What causes pelvic pain and how to relieve it.

>> Thursday, August 21, 2014

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Many women experience pain in their bodies. It comes and goes and can be cyclic, relating to menstrual periods and ovulation. Other pain can include migraines, breast pain, lower back pain and deep or superficial pelvic pain. It doesn't matter if it's cyclic or relatively constant - pain brings fear and disrupts our ability to enjoy life. Today we're going to focus on pelvic pain.

Pelvic pain can be dull and achy, sharp, steady, intermittent, crampy, and sometimes just feel like a deep pressure or heaviness. It can be triggered by menstrual cycles, sex, and even having a bowel movement or urinating, and it can worsen when sitting or standing for long periods of time. The pain may have obvious origins like painful periods, endometriosis or ovarian cysts. But for some women, it is not so obvious and can be so frustrating.

PCS (pelvic congestion syndrome) is one cause of pelvic pain that is common, but not well-known or talked about too much. In fact, you may never have heard of this before. There is no immediate treatment for PCS, and it can go on for years without being diagnosed. Pelvic congestion syndrome is also known as pelvic venous insufficiency. With PCS, the pelvis become swollen from the back flow of blood (similar to varicose veins in our legs). This prevents normal blood flow through the pelvis, creating congestion, and this causes pain and other symptoms. The condition is associated with ovarian and pelvic vein dilatation where the veins are stretched beyond normal dimensions. This over-stretching can cause permanent damage.

In normal veins, blood flows from the pelvis up toward the heart by way of the ovarian veins, and it is prevented from flowing backwards by valves within the vein. When the ovarian veins are damaged, the valves do not close properly, resulting in back flow of blood.

Weight gain and pregnancy can worsen this condition because increased pressure and stress on the pelvis affects the ovarian veins. This, along with the increase of estrogen in pregnancy and weight gain, causes the vessels to over-stretch and weaken.
The pain with PCS can worsen when sitting or standing, and it is relieved with lying down. It can sometimes be associated with varicose veins in the thighs, buttock regions, or vaginal area. Some women experience pain with urination and during or after sexual activity. This can worsen to the point where you may have constant pain or sharp, stabbing pain, even while laying down resting.

Problems with orgasms during sex can be a cause of PCS. This is because sexual excitement increases blood flow to the pelvis, and orgasm releases the buildup of blood, similar to what we can visibly see in a man who is excited. Increased blood flow to the pelvis will cause an erection in a man, which quickly goes away as pelvic circulation normalizes.

It is important to go see your doctor for a definite diagnosis of your pain and to rule out other causes. Abdominal and pelvic ultrasound is an important tool in the diagnosis of PCS because it can eliminate other common causes of pain and evaluate blood flow. CT Scans and MRI are helpful, but only if ultrasound is unable to see everything or to delineate an abnormality better. Pelvic venography is considered the most definitive imaging modality for diagnosing PCS because it can identify the abnormal veins and the reversal of blood flow within the affected veins.

This may seem strange, but physical therapy and relaxation techniques can be amazingly beneficial. Applications of heat and cold to your abdomen, stretching exercises and massage may help the pain because it can increase your circulation. Kegel exercises may also be helpful, but if the pain is caused from difficulty achieving an orgasm, sexual therapy and evaluation is crucial. Pain relievers that decrease inflammation like aspirin, ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain and is not recommended long-term.

Laparoscopic surgery is an excellent way to evaluate pelvic congestion and to determine if there are other factors involved that can't be seen by any other means (i.e. extensive scarring, adhesions or endometriosis).

It is important to see your doctor and not continue to suffer with the pain. It could be easily corrected, or it may take some time and multiple treatments, but waiting may be making it worse and harder to treat as time goes on.
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