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Saturday, March 31, 2012

Pelvic Congestion Syndrome

Pelvic Congestion Syndrome-What is pelvic congestion syndrome?

Pelvic congestion syndrome, the most important symptom is lower abdominal pain, low back pain, unhappy sexy, extreme fatigue, bleeding and dysmenorrhea and premenstrual breast pain. The pain is often aggravated a few days before menstruation, alleviate cramps after the first or second day, there are a few cases of continued pain. The pain is often the patient to stand for some time to run, jump, or a sudden sit down heavier after intercourse also increased in the afternoon than the morning weight. Deep intercourse pain is a symptom of the common and do not want ashamed. Pain, such as vaginal discharge and more, constipation, bladder pain, irritable temperament, which is also the syndrome of the common symptoms. Most patients were married, the symptoms mostly in a short period of time after a childbirth or abortion. Is most common in women aged 25 to 40, rare in premenopausal, never seen may, after menopause. Gynecological examination, premeditated cervix, the uterus of the posterior fornix tenderness, attachment area tenderness, seem to have a sense of thickening; post-uterine tissue tenderness is also common.

Pelvic congestion syndrome - diagnosis
As mentioned above the pelvic congestion syndrome, pelvic congestion symptoms involve a very wide range, on the signs be confused with some other lesions, often resulting in the clinical diagnosis difficult. However, if asked in detail about the history, attention to the differences in the symptoms and signs, except for other related diseases, appropriate application of pelvic vein venography and laparoscopy can be made more reliable diagnosis. The following points provide a reference:First, patients in women of childbearing age, had two or more production history of abortion, following a production or post-abortion soon, these chronic pelvic pain, low back pain, sexy unhappy, dysmenorrhea, and other symptoms, but postpartum or post abortion infection.
Two subjective symptoms and objective examination findings are incompatible. Patient complained of symptoms, gynecological examination only see the cervical hypertrophy, purplish blue, some erosion, uterus down on the sacrum concave, but as fierce one touches the cervix or posterior fornix touch arrived, it will cause serious pelvic and lumbosacral pain, uterine, and attachment District obvious tenderness and full of sense, if they continue to slowly touch the feeling of a soft, such as sponges, and there is no thickening the chronic annexitis often and hard strips cords, there is no muscle tension and rebound. When the uterus down in trying to make use practices complex anterior, the patient felt pain.
Pelvic congestion syndrome, often accompanied by premenstrual breast swelling and pain and certain symptoms of neurasthenia.
Fourth, although has been diagnosed as "chronic annexitis" or "chronic pelvic inflammatory disease, but rarely prevent pregnancy. Even abortion after being diagnosed as chronic inflammation annex, the symptoms of a cure is not pregnant.
A variety of treatment Click for chronic pelvic are effective little or no effect. The patients consciously serious gynecological diseases and permanently, the gynecologist as the intractable disease.
By gynecological examination and other ancillary diagnostic method with the above symptoms, such as the uterus fallopian tube, etc., to rule out pelvic organic disease, and clinically suspected pelvic venous congestion syndrome, feasible pelvic venography to help diagnose the specific implementation details .
Pelvic venography pelvic vein angiography contrast agent injection in the bottom of the myometrium of the uterine cavity, uterine vein, ovarian vein and part of the vaginal vein, internal iliac vein imaging, continuous shooting and a certain time interval, to understand pelvic blood (uterine vein and ovarian vein) and outflow of the pelvic congestion syndrome as a secondary diagnosis method.
In the pelvic venous transport normal, the contrast agent is usually within 20 seconds completely out of the pelvic; pelvic congestion syndrome, venous return speed was slow, the outflow of contrast agent pelvic, more than 20 seconds.

