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274: PELVIC CONGESTION SYNDROME

Cynthia E. Neville, DPT, PT, WCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Ovarian vein and pelvic varicosities

  • Pelvic venous incompetence

ICD-9-CM CODES

  • 625.5 Pelvic congestion syndrome

  • Associated Physical Therapy Diagnoses

    • 729.1 Myalgia

    • 782.3 Edema

ICD-10-CM CODES

  • G89.4 Chronic pain syndrome

  • R10.2 Pelvic and perineal pain

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

PREFERRED PRACTICE PATTERN

  • As of July 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology.

  • Associated or secondary musculoskeletal patterns include:

    • 4C Impaired Muscle Performance1

    • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

PATIENT PRESENTATION

A 32-year-old woman reports a gradual onset of pain and swelling in the vaginal area, upper thigh, and labia which worsens when she is sitting. In the past year, she has developed more symptoms. She has noticed that she has to urinate more frequently, at least 10 times per day. She now is having pain during intercourse, and sometimes feels a throbbing pain in the vaginal regions at the end of the day.

KEY FEATURES

Description2

  • Noncyclical 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, vaginal area

FIGURE 274-1

On the image’s right, pelvic varices have already been treated with sclerosant and coils in the left ovarian vein. On the image’s left, a guiding catheter is threaded into the right ovarian vein to perform ovarian venography and embolization. (From Kim HS, Malhotra AD, Rowe PC, et al. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Intervent Radiol. 2006; 17:289, with permission.)

image
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Essentials of Diagnosis

  • 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

General Considerations

  • Chronic pain condition

  • Often misdiagnosed

  • PT intervention is often appropriate for associated musculoskeletal impairments.

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

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

  • May mimic other visceral pain conditions including coloncancer or tumor, irritable bowel, colitis.

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

FIGURE 274-2

Embolization of ovarian vein varices in a 30-year-old multiparous woman with pelvic congestion syndrome. She complained of increasing pelvic pain and dyspareunia. On examination there were prominent vulval varicosities. ...

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