause burning?

The most severe burning occurs in the lower abdomen. This is also called chronic pelvic pain. That is, long-term (more than 6 months) pain under the abdomen. 30% of women have constant abdominal pain at some point. However, not every abdominal pain is a symptom of this disease, and every pelvic pain syndrome may not have abdominal pain. In addition to pain, the disease causes complaints of swelling and heaviness in the lower abdomen.

Pain is the most common complaint. The pain is not sharp and does not occur at regular intervals. It starts to hurt mainly before menstruation, on the last day and after being on your feet for a long time or after being tired. Pain may occur during or after intercourse. Sometimes the degree of pain affects the patient's behavior and social relationships. Pains can also happen during the advanced stages of pregnancy.

Is chronic pelvic pain syndrome dangerous?

This disease is not a very dangerous disease. It is not necessary for every patient to receive treatment. However, pelvic pain in women is a common occurrence, and pelvic pain syndrome is an under-recognized cause. The burning caused by pelvic pain syndrome can noticeably reduce quality of life. In case of such complaints, the disease should be treated.

What are the symptoms of the disease?

Other symptoms, such as pain, may become more severe after prolonged standing or after intercourse.

• Swelling around the vagina
• Varicose veins around the vagina, calf, groin and legs
• Menstrual disorders
• Pain when touched in the lower abdomen
• Painful menstruation
• Vaginal discharge
• Depression

How is it diagnosed?

It is actually very easy to diagnose the disease, but it is very difficult for the patient to suspect this disease.

If a large number of varicose veins are seen around the vagina with transvaginal ultrasonography, it is necessary to undergo an examination. With computed tomography or venography, it is possible to visualize and diagnose ovarian vein dilatation. However, the presence of varices alone is not a reason for treatment. Alongside these varices the patient must also have the symptoms listed above, because varices around the vagina are found in many women who have given birth more than once.

What is the treatment and how is it done?

If the ovarian veins (over) are enlarged and there are varicose veins in the vagina, it is necessary to treat if the patient complains of burning and soreness.

The main treatment is to close this vein with valvular deficiency and treat the varices. In this way, the patient's complaints will decrease. This vein can also be closed with surgery. However, currently, embolization (closure) treatment performed by a simple angiography method is one of the most effective and preferred methods. Angiography is easier to perform than arterial vascular angiography, because it is performed on veins.

With angiography, one of the veins in the groin is accessed (in normal angiography, an artery is accessed). In some cases, it can be accessed not only from the groin, but also from the jugular veins

The ovarian veins are visualized and the diagnosis made to the patient is clarified. Then, a 1 mm thick plastic tube is inserted into the ovarian vein with an angio catheter and embolized.

After the intervention, there may be a feeling of pain in the lower abdomen for a day or two. The pain is stopped with pain medication.

After treatment, the patient is not necessarily hospitalized. Patients are discharged on the same day.