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Pelvic Pain and Pelvic Congestion Syndrome: Finally the Relief That Women Seek

Center for Vein Care Provides Leading-Edge Treatment, Improves Lives

By Olympia Christoforatos, RN, MS, Patient Care Coordinator, Vascular and Endovascular Surgery Division

Pelvic Congestion Syndrome
Ovarian vein embolization is a minimally
invasive procedure for treating pelvic
congestion syndrome (shown here; note
close-up of varicosed vein).

Chronic pelvic pain is very common in women and can potentially lead to significant disability. Approximately one out of every three women will suffer from pelvic pain at some point during their lifetime. It is described as "non-cyclic" pain lasting greater than six months in duration.

The good news is, a minimally invasive non-surgical outpatient treatment of one of the common causes of pelvic pain is available at Stony Brook Medicine, where women can get the pain relief they seek.

"There are many different conditions that can cause pelvic pain, thus making diagnosis difficult," explains Antonios P. Gasparis, MD, director of the Center for Vein Care. "Women tend to go through multiple testing before seeing us in the office."

Pelvic congestion syndrome (PCS), also known as pelvic venous insufficiency or incompetence, is one of the causes of chronic pelvic pain, and must be considered as part of the differential diagnosis.

The pain associated with PCS worsens when sitting or standing, and is relieved with lying down. It can be associated with varicose veins in the thighs, buttock regions, or vaginal area.

Pelvic congestion syndrome is becoming increasingly recognized as a cause of chronic pelvic pain, and at Stony Brook Surgery, we know how to provide the treatment of it and the relief that women seek.

Some women may also experience pain with urination or during/after sexual activity. The condition is associated with ovarian and pelvic vein dilatation — veins being stretched beyond normal dimensions — resulting in varicose veins in the pelvis.

Dr. Gasparis is a specialist in the treatment of pelvic congestion syndrome. He uses the very latest diagnostic and therapeutic technology to manage this condition, treating it effectively with a minimally invasive outpatient procedure.

What Causes Pelvic Congestion Syndrome

The cause of PCS is unclear. However, the possibility of anatomic or hormonal abnormalities or dysfunction can contribute to the development of PCS. The majority of women who are affected are between the ages of 20 and 45 years and have a history of multiple pregnancies.

It is believed that the hormonal changes and weight gain along with the anatomic changes in the pelvic structures during pregnancy can cause an increased pressure within the ovarian veins and weaken the vein wall leading to dilatation (the condition of being stretched beyond normal dimensions). Estrogen has been also identified to weaken the vein walls, thus predisposing women to PCS.

In normal veins, blood flows from the pelvis up toward the heart in the ovarian vein, and is prevented from flowing backwards by valves within the vein. When the ovarian vein dilates, the valves do not close properly, resulting in backwards flow of blood, also known as reflux.

Consequently, there is pooling of blood within the pelvis that leads to pelvic varicose veins and clinical symptoms of pain and the sensation of heaviness.

How We Diagnose Pelvic Congestion Syndrome

We recognize the need to consider PCS as a possible cause of pelvic pain in women. The proper diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.

Ultrasound: Abdominal and pelvic ultrasound is a vital initial step in the diagnosis of PCS because it can eliminate other common causes of chronic pelvic pain.

CT or MR: It is possible with both of these tests to visualize the abnormal veins within the pelvis. Since CT is associated with radiation exposure, it is not recommended for use in pregnant women.

Pelvic venography: This is considered the most definitive imaging modality for diagnosing PCS because it can identify the abnormal veins and the reversal of blood flow within the affected veins. This procedure is done by Dr. Gasparis in the hospital as an outpatient procedure.

Pain medication will be given prior to the start of the procedure to alleviate any minor discomfort. The procedure is minimally invasive and performed by placing a small catheter (tube) directly into the abnormal ovarian vein.

How We Treat Pelvic Congestion Syndrome

Antonios P. Gasparis, MD
Dr. Antonios P. Gasparis

Pelvic venography is often performed as a diagnostic procedure but also may be performed in conjunction with treatment in the form of pelvic embolization.

