Post-Hysterectomy Pain & Veins: Understanding Endometriosis & Varicose Veins

Question
Hi I just had a hysterectomy on April 17th, they also removed my cervix and my right ovary, during the removal of my uterus, they also ripped my bladder, but when they removed my cervix, not only did I have endo, but I had severe vericose veins under and behind my uterus, right now I feel like garbage, just got my catheter out yesterday, and I still have the same pain that I went in to get rid of, it is in my butt.  Could you tell me what causes these veins, why they didn't know that I had them and will I ever feel any better?  Thanks

Answer
Dear Margie,

Veins have valves that act as one-way flaps. These valves prevent the blood from flowing backwards as it moves up the legs. If the one-way valves become weak, blood can leak back into the vein and collect there. This problem is called venous insufficiency. Pooled blood enlarges the vein and it becomes varicose.

The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don't close properly, this allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva. Up to 15% of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.

Please note that the diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing. This is not at all uncommon.

Risk Factors for pelvic congestion syndrome (PCS) include:
-Two or more pregnancies and hormonal increases
-Fullness of leg veins
-Polycystic ovaries
-Hormonal dysfunction

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:
-Following intercourse
-Menstrual periods
-When tired or when standing (worse at end of day)
-Pregnancy

Other symptoms include:
-Irritable bladder
-Abnormal menstrual bleeding
-Vaginal discharge
-Varicose veins on vulva, buttocks or thigh.

Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.

In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal. The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95-100 percent of cases. A large percentage of women have improvement in their symptoms, between 85-95 percent of women are improved after the procedure. Although women are usually improved, the veins are never normal and in some cases other pelvic veins are also affected which may require further treatment.

Additional treatments are available depending on the severity of the woman's symptoms. Analgesics may be prescribed to reduce the pain. Hormones such birth control pills decrease a woman's hormone level causing menstruation to stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins. Since this has already been done for you, it difficult to say whether your pain is still continuing related to the varicosities themselves that were left untreated or if you are just too too soon post-op to feel much relief yet. That may be something to discuss with your doctor.

I hope this information has helped you and answered your question. I wish you well.

Brenda