Finding Help for Pelvic Pain: Karine's Story

Karine C. had been suffering from chronic pelvic pain and discomfort for 15 years when an article caught her eye. Someone had been diagnosed with pelvic congestion syndrome—a term that refers to varicose veins in the pelvis—and had been successfully treated by an interventional radiologist.

"It's not on people's radar to look at a vascular doctor for pelvic pain," says Karine, a paramedic and mother of two who lives in Westchester County, New York. She began to read more about the condition and the doctors who treat it, eventually scheduling a consultation with interventional radiologist David Sperling, MD, at Columbia Radiology's office in Tarrytown, NY.

Karine's chronic pelvic pain had already led her to many health professionals, including gynecologists, urologists, and a physical therapist who specializes in pelvic floor dysfunctions. She had been diagnosed with a possible bladder condition called interstitial cystitis and adenomyosis, which led to a hysterectomy but no final solution for her pelvic pain.

Some of the interventions, including daily pain medication, provided temporary relief, but they didn't eliminate the pain. "I would go to the supermarket and wait on line, then I'd have to go home and lay down," she says. "Every three months there was something new I couldn't do any more. You push through the pain, but your quality of life goes down the drain really fast."

Karine's story is a familiar one to Sperling and his colleagues, who usually see patients who have already had long and frustrating journeys in their search for relief from pelvic pain.

"Complex pelvic pain is by definition very complicated and can have multiple causes," Sperling says, adding that many women he treats say they were not aware that their veins might be the culprit until they did their own research. "Sometimes the symptoms can be confusing both to the patients and the physicians who are taking care of them."

One symptom in particular puzzled Karine's doctors: standing, exercising, and even sitting made her pain worse, but she felt some relief when she lay down. Her pain also improved with pressure on her lower abdomen—from lying on her belly or wearing a tight cloth. "That was another thing my doctors had no answer for," she says.

For Sperling, who was thinking about her veins, her symptoms made sense.

Varicose veins are the result of faulty valves, whose job it is to open and close and help blood move up towards the heart. When the valves don't fully close, blood moves backwards and pools lower in the veins. Most people think of varicose veins as a problem of the legs, but they can occur anywhere in the body where blood is moving against gravity.

"If you think about all of that extra blood just sitting in the pelvis, you can imagine how it can cause pressure, pain, and heaviness," says Sperling, adding that the enlarged veins can also rub against the bowel, bladder, and nerves and cause symptoms related to those structures. "But it's really the vein that's the issue."

An MRI confirmed what Sperling suspected; Karine's pelvic veins were engorged. He recommended that she undergo a minimally invasive procedure called embolization, in which an interventional radiologist uses tiny tools and catheters to block the leaking vein. "The nice thing about the pelvis is that if you get rid of one vein, another vein will take over the job," says Sperling.

During an embolization procedure, an interventional radiologist uses live X-ray imaging, along with tiny catheters, to find and block a leaking or otherwise problematic vein. Embolization is used to treat many conditions that would otherwise require open surgery; when it's used to treat pelvic congestion syndrome, the procedure can be done in an outpatient office, and patients go home afterwards with a Band-Aid.

The relief was almost immediate for Karine. Within three weeks of her procedure, she was no longer waking up several times during the night to use the bathroom. She found herself enjoying basic things that used to feel difficult because of the pain, like taking a walk with her kids or even biking again.

Eight weeks after the procedure, she says the pain is 70 percent gone. "I can actually be active without having to lay down constantly," she says.

Karine's advice for women who are suffering from chronic pelvic pain: Be your own best advocate. “Just because you are a woman does not make it OK to live with pelvic pain," she says. "An interventional radiology consultation should be part of your investigational workup. It made a difference for me.”