Ovarian vein embolization: In this procedure, Dr. Gasparis places a catheter (tube) directly into the abnormal ovarian vein, as described above. He injects sclerosing agents into the pelvic varicose veins to occlude (seal) them.

Small metal coils or plugs are subsequently placed to block blood flow into the ovarian vein. This prevents the reversal of blood flow in the abnormal vein, which reduces the pressure within the enlarged pelvic veins.

If reversed blood flow is present within the other ovarian vein or within other pelvic veins, these vessels can be embolized, as well, in a similar fashion.

This procedure is typically performed on an outpatient basis, with most patients going home after a few hours of observation and returning to normal activity after the first week.

What to Expect after Ovarian Vein Embolization

Ovarian vein embolization is a non-surgical procedure that is an effective treatment for painful ovarian varicose veins.

Following the procedure, patients have mild to moderate pelvic discomfort which lasts for a few days. This discomfort resolves slowly over a few days, and the original pelvic symptoms resolve over the next few weeks. Symptom relief varies, with some patients experiencing 90% improvement.

"The procedure gave me my life back, and allowed me to make plans in the future, not for tomorrow," said one grateful patient who was treated for PCS with ovarian vein embolization.

For consultations/appointments with Dr. Gasparis, please call 631-444-VEIN (8346). For more information about pelvic congestion syndrome and its diagnosis, watch these 2016 videos featuring Dr. Gasparis:

Defining Pelvic Congestion Syndrome Diagnosing Pelvic Congestion Syndrome

All health and health-related information contained within this web site is intended to be general and/or educational in nature and should not be used as a substitute for a visit with a healthcare professional for help, diagnosis, guidance, and treatment (read more).

Comments

I had ovarian vein embolism 12 years ago. Can the coils break loose? I'm having sharp pain again in the area and I also feel a sharp pain and kind of a pinching in my neck and chest. It doesn't last very long but it is bothersome.
Yes, coils can dislodge, but this generally occurs early on after treatment. I have not heard of them dislodging so many years after implantation. In addition, I suspect the symptoms associated with a dislodged coil would be present all the time rather than come and go. If they would dislodge they would travel to the lungs (chest pain) but not to the neck. Finally, if still concerned, a chest x-ray can show if any part of a coil has dislodged. Seeking medical attention is advised. — Antonios P. Gasparis, MD
I had severe pelvic and menstrual pain with varied diagnoses for many years. Went through endometrial surgery 2x (showed minimal endometriosis, which was removed), ablation, and finally a full hysterectomy (a close relative passed from ovarian cancer very young) in 2010. The GYN told me that he found varicose veins throughout my pelvic region which had been causing the pain, and he cauterized them during surgery; also said there was a lot of blood, and asked if I was a "bleeder," which I am not. I am having similar dull pain, not severe at this point, in the same area (left and right side of lower abdomen, I used to think it was my ovaries before the oopherectomy). Is it possible there are new varicose veins causing this? What would the treatment be, if so?
Hysterectomy and oophorectomy (removal of ovaries) are treatment options for pelvic congestion syndrome. But if symptoms resolve and later recur, it is possible to have recurrence of pelvic varicose veins. Examination of the pelvic veins should be considered to evaluate if there are new veins. Treatment of them, if present, would be embolization (blockage of the veins with medication and coils). — Antonios P. Gasparis, MD
Hello, I am having unexplained pelvic pain. My pelvic ultrasound I am told is negative. It is not appendicitis or kidney stones. Nobody seems to know what it is. I have trouble sitting at my desk for 8 hours a day. Is it possible I have the PCS? I also have IBS but have had it for years. Help!
From the limited clinical history you provide it is difficult to determine if you do have PCS. Although your ultrasound was normal, not all imaging centers are able to evaluate for pelvic reflux and PCS. It would be best for you to be seen by a specialist who diagnoses and treats PCS in order to determine if this is your underlying problem. — Antonios P. Gasparis, MD
Dear Sandy, I have had Crohn's disease for 30 years and this pelvic venous congestion syndrome has been hidden for years, while my Crohn's and IBS have become worse. I luckily found out about it while having a CAT scan of my abdomen for Crohn's disease and that's where it showed up. I was hospitalized two years ago and had a CAT scan then, and it said I had the PVCS but no one noticed — they just looked at where it said colitis. So I recommend a CAT scan and several different doctors' opinions on how to treat. Good luck.
I agree that CT scan can be helpful in identifying pelvic varicosities, especially if you do not have access to a good ultrasound lab. The only thing one needs to be aware is that pelvic varicosities are very common in women with multiple pregnancies. However, that does not translate that all of them will have or develop PCS. — Antonios P. Gasparis, MD
I am very shocked i found this site....diagnosed with an incompetent cervix in 2002 which caused my first pregnancy to be harsh and giving birth at 29 weeks after a six week hospital stay..then miscarriage with second pregnancy..fullterm birth with third pregnancy with being on breathine and pain meds ..fourth pregnancy fullterm birth after once again falling victim to preterm labor for the again as i did with each pregnancy ..but now i was taken to emergency surgery for a cerclage..this was extremely painful...now 15months after giving birth...my low back pain is out of control..tingling sensations in my thighs and legs.and feet..my legsand feet hurt so bad..i cant stand or sit long not even cook dinner ..i cant work..or school..im uncomfortable when doing anything besides laying in bed..my body hurts all day..my bladder refuses to void although it feels full..but then it leaks if im a second too late to get to the restroom..neuro..pcp..and thyroid doctors all think im crazy...negative test on so many things but my blood pressure and weird sensations and pain is the only reason they give me any treatment..i know that im not crazy thaanks to this site and good info..my symptoms are exact..now what kind of specialist do i consult in Kentucky or Illinois. ...tears...God bless...thanks making me know I AM NOT CRAZY
I had treatment for PCS six weeks ago. The veins being embolized and one very large one had three coils placed in it. At this time I am still experiencing enough pain to require Vicodin 3-4 times a day along with ibuprofen. I have been in contact with my doctor's nurse and even seen the doc. All I'm told is to be patient and the veins need time to absorb. No one can give me any timeline on how long this will continue. I have been in pain since March and had hoped I would feel better after the procedure. While I have had some good days they are infrequent and I'm still on pain meds which I don't care for. Last conversation with the docs nurse was only that they want me off the Vicodin and ibuprofen. I have tried backing off with bad results. Having to lie on the couch with a heating pad. I have lost months of my life to this. At this point what should I insist on from my doc? Another CT scan, a refill of the pain meds? Prior to this I was an active person, working out at the gym three days a week, doing miles on the elliptical and doing yoga. I have been reduced to short walks in my neighborhood. I just want the pain to stop so I can go back to my life. I'd appreciate any help. Thanks.
It is difficult to tell what your symptoms are due to from this limited information. If this is not due to PCS, other causes of pelvic pain should be evaluated by an OB-GYN. If it is due to PCS, imaging to make sure treatment was successful may be required. Treatment for PCS has some improvement in symptoms in 70% of patients. It can take 2-3 weeks to see improvement. Failure of improvement may indicate that although pelvic reflux and varicoseties were present (which is very common in women with multiple pregnancies), PCS was not the cause of the symptoms. So, not all patients with pelvic reflux develop symptoms. In fact, pelvic reflux is much more common than PCS, similar to varicose veins in the legs; they are very common but only few patients develop symptoms. If treatment was successful and symptoms persist with no relief, further work-up by an OB-GYN is necessary. — Antonios P. Gasparis, MD
I was diagnosed with PCS by laproscopy in August/2012. The pain is more of a harsh discomfort. It is pressure beneath my C section scar and at times pressure into my vaginal walls. My legs ache as well. The only relief I receive is from pain medications. I have had a spinal block, which may have helped some, but my doctor feels I need 3 more. This would be too expensive for me, not knowing if it has truly helped. My doctor indicated that my PCS is in my abdomen wall and not on my ovaries or uterus. Do you have any suggestions? I live in Georgia. Do you happen to know of any doctors in Georgia who may specialize in this? Thanks in advance.
PCS is a result of development of varicosities (enlarged veins) around the ovaries and uterus from multiple pregnancies. It is difficult to determine if your symptoms are related to PCS. If a woman's varicosities are on the abdominal wall and there are none around her uterus, she does not have PCS. Unfortunately, I do not have any contacts in Georgia. The closest person I could refer you to would be in Washington, DC. — Antonios P. Gasparis, MD
I am a Nigerian aged 33. Been having lower abdominal pain for over 1 year. The pain worsened and I had to travel out of my country to Apollo hospital, New Delhi, India, where I was diagnosed with gallstones, cyst and pelvic congestion. My gallbladder was removed but the OB-GYN did nothing about the pelvic congestion. I am still having severe pains in my lower abdomen. I have severe pains during and after intercourse and when I am sitting. And now that I am pregnant, the pain is more severe. I would like to book an appointment with you, if possible, so that I can be thoroughly checked. My lifestyle has changed due to the constant pains I am having. My work and family are suffering.
Look up vascular surgeons and call their offices until you can find one that has dealt with pelvic congestion. After 4 years of doctors telling me there is nothing that can be done, I have finally found one that said she can embolize the vein, and she said it has an 80% success rate for women with this condition. Good luck!
I have been having dizziness when sitting and standing before and during my menstrual cycles. I was diagnosed with PCS during an ER visit through a CT scan. I was also having a rapid heart rate. I took my hospital paperwork to my OB-GYN, and was told that they would only treat the heavy bleeding. I have to take off from from work during my cycles. Do you know of anyone who treats PCS in Memphis, TN area?
The symptoms you describe are not consistent with PCS. The presence of veins in the pelvis from previous pregnancies found on CT scan does not translate to PCS. It is not uncommon for women with multiple pregnancies to have pelvic veins present. PCS consists of symptoms of pelvic pain, pelvic heaviness, dysuria (pain with urination), and dyspareunia (pain with intercourse). I am not aware of anyone in Memphis who treats PCS. — Antonios P. Gasparis, MD
I live in Chile, and have been having throbbing right-sided pelvic pain for a year now. I had a "colored" ultrasound this past week, and was dx'd with congested pelvic syndrome, with varicose veins on my uterus. I'm wondering what other diagnosis tools can be used to confirm this dx. I'd like to have the procedure you describe here, but I want to make sure this is what I am suffering from. I have occasional dysuria, no pain with intercourse. I do have pelvic heaviness, though. I'm thinking to return to the US to have this procedure done. I have family in Richmond, VA, and Charlotte, NC. Do you have any contacts in either city? According to my symptoms, do you feel I am truly suffering from said issue?
If the ultrasound shows pelvic varicosities, no further diagnostic imaging is required. The diagnosis of PCS is one of exclusion. A full clinical evaluation is the best way to determine the cause of your symptoms. All other causes of pelvic pain should be excluded by a gynecologist, and if no gynecologic causes can be found, then PCS is most likely the underlying cause of your pain. I have not contact in either Charlotte or Richmond. There is someone I can recommend in Washington, DC; his name is Dr. Anthony Venbrux (he is director of interventional radiology at George Washington University Hospital). Hope this helps you. — Antonios P. Gasparis, MD
Dr. Gasparis, is there someone you recommend in NYC who specializes in treating PCS? I had pelvic veins ligated and one enlarged vein sclerotized in May 2013, in Phoenix, AZ. But I now live in New York City and would like to find a local specialist (my AZ doctor was more of a nerve specialist). With thanks, Rebecca
In NYC you can see Dr. Robert A. Lookstein at Mount Sinai; he is an interventional radiologist. If you wish to come to Stony Brook, I also will be happy to see you. — Antonios P. Gasparis, MD
I was just told of a diagnosis of PCS from my doctor's office after a transvaginal ultrasound. They recommended I drink extra water and wear support stockings to ease the pain. Upon looking up this diagnosis to get more information, I do have by far most of the symptoms, but I have a hard time believing just the above would be a benefit considering all I have read from yours and other sites. I do know that my doctor is hesitant to provide any type of hormones due to immediate cancers in my family history. Should I be asking for a follow up or doing more than the above? I am 45 with 3 kids. Thank you for any information you can provide.
The recommendations of your physician are reasonable first-line treatment but often do not provide significant relief. Hormone therapy may be beneficial but has significant side effects. If you have life-style limiting symptoms, further therapy would be appropriate. You should have a complete workup for other causes of pelvic pain by your OB-GYN. If he/she cannot find any gynecologic reasons for your symptoms, then you may indeed have PCS and should be evaluated by a physician with expertise in diagnosis and treatment of PCS. — Antonios P. Gasparis, MD
Three years ago at 27 I was diagnosed with PCS. I had seen many doctors before I found one that took my case. He concurred I did have PCS, and said he would be able to help by embolizing my veins. So he put six 6-foot coils in me. That was 15 months ago. For a while after surgery I was doing better, but that soon changed. I began hurting again, experiencing the same pain as I did before the surgery. So, I called the interventional radiologist who did the procedure, and explained that I'm still hurting. I asked if he would take a look at me. He responded by saying he had never put that many coils in one person, that he had done all he could do, and that for me to come back to his state to see him again would be "A WASTE OF GAS MONEY." He released me from his care and now I don't know where to go or where to start. I had a hysterectomy and one ovary removed. My GYN tested my other ovary to make sure it wasn't causing my continued pain. Can you steer me in a direction to receive help or, at least, to someone that might just look at my case and see what they think!! PLEASE and THANK YOU sooo much. I just want to be normal again and I need help!! Thanks, "Begging-for-Help-in-West-Virginia"
Hi, I was diagnosed with endometriosis in 2009 after a laproscopy due to pelvic pain. The surgery helped for a while but pain came back again after my second pregnancy. I went 4 months ago to a pelvic pain specialist, and he did surgery on me (excision surgery to remove the endo and performed a prescral neurectomy to stop the pain signals from my uterus from sending to my brain).... He stated that I had pelvic congestion which he couldn't do anything about. I felt GREAT for those 4 months until now.... The pain is back already. Could this be from pelvic congestion rather than the endometriosis? I'm so confused and needing an answer. I'm so dissapointed that I felt awesome for a short time and now feel horrible!
It is difficult to say if this is PCS by the limited history. I can't provide a diagnosis over the web. It seems that your symptoms may be more related to endometriosis rather than PCS. There could be a component of PCS, but I am not sure how much this is contibuting to your pelvic pain. Further imaging with CT or ultrasound of the pelvis will identify if is there are pelvic varicosities and the extent. Then a decision needs to be made if further treatment of the endometriosis is warranted or treatment of the PCS. — Antonios P. Gasparis, MD
