Pelvic congestion syndrome

　　Any factor that causes poor or blocked outflow of pelvic veins from the pelvic cavity can lead to pelvic venous congestion.

　　1. Anatomical factors

　　The characteristics of the female pelvic circulation are mainly an increase in the number of veins and a weak structure.

　　The medium veins in the pelvic cavity, such as the uterine vein, vaginal vein, and ovarian vein, are generally accompanied by 2 to 3 veins with a同名 artery, and the ovarian veins can even reach 5 to 6, forming a network of veins, winding on both sides and behind the uterine body until they form a single ovarian vein before flowing through the pelvic margin. There are many anastomoses between the uterine, fallopian tube, and ovarian veins, and within the mesosalpinx, there are anastomoses between the uterine and ovarian veins, forming a circular venous circulation that connects with the external ovarian venous plexus. Originating from the mucosa, muscular layer, and subserosal venous plexus of pelvic organs, they integrate into two or more veins that flow into the large iliac internal vein. The increase in the number of pelvic veins is to adapt to the slow flow of pelvic venous blood.

　　3. The venous wall of the pelvic veins is thinner than that of other parts of the body, lacks an outer sheath composed of fascia, has no valves, lacks elasticity, and runs through the loose connective tissue in the pelvis. Therefore, it is easy to expand and form many twisted venous plexuses. The medium and small veins in the pelvis only have valves before entering large veins. Some multiparous women also often have incomplete valve function. These characteristics make the venous system of pelvic organs, like a water network-connected swamp, able to accommodate a large amount of rapidly flowing arterial blood.

　　Two, constitution factors

　　Some patients, due to factors such as constitution, have significantly weak vascular wall tissue, fewer elastic fibers, and poor elasticity, which are prone to form venous blood stasis and varicose veins. Even in the first pregnancy, without engaging in long-term standing or sitting work, varicose veins in the lower limbs or pelvic congestion syndrome may occur.

　　Three, mechanical factors

　　1. Body position: People who have long-term standing or sitting work, the pelvic venous pressure continues to increase, and it is easy to cause pelvic congestion syndrome. Such patients often complain of increased pain in the lower abdomen and back, increased leukorrhea and menstrual flow after long standing or sitting, and symptoms often subside after rest. In addition, those who are accustomed to supine sleep may also affect the outflow of pelvic veins due to the gravitational effect of the uterus and the filling of the bladder, causing the uterus to move backward. From the perspective of mechanics, when habitual supine sleep occurs, the position of most pelvic veins is lower than the inferior vena cava, which is not conducive to the outflow of pelvic veins. Lateral sleeping or lateral prone sleeping is beneficial to the outflow of pelvic veins.

　　2. Retroverted uterus: Retroverted uterus accounts for 15-20% of gynecological patients, and may be higher in multiparous women. A hundred years ago, people believed that retroverted uterus was the cause of various pelvic symptoms and often performed uterine suspension surgery. By the beginning of this century, people gradually realized that the vast majority of retroverted uteri without symptoms did not require treatment, only a small part had pathogenic effects. However, many doctors believe that a few retroverted uteri can indeed cause pelvic pain.

　　3. When the uterus is retroverted, the ovarian plexus vessels follow the uterus downward and bend on both sides of the sacral凹, which increases venous pressure and affects the return, causing the veins to be in a stasis state. If there is a habit of supine sleep, it can lead to pelvic congestion syndrome over time.

　　More than 1/3 of patients with pelvic congestion syndrome have bladder irritation symptoms, which are manifested as significant urinary frequency during menstruation and are often misdiagnosed as urinary tract infection. Cystoscopy shows that the bladder trigone is filled with veins, congested, and edematous. Some patients may develop hematuria due to the rupture of small veins with blood stasis.

　　The main manifestations of pelvic congestion syndrome are widespread chronic pain, extreme fatigue, and certain symptoms of neurasthenia, among which chronic lower abdominal pain, low back pain, lack of pleasure, extreme fatigue, excessive leukorrhea, and dysmenorrhea are the most common. Almost more than 90% of patients have varying degrees of the above symptoms. Chronic pain refers to various forms of pain lasting for more than half a year, with a frequency of not less than 5 days a week, and the pain time is not less than 4 hours per day. In addition, patients often have symptoms such as excessive menstrual bleeding, premenstrual breast tenderness, premenstrual defecation pain, bladder irritation symptoms, and vaginal and anal坠坠痛. These symptoms worsen in the afternoon, evening, or after standing. The symptoms are more severe after sexual intercourse or before the onset of menstruation.

　　To prevent the occurrence of pelvic congestion syndrome, it is necessary to strengthen the publicity of family planning, prevent early marriage, early childbearing, frequent sexual intercourse, and dense childbirth. It is advocated to have at most two children, with an interval of at least 3 to 5 years between births, so that the reproductive organs can not only recover anatomically and physiologically but also in terms of vascular function. Publicize scientific methods of contraception and do not use the withdrawal method of contraception. Pay attention to physical exercise, enhance physical fitness, and improve general health. Strengthen postpartum health publicity and education, promote postpartum exercises, which are very beneficial for the recovery of reproductive organs and their supporting tissues. Avoid habitual supine position during rest or sleep, advocate alternating lateral decubitus position, which is conducive to preventing the formation of posterior position of the uterus. Prevent constipation and urinary retention after delivery, which helps the recovery of reproductive organs and the return of pelvic veins. For those who work for a long time in a standing or sitting position, it is advisable to carry out intermission exercises and appropriate activities when possible.

　　Generally, the following examinations are required to diagnose pelvic congestion syndrome:

　　1. Vaginal ultrasonic color Doppler examination:Ultrasonic examination is an important measure for the diagnosis of pelvic congestion syndrome.

　　2. Laparoscopic examination:In some cases, varicose veins may not be visible, but they can be distinguished from other lesions such as inflammation.

　　3. Spiral CT:Recent literature reports that spiral CT is an effective non-invasive diagnostic method for pelvic congestion syndrome. Spiral CT images of arterial phase when the patient takes a deep breath because deep breathing causes an increase in abdominal venous pressure, leading to retrograde blood flow in the renal veins, filling the varicose veins around the uterus and ovaries. Varicose veins with a diameter greater than 5mm can be visualized. Conventional CT only shows some dilated veins, which are not related to pelvic congestion syndrome.

　　4. Pelvic venography:Pelvic venography involves injecting contrast material into the myometrium at the bottom of the uterine cavity, making the uterine veins, ovarian veins, and some vaginal veins, and iliac internal veins visible. Continuous filming is taken at certain time intervals to understand the time of outflow of pelvic blood (mainly uterine veins and ovarian veins) from the pelvic cavity, as a method of auxiliary diagnosis for pelvic congestion syndrome. When the pelvic venous blood supply is normal, the contrast material usually completely leaves the pelvic cavity within 20 seconds; while in pelvic congestion syndrome, the venous return rate is significantly slower, and it takes more than 20 seconds for the contrast material to leave the pelvic cavity.

　　5. Radioisotope Pelvic Blood Pool Scan:This method is used to diagnose pelvic venous congestion after tubal ligation, the principle is that when there is pelvic venous congestion, local varicose veins occur, blood stasis forms a 'blood pool', thus obtaining a scan image with radioactive readable isotope concentration.

　　6. Body Position Test:When in the prone-knee position, the pressure of the pelvic veins decreases, there is no lower abdominal pain or slight pain. If you immediately change to sit on the heels with the buttocks facing backward, maintaining a position slightly higher than the abdomen, due to the tight curvature of the inguinal canal, the blood flow from the external iliac artery to the femoral artery is blocked, thus increasing the blood flow of the internal iliac artery, causing an increase in pelvic venous pressure, resulting in congestion, and the appearance of lower abdominal pain. When returning to the prone-knee position, the symptoms are relieved, which is called 'positive body position test'.

　　In addition to actively accepting drug treatment, patients with pelvic venous congestion syndrome can try the Dandelion Radish Soup, which is effective.

　　1. Composition: Dandelion 100 grams, honeysuckle 20 grams, dandelion 25 grams, white radish 200 grams.

　　2. Usage: Boil the four ingredients together, eat radish and drink the soup after removing the medicine. One dose per day.

　　3. Effect: Clear heat and detoxify.

　　4. Note: The honeysuckle has varying degrees of inhibitory effect on a variety of bacteria such as staphylococcus, streptococcus, pneumococcus, E. coli, Pseudomonas aeruginosa, and skin fungi.

　　According to the severity of pelvic venous congestion syndrome, the specific treatment methods are as follows:

　　1. Treatment for Mild Patients

　　Mild patients often do not need drug treatment, and can provide health guidance based on their relevant causes, so that patients have a full understanding of the formation and prevention and treatment of this disease. During rest, change the habitual supine position to the lateral recumbent position, correct constipation,节制房事, do appropriate physical exercise to increase pelvic muscle tension and improve pelvic blood circulation. Generally, the effect is good.

　　2. Treatment for Severe Patients

　　Severe patients should persist in the kneeling chest position for more than 10 minutes in sequence, then rest in the lateral recumbent position, observe the effect. Generally, it can significantly alleviate or mitigate symptoms such as severe pelvic pain. If the lateral recumbent position therapy is effective but cannot be consolidated, surgical treatment can be considered, generally including three types: round ligament suspension surgery, broad ligament laceration repair surgery, and total abdominal hysterectomy with附件切除术.