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Condition/Disorder Synonyms

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  • Ovarian vein and pelvic varicosities

  • Pelvic venous incompetence

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ICD-9-CM Code

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  • 625.5 Pelvic congestion syndrome

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ICD-10-CM Codes

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  • G89.4 Chronic pain syndrome

  • R10.2 Pelvic and perineal pain

  • N94.89 Other specified conditions associated with female genital organs and menstrual cycle

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Preferred Practice Pattern

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Associated Physical Therapy Diagnoses

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  • 729.1 Myalgia and myositis, unspecified

  • 782.3 Edema

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Key Features

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Description2

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  • Non-cyclical, poorly localized pelvic pain

  • Pain worsened by sitting, standing, at the end of the day, during or after intercourse

  • Blood pooling in the pelvic and ovarian veins

  • Pain associated with varicose veins in the thigh, buttock regions, and vaginal area

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Essentials of Diagnosis

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  • Initially is a diagnosis of exclusion

  • Multidisciplinary approach to rule out other end organ pathology

  • Standard workup includes abdominal and pelvic examination, Pap smear, routine blood work, cross sectional imaging

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General Considerations

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  • Chronic pain condition

  • Often misdiagnosed

  • PT intervention is often appropriate for associated musculoskeletal impairments

  • Diagnosis is a process of exclusion and often takes time, requiring intensive diagnostic testing

  • Urogenital pain disorders frequently affect nearby body areas; especially back, pelvic, hip, and groin regions, and may be inappropriately referred to PT

  • May mimic other visceral pain conditions including colon cancer or tumor, irritable bowel, colitis

  • May mimic gynecologic problems in females: endometriosis, uterine fibroids, ectopic pregnancy

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Demographics

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  • Only in females, typically between ages of 20 to 452

  • More prevalent in multiparous women

  • Exact prevalence of pelvic congestion syndrome is unknown

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Clinical Findings

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Signs and Symptoms2

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  • Symptoms often worsened by prolonged sitting or standing, anxiety, bowel movements, physical activity, or sexual intercourse

  • Pain becomes progressively worse throughout the day

  • Generalized lethargy, depression

  • Abdominal or pelvic tenderness

  • Vaginal discharge

  • Dysmenorrhea

  • Swollen vulva

  • Lumbosacral neuropathy

  • Rectal discomfort

  • Urinary frequency

  • May have tenderness of the uterine cervix, ovaries, or uterus

  • Pain during sexual intercourse

  • Report of vaginal, rectal, or lower abdominal pain.

  • Symptoms are usually vague and poorly localized

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Functional Implications

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  • Pain

  • Painful urination, defecation, and sexual activity

  • Urinary urgency and frequency

  • Fatigue, lethargy

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Possible Contributing Causes

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  • Pregnancy and vaginal childbirth

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Differential Diagnosis

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  • Bowel pathology

  • Cancer

  • Neurologic pathology

  • Musculoskeletal pathology or impairment

  • Gynecologic problems in females

    • Endometriosis

    • Menses

    • Ectopic pregnancy

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