Dr. Kirsch was interviewed - UAE - TV Channel 6 News, November 19, 2004

Interview:  Scene 8 CN8 Uterine Artery Embolization (2004)   Healthcast CN8  May 25 at 6:30 PM

A Treatment for Pelvic Congestion Syndrome

By Hope Waltman 

Chronic pelvic pain can cause women to become addicted to pain medication, seek psychiatric treatment, have their sex lives fall apart, undergo multiple surgical treatments and even have reproductive organs removed.   

What is Pelvic Congestion Syndrome? 

Internal varicose veins cause chronic pelvic pain. The valves that control the blood flow to the heart leak, causing the blood to flow backward and pool in the pelvis.  The additional pressure to the veins causes them to twist, stretch, bulge and become dilated and congested. The organs that are affected by pelvic congestion syndrome are the uterus, ovaries and vulva (the external genitals). 

What percentage of women experience Pelvic Congestion Syndrome? 

Approximately 15 percent of women experience Pelvic Congestion between the ages of 20 and 50, but not all experience symptoms. Pregnancy increases the pelvic vein capacity by 60 percent (successive pregnancies can make the valves in the veins break down) and most women are premenopausal (the condition is rarely seen in women after menopause).  

What are the symptoms? 

Symptoms include:  pelvic pain that worsens towards the end of the day or after long periods of standing; lower back pain; vaginal discharge; continuous or recurring pain for at least six months; initial sensation of fullness or heaviness, which can increase to severe pain, including during or after menstruation or intercourse.   

How will the doctor examine a patient for Pelvic Congestion Syndrome? 

The doctor will first check to make sure that the problem is not cancer, pelvic inflammatory disease, uterine fibroids, uterine prolapse, ovarian cysts, lower gastrointestinal tract problems or endometriosis (pain caused by menstrual tissue being outside of the uterus usually as adhesions or cysts).

After other medical conditions have been ruled out, the doctor will perform an x-ray study of the pelvic veins, performed while the patient is upright because the vein is decompressed if the patient is lying down. (Many patients are misdiagnosed, because conventional imagings are taken in the supine position, with the patient lying down on a table.) 

March 2003 Update -  I asked Dr. Worthington-Kirsch, “ What medical examination will an Interventional Radiologist perform to diagnose Pelvic Congestion Syndrome?”

He replied, “The doctor may perform a pelvic exam to check for labial varicosities (external genitalia varicose veins).  The newest data suggest that a Magnetic Resonance Imaging (MRI) best evaluates this entity. However, I prefer to order the MRI myself rather than have a patient come with a possibly inadequate study.”

Will a hysterectomy take care of the pelvic pain? 

No. One-fourth of all women with Pelvic Congestion Syndrome have had hysterectomies, which does not solve the problem. 

What treatment is available for Pelvic Congestion? 

Ovarian Vein Embolization (a.k.a.Gonadal Vein Embolization) has been performed since the mid 1980s. The procedure is done as an outpatient (day surgery) and takes approximately two hours.

Dr. Robert Worthington-Kirsch, an Interventional Radiologist, who performs Ovarian Vein Embolization at Roxborough Memorial Hospital in Philadelphia, describes the procedure as follows:  “The patient is given local anesthesia with a light sedation. The Interventional Radiologist makes a pencil-tip sized incision in the vein at the groin or neck and then uses x-ray guidance to guide the catheter through the ovarian vein and x-ray dye that shows the direction the blood flows and lights up the abnormal veins on the x-ray. A tiny catheter is inserted into the vein and tiny stainless steel coils or gelatin slurry (glue-like liquid) is passed through the catheter to block the damaged ovarian vein.  The ovarian varicose vein is closed off and the pressure and congestion is eliminated.  Once the damaged vein is closed off, healthy veins take over, regulating the blood flow in the pelvic area.”

After the procedure most patients will return to work the next day. The pelvic pain is improved or eliminated in 80 percent of women who have this non-invasive procedure.

For more information refer to:  Severe Ovarian Vein Syndrome (case studies) by Dr. Robert Worthington-Kirsch.

Email Questions:

Friday, December 23, 2005

I was reading your piece on pelvic congestion.  The question was asked, "Will a hysterectomy take care of the problem?".   You said , "No".   My question is, "Why?"

The problem in PCS is abnormality of the veins draining the pelvis, not the uterus.  Removal of the uterus may reduce the blood flow and provide some relief, but it does not correct the underlying abnormality of the veins, nor change the abnormal homodynamic that cause symptoms. – Robert Worthington-Kirsch, M.D.

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If you have questions or need more information on Pelvic Congestion Syndrome, contact Robert Worthington-Kirsch, M.D., FSCVIR, Image Guided Surgery Associates, PC, e-mail kirsch@igsapc.com, website www.IGSAPC.com.

www.sirweb.org has a "Find an Interventional Radiologist (Search - Chronic Pelvic Pain)".