{"paper_id":"8a32178f-0be6-40de-ab31-91ac056db01b","body_text":"Management of Chronic Pelvic Pain\nBuy print or eBook\n[Opens in a new window] A Practical Manual\n- Management of Chronic Pelvic Pain\n- Management of Chronic Pelvic Pain\n- Copyright page\n- Contents\n- Contributors\n- Foreword\n- Chapter 1 Introduction to Chronic Pelvic Pain\n- Chapter 2 Neurobiological Basis of Pelvic Pain\n- Chapter 3 History and Evaluation of Patients with Chronic Pelvic Pain\n- Chapter 4 Psychological Assessment of a Female Patient with Chronic Pelvic Pain\n- Chapter 5 Musculoskeletal Assessment for Patients with Pelvic Pain\n- Chapter 6 Pharmacological Management of Patients with Pelvic Pain\n- Chapter 7 Evidence for Surgery for Pelvic Pain\n- Chapter 8 Pelvic Pain Arising from Endometriosis\n- Chapter 9 Bladder Pain Syndrome\n- Chapter 10 Pelvic Pain Arising from Pelvic Congestion Syndrome\n- Chapter 11 Irritable Bowel Syndrome\n- Chapter 12 Vulvodynia\n- Chapter 13 Pelvic Pain Arising from Adhesive Disease\n- Chapter 14 Pelvic Pain Arising from Ovarian Remnant Syndrome\n- Chapter 15 Pudendal Neuralgia\n- Chapter 16 Other Peripheral Pelvic Neuralgias\n- Chapter 17 Chronic Pain After Gynecological Surgery\n- Chapter 18 Pain Arising from Pelvic Mesh Implants\n- Chapter 19 Treatment of Sexual Dysfunction Arising from Chronic Pelvic Pain\n- Chapter 20 Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain\n- Chapter 21 If Everything Else Fails\n- Index\n- References\nPublished online by Cambridge University Press: 08 March 2021\nEdited by\nBook contents\n- Management of Chronic Pelvic Pain\n- Management of Chronic Pelvic Pain\n- Copyright page\n- Contents\n- Contributors\n- Foreword\n- Chapter 1 Introduction to Chronic Pelvic Pain\n- Chapter 2 Neurobiological Basis of Pelvic Pain\n- Chapter 3 History and Evaluation of Patients with Chronic Pelvic Pain\n- Chapter 4 Psychological Assessment of a Female Patient with Chronic Pelvic Pain\n- Chapter 5 Musculoskeletal Assessment for Patients with Pelvic Pain\n- Chapter 6 Pharmacological Management of Patients with Pelvic Pain\n- Chapter 7 Evidence for Surgery for Pelvic Pain\n- Chapter 8 Pelvic Pain Arising from Endometriosis\n- Chapter 9 Bladder Pain Syndrome\n- Chapter 10 Pelvic Pain Arising from Pelvic Congestion Syndrome\n- Chapter 11 Irritable Bowel Syndrome\n- Chapter 12 Vulvodynia\n- Chapter 13 Pelvic Pain Arising from Adhesive Disease\n- Chapter 14 Pelvic Pain Arising from Ovarian Remnant Syndrome\n- Chapter 15 Pudendal Neuralgia\n- Chapter 16 Other Peripheral Pelvic Neuralgias\n- Chapter 17 Chronic Pain After Gynecological Surgery\n- Chapter 18 Pain Arising from Pelvic Mesh Implants\n- Chapter 19 Treatment of Sexual Dysfunction Arising from Chronic Pelvic Pain\n- Chapter 20 Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain\n- Chapter 21 If Everything Else Fails\n- Index\n- References\nPelvic congestion syndrome is another condition causing pelvic pain for which there is no consensus on diagnosis or treatment; moreover, some physicians don’t even believe it causes pelvic pain. Pain from pelvic congestion is multifactorial and may be caused by hypoxia and mechanical stretching of pelvic veins. It usually occurs after pregnancy (may be full term, ectopic, or miscarriage) and presents as a sensation of heaviness in the lower abdomen with upright body position. On the background of this sensation there is intermittent sharp lower pelvic pain. In our practice we diagnose pelvic pain based on symptoms but confirm it with transfundal venography preformed in the operating room immediately prior to surgery. We treat pelvic congestion syndrome either by referring the patient to interventional radiology for embolization of the pelvic veins or by surgical selective pelvic vein ligation. In this procedure we separate ovarian veins from arteries and legate them and then legate any significantly enlarged veins in the broad ligament. Outcomes from this treatment are effective; however, pain and congestion may return with time, especially if the patient becomes pregnant again.\n- Type\n- Chapter\n- Information\n- Management of Chronic Pelvic PainA Practical Manual, pp. 112 - 119Publisher: Cambridge University PressPrint publication year: 2021\nPhillips, D, Deipolyi, AR, Hesketh, RL, Midia, M, Oklu, R. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol. 2014;25(5):725–3. DOI: 10.1016/j.jvir.2014.01.030.Google Scholar\nBrown, CL, Rizer, M, Alexander, R, Sharpe, EE, Rochon, PJ. Pelvic congestion syndrome: systematic review of treatment success. Semin Interv Radiol. 2018;35(1):35–40. DOI: 10.1055/s-0038-1636519.Google Scholar\nMathias, SD, Kuppermann, M, Liberman, RF, Lipschutz, RC, Steege, JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321–7.Google Scholar\nAndrews, J, Yunker, A, Reynolds, WS, Likis, FE, Sathe, NA, Jerome, RN. Noncyclic chronic pelvic pain therapies for women: comparative effectiveness. Comp Effect Rev. 2012;41. Rockville, MD: Agency for Healthcare Research and Quality (US). Report No. 11(12)-EHC088-EF.Google Scholar\nBorghi, C, Atti, LD. Pelvic congestion syndrome: the current state of literature. Arch Gynecol Obstet. 2016;293(2):291–301. DOI: 10.1007/s00404-015-3895-7.Google Scholar\nMeissner, MH, Gloviczki, P. Pelvic venous disorders. In Atlas of Endovascular Venous Surgery, 2nd ed. Philadelphia: Elsevier; 2019, 567–99.Google Scholar\nBeard, RW, Highman, JH, Pearce, S, Reginald, PW. Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet. 1984; 2(8409):946–9.Google Scholar\nLiu, J, Han, LH, Han, X. The effect of a subsequent pregnancy after ovarian vein embolization in patients with infertility caused by pelvic congestion syndrome. Acad Radiol. 2019;pii: S1076-6332(19)30017–0. DOI: 10.1016/j.acra.2018.12.024.Google Scholar\nFarquhar, CM, Rogers, V, Franks, S, Pearce, S, Wadsworth, J, Beard, RW. A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. Br JObstet Gynaecol. 1989;10:1153–62.Google Scholar\nShokeir, T, Amr, M, Abelshaheed, M. The efficacy of Implanon for the treatment of chronic pelvic pain associated with pelvic congestion: 1-year randomized controlled pilot study. Arch Gynecol Obstet. 2009;280: 437–43.Google Scholar\nSoysal, ME, Soysal, S, Vicdan, K, Ozer, S. A randomized controlled trial of goserelin and medroxyprogesterone acetate in the treatment of pelvic congestion. Hum Reprod. 2001;16(5):931–9.CrossRefGoogle ScholarPubMed\nTan, SL, Zaidi, J, Campbell, S, Doyle, P, Collins, W. Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle. Am J Obstet Gynecol. 1996;175(3 Pt 1):625–31.Google Scholar\nIgnacio, EA, Dua, R, Sarin, S, Harper, AS, Yim, D, Mathur, V, Venbrux, AC. Pelvic congestion syndrome: diagnosis and treatment. Semin Interv Radiol. 2008;25(4):361–8.CrossRefGoogle ScholarPubMed\nPDR (Prescriber’s Digital Reference). Drug Summary. ConnectiveRx. May 28, 2019. www.pdr.net/drug-summary/Provera-medroxyprogesterone-acetate-1015Google Scholar\nRay, CE, Bauer, JR. Embolization agents. In Mauro, MA (ed.), Image-Guided Interventions. Philadelphia, PA: Saunders Elsevier; 2008,131–9.Google Scholar\nDaniels, JP, Champaneria, R, Shah, L, Gupta, JK, Birch, J, Moss, JG. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Interv Radiol. 2016;27(10):1478–86.CrossRefGoogle ScholarPubMed\nGloviczki, P, Comerote, AJ, Dalsing, MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 Suppl):2S-48S. DOI: 10.1016/j.jvs.2011.01.079.Google Scholar\nEdwards, RD, Robertson, IR, MacLean, AB. Case report: pelvic pain syndrome: successful treatment of a case by ovarian vein embolization. Clin Radiol. 1993; 47:429–31.Google Scholar\nFreedman, J, Ganeshan, A, Crowe, PM. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 2010;86(1022):704–10. DOI: 10.1136/pgmj.2010.099473.Google Scholar\nKim, HS, Malhotra, AD, Rowe, PC, et al. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006;17:289.Google Scholar\nGargiulo, T, Mais, V, Brokaj, L, Cossu, E, Melis, GB. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome. J Am Assoc Gynecol Laparosc. 2003;10(4):501–4.Google Scholar\nBeard, RW, Kennedy, RG, Gangar, KF, et al. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. Br J Obstet Gynaecol. 1991;98:988.Google Scholar\nPropst, AM, Laufer, MR. Endometriosis in adolescents: incidence, diagnosis, and treatment. J Reprod Med. 1999 ;44(9):751–8.Google Scholar\nBookwalter, CA, VanBuren, WM, Neisen, MJ, Bjarnason, H. Imaging appearance and nonsurgical management of pelvic venous congestion syndrome. Radiographics. 2019;39(2):596–608.CrossRefGoogle ScholarPubMed\nAccessibility compliance for the HTML of this chapter is currently unknown\nand may be updated in the future.\n- 1\n- Cited by\nTo save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. 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