Hi There. Can you, please, help me? I am a 33-year-old female and for years suffered with great pain. I fought for help in the UK and no one believed that I was ill until I was sent to see a radiologist. He performed a CT with me lying down. Usually CTs for pelvic congestion, I am told, are performed with the patient standing so the various veins show up. Well, my veins were so large they were clear to see. They measured 16 mm on lying down. I was scheduled for the embolization. The radiologist had issues placing the catheter but argued it was best I get it done, even though when he placed it a second time, the pain down my leg was immense. He entered the right side of my body to then trace around my abdomen to thread the platinum coils through to the left ovarian vein. This took over an hour and a half, and I lost count after 30 coils. He even joked that the PCT (primary care trust in UK) would be chasing him as he was only meant to put £1000 worth in and it had cost £2500 in coils. I have been very poorly since. I could feel small clots travelling around my veins in my legs, and even see them when they got stuck at times in my hand or arms. I lost 3 stone in weight as I can no longer take solid food — my digestive system is so mucked up now. I cannot even go to the loo without great pain and vomiting. Have you ever heard of anyone that has had nerve damage happen when having this procedure because too many coils were placed in their ovarian vein? Or, can this procedure damage bowels? Because this all happened from word dot after my procedure. Please help me. Kindest regards, Jessica
I do not think your symptoms are related to the procedure. I have not come across either nerve damage or bowel issues following OV embolization. It seems that you have something else going on that is causing your gastrointestinal issues. I would have to evaluate you thoroughly to confirm my suspicion. — Antonios P. Gasparis, MD
I too was diagnosed with endo few years ago, underwent surgery to clear it out. I was feeling good for some time and then my pain began again for a while. I was a heavy bleeder as well which led me to have a hysterectomy. I felt great for 2 years then bam! the pain came. Now I am diagnosed with pelvic congestion syndrome and have been living with the pain again for almost a year now. None of the doctors has ever mentioned anything about the procedures mentioned in these comments. I am in so much pain that it is affecting my life. I cannot even work anymore as it is too much pain for me to stand long periods of time or even sit.
Dr. Gasparis, I was diagnosed with PCS on 11/6/13 after a laproscopic surgery to get rid of endometriosis (for the 2nd time). Hence, my menstruation the following month indicated to me the horrific bleeding & discomfort are due to the PCS (it finally makes sense now). Do you have evening hours? I would love to come in & discuss the next step as I have a very difficult time dealing with the constant pain & horrendous menstrual cycles. Please help! I live in West Babylon, NY, & work in Manorville. I can come to Stony Brook. P.S. Do you accept NYSHIP insurance?
Yes, I will be happy to see you. Please call my office at (631) 444-VEIN (8346). And yes, I accept NYSHIP insurance. — Antonios P. Gasparis, MD
Hi! I have had severe pain in my left pelvic area and lower back and now down my left leg and even my left ankle throbs. It came after my 2nd child was delivered by c-section 5 years ago. The pain has gotten so bad that I can hardly work. I have had 2 laps, my left ovary removed, numerous test and went to numerous doctors. I was told last week that I have PCS and that my best option would be a hysterectomy. He also found fibroids and adenomyosis (endo in the uterine wall) and for that reason thought that a hysterectomy would be the best choice, at which time he would eliminate the veins. I was wondering what your opinion is on this treatment?
If you are not planning for any other children, hysterectomy is an option, but it is a more extensive procedure than embolization. If your symptoms are truly due to PCS and not the fibroids, embolization would be a less invasive and better option. Do you have varicose veins in your legs? Are the symptoms worse during your cycle? Any other symptoms other than the pain? Any dyparunia? Are symptoms improved when you lie down? A more detailed history would help determine what is the most likely cause of your symptoms. If they are due to fibroids, hysterectomy is the answer. A full (not online) evaluation is needed to give you the information you seek. — Antonios P. Gasparis, MD
I had a partial hysterectomy back in 2004. I have severe pain after sitting more than 3 hours. I recently had an MRI of the abdomen and pelvic done which came back normal other than the ovaries demonstrating tiny physiologic follicles bilaterally. Final impression: No MRI findings to suggest pelvic congestion and benign liver cyst. Does this mean I do not have pelvic congestion syndrome? Could the tiny cyst on my ovaries be causing the pain?