Pelvic congestion syndrome - disease factorsFactors the pelvic impeded or obstructed pelvic venous outflow of the pelvic congestion syndrome can be induced into the pelvic venous stasis. And compared to men, women pelvic circulation in anatomy, hemodynamics, and mechanics are very different. Is easy to form the basis of pelvic congestion.First, the anatomical factors
Characteristics of the female pelvic circulation, mainly venous increase in the number and weak construct.
Medium veins of the pelvis, such as uterine vein vaginal vein and ovarian vein, usually two to three veins with a same name artery, ovarian vein and even up to 5 ~ 6 to form the pampiniform venous plexus, bending on both sides of the rear of the uterus until they flow through the edge of the pelvis before the formation of a single ovarian vein. Many anastomotic branch between the uterus, fallopian tubes, ovarian vein and the anastomotic branch of uterine vein and ovarian vein in the membrane of the fallopian tube, and the formation of the venous circulation of the ring, and then the ovarian venous plexus and lateral anastomosis. Originated in the mucosa, muscular layer and the serosa of the pelvic organs, venous plexus, a collection of more than two veins, the flow of the thick iliac vein. The increase in the number of pelvic veins, is the need to adapt to the slow flow of pelvic veins.
Pelvic veins vein wall is thin compared to other parts of the body, the lack of the fascia sheath, there is no valve, lack of flexibility, through the pelvic loose connective tissue. Are prone to expansion and the formation of a number of curved venous plexus. Small and medium-sized veins in the pelvic only have the valve before it enters a large vein, some mothers also often valvular insufficiency. These characteristics make the venous system of the pelvic organs, like a water network is connected to the swamp to accommodate a large number of rapid inflow of arterial blood.
In addition, bladder, reproductive organs and rectum three systems venous plexus connected to each other. The lack of valve of any one system among the three circulatory disorders can affect the other two systems.
On the basis of these anatomical features of the pelvic veins, such as longer subject to the following factors will contribute to pelvic congestion syndrome, and the performance of various clinical signs.
Second, physical factors
Some patients due to physical factors, the vessel wall was significantly weak, elastic fiber, poor flexibility, easy formation of the venous blood flow stasis and varicose veins. Even if the first pregnancy, usually do not engage in prolonged standing or sitting, may appear lower limbs and / or pelvic varicose veins and pelvic congestion syndrome.
Third, the mechanical factors
Different mechanical factors that can affect the pelvic blood flow, thereby changing the pressure of local blood vessels, veins more likely to be influenced.
(A) position: workers has long been engaged in standing or sitting, pelvic venous pressure continued to increase, easily induced into the pelvic congestion syndrome. Such patients often complained of the long standing sedentary after lower abdominal pain, low back pain, increase the amount of vaginal discharge and menstrual flow Cadogan, and after a rest, often the symptoms reduced. In addition, accustomed to the supine sleep, due to the gravity of the uterus and bladder filling the uterus backward shift, may also affect the outflow of the pelvic veins. From a mechanical point of view, habitual sleep supine position, the position of the pelvic most of the vein below the inferior vena cava, is not conducive to the outflow of the pelvic veins pelvic, lateral position or prone position, sleeping side is conducive to the outflow of the pelvic veins.
Backward (b) of the uterus: the uterus backward in gynecological patients accounted for 15 to 20 percent, may be even higher in the maternal. 100 years ago, people had thought that the uterus backward is caused by a variety of pelvic symptoms, and often line the Palace suspension surgery. Backward to the beginning of this century, people gradually realized that the vast majority of the activities of the uterus has been no symptoms, no treatment, only a portion of the uterus backward role of disease-causing pain. But many doctors believe that there are a few of the activities of the uterus backward indeed can cause pelvic pain.
Uterus backward, the ovarian plexus blood vessels with the uterus decreased bending in the sacral concave on both sides, so that the increased venous pressure, reflux affected, causing the vein in stasis state. If supine sleep habits, and the passage of time can lead to pelvic congestion syndrome.
(C) the frequency of early marriage, early childbearing and motherhood: a result of the large number of male and progesterone, during pregnancy, plus on the enlarged uterus on the veins of the uterus around oppression, can cause the uterus around the vein dilation.
(D) of constipation: constipation affect rectal venous return, rectