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  • Ovarian vein and pelvic varicosities
  • Pelvic venous incompetence

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  • 625.5 Pelvic congestion syndrome

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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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  • 729.1 Myalgia and myositis, unspecified
  • 782.3 Edema

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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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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
    • Ovarian cyst
    • Fibroids
    • Menopause
    • Uterine prolapse
  • Fibromyalgia
  • Urologic pathology
  • Pelvic inflammatory disease

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Laboratory Tests

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  • Blood tests
  • Pap smear
  • Urine culture/urinalysis
  • H&H for signs of bleeding, anemia, pathogens, immune status, vitamin deficiencies, white blood cell count

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