MRI results can be very dependent on the quality of the study. If the study is good and shows no evidence of pelvic varicosities then there is a good chance that you do not have PCS. If there is any concern on the quality of the study, further imaging can be obtained such as ultrasound or CT scan. I would suggest that you talk with your OB-GYN doctor about the cyst as the possible cause of your pain. — Antonios P. Gasparis, MD
I had gastric by-pass in 2002. I have had issues of intermittent diarrhea/constipation. More constipation. I lost 100 lbs. in 9 months and after 10 years of infertility, became pregnant with my first child who was full-term in 2004 and was healthy and weighed over 8 lbs. I had developed severe hyperplasia, border-lining a well-differeniated carcinoma. My OB-GYN, who I adore, performed 6 endometrial biopsies along with 6 D&C's within a year's time. I was told by that OB-GYN that my uterus scared her and she wanted to perform a hysterectomy; this was all before my gastric bypass and first pregnancy. I became pregnant with my second child in 2005. Tough pregnancy due to the fact he wanted out at approximately 5-month gestation. He was born at 38 weeks, healthy and also over 8 lbs. Jump ahead to middle of 2012. I had literally tried so hard to have a BM that my entire peritoneal region was bulging as if I was delivering a child. I gently pushed everything back in and suffered a few days with peritoneal pain. Toward the end of 2012, I developed a dull, heavy, sometimes pressure-like pain in my left epigastric region of my abdomen. Went to my PCP who finally did a regular abdominal ultrasound. Showed nothing. By this time the pain was excruciating at times, i.e., standing for long periods of time. I developed urinary leaking and at times what seemed like stool leakage. I went to the ER during the latter part of the summer this year and they did a CT scan which showed PCS. I have new insurance, and I will be returning to the doctor I was seeing during the above issues. My question is, could this condition be so severe that it has developed into an aneurysm? Sometimes it feels like my gut is going to explode and now my jugular veins feel this same way at times. I had no insurance before or during the ER visit, which is why I have not sought treatment. New insurance kicks in March 1st. Am I a ticking time bomb?
I think it is unlikely this will turn into an aneurysm. You are not a "ticking time bomb." Pelvic varicose veins (which is what they noticed on the CT scan) are not uncommon after 2 pregnancies. We would need to have further clinical evaluation to determine if you have PCS — this cannot be diagnosed by CT scan. — Antonios P. Gasparis, MD
I know I have this condition. I have found out from doing my own research. I have varicose veins in and around my vagina to the point that I can now see bulging veins on either side of the vaginal entrance (by opening the labia). I need to treat this. To date I have been to another vein doctor who has injected the veins that were noticeable. But it didn't get to the bigger problem which is obviously happening from the INSIDE of my body. Okay, I'm in Dutchess County, NY, and I can easily come down to Stony Brook. My question: Do I have to have the coils put in? I was with you until I read that part. I would like only to have the injections which get rid of the offending veins. Is that possible? Please advise. — Christa
Treatment is dependent on results of your clinical evaluation. You will need a duplex ultrasound to evaluate extent and location of disease. If there is a problem with the ovarian veins, use of coils is the most effective treatment. Injections alone are used if the ovarian veins are normal. Use of injection alone with disease in the ovarian vein has poor results with early recurrence. If you wish to visit us, we can schedule your ultrasound on the same day as your clinical exam to minimize your visits. Please call my office at (631) 444-VEIN (8346). Thank you. — Antonios P. Gasparis, MD
I am dealing with pelvic pain and tightness on my right side since having a hysterectomy 14 years ago. It has caused pain and dysfunction that goes all the way to my right foot. I had a rectocele repair 7 years ago. I feel like the tightness has to do with the ligament issues from the hysterectomy, as my problem started 1 1/2 years later. But the hysterectomy has never felt right. My question is, If there is an internal pelvic floor tightening due to a ligament issue, is there a way to diagnose and deal with it? Does your center deal with these issues? I have had consults and pelvic floor therapy that has done nothing. If I don't get a better understanding of my issues and some form of help, I will not be able to walk, as it has already caused many problems. If I were to send my pelvic floor history to someone there, could it be evaluated to determine whether an exam by your center might give insight? I live in Williamsburg, VA. Who would likely be able to deal with this issue? Thanks for any help.
The cause of your pelvic pain does not appear to be related to PCS. A physical (not online) evaluation would be needed to confirm this. Unfortunately, we do not have a specialist for pelvic floor pathology in our group. You may want to consider seeing a pain specialist to help you with the chronic pain. — Antonios P. Gasparis, MD
I have been diagnosed with pelvic varicosities with ultrasound and a CT scan. I also have varicose veins in both legs with large varicosities near the top of my inner thigh. I am a fit 38-year-old mother of 4. Do I need to treat the pelvic veins before I can get treatment on my legs, or is it possible to treat everything at once? Thanks very much.
Treatment of pelvic varicosities in patients with leg varicose veins is variable depending on the clinical picture. There are multiple factors that determine when the pelvic veins should be treated. If the veins in the legs are not connected with the veins in the pelvis and there are no symptoms of PCS, then the pelvic veins are not treated. If there are pelvic symptoms of PCS, then treatment of the pelvic veins should be considered if symptoms are significant. If there are no pelvic symptoms but the veins communicate with the leg veins, then treatment of the pelvic veins should be considered to decrease recurrence of the leg veins (this, however, may depend on the patient's insurance policy, as some insurances do not cover treatment of pelvic veins if there are no pelvic symptoms). The above management plan is what we use at the Stony Brook Vein Center in the evaluation and treatment of pelvic varicosities, and the approach may differ from center to center. Please let us know if we can help you further. Thank you. — Antonios P. Gasparis, MD
I have had two surgeries for PCS in the past 6 months (embolizations) in Montana, and I am still experiencing discomfort and what feels like an abnormal pressure in my groin area. I have difficulty sleeping, due to the discomfort whenever I turn, and I also feel this same pressure often when I walk or cough, for example. I am presently living in Santa Fe, NM, until April, and then I return to Montana. Is there a specialist either in the Salt Lake or Denver area, with whom I could make contact? If not, would you recommend I come to New York to see you? I know that this is not a normal situation, and I am fearful that something other than PCS could be occurring. Please advise as to what my next step should be. Thank you.
You are correct: this is an unusual symptom of PCS and not possible to figure out over the web. Was the groin discomfort present prior to the procedure? Did you have any other symptoms? Did you get any relief from procedure? Is the pain on one side or both? Regarding a specialist in the West, I have a good friend in Seattle (University of Washington) who is an excellent physician and who treats PCS, Mark Meissner, MD (206-598-4477). If you wish to come to New York, I will be happy to see you. Hope this helps. — Antonios P. Gasparis, MD
Hi, I have been having pelvic pain and a constant heaviness feeling, also a burning sensation which gets worse as day goes on and is uncomfortable when I sit. I am usually very active but have been unable to go to the gym. I have had an ultrasound scan which showed I have full veins. I was sent to see a gynecologist and the ultrasound scan suggested varices. I have also been experiencing a lot of gas and wind and unable to eat a large amount without feeling sick. My gynecologist said to go back to my doctor, as he thinks could be bowel related. I am very frustrated as all my symptoms seem to be associated with pelvic congestion. My gynecologist didn't even mention the veins; he said my scan was normal. Are these symptoms normal with full veins? Please help.
Yes, some patients with PCS may experience symptoms of bloating and fullness. Any other symptoms of PCS? A complete evaluation from a specialist that deals with PCS may help get the answers you are seeking. — Antonios P. Gasparis, MD
Hi, I was recently diagnosed with PCS and I am scheduled for surgery for a week from now. The weird thing is, I'm 20 years old and have never been pregnant. Can anyone explain this? I am confused as to why I've gotten this syndrome but can't figure out HOW I got it.
There are some cases of PCS in women without previous pregnancy. Sometimes this is associated with renal vein compression (nutcracker syndrome). In this situation, the blood flow out of the kidney is blocked and the ovarian vein acts as a bypass to drain the blood from the kidney. You have to make sure this is not the case, because it can affect the treatment plan. In most cases of PCS the treatment is embolization of the ovarian vein. In the case of nutcracker syndrome, the treatment is to relieve the blockage in the renal vein and not to embolize the ovarian vein. If this is done, it may make things worse. Are you having any back pain? How was your diagnosis made? What type of procedure are you having done? — Antonios P. Gasparis, MD
I have been diagnosed with PCS years ago and had a hysterectomy. The pain is back. Are there any complementary treatments that you can suggest to decrease the abdominal discomfort? Diet, exercise, anti-inflammatories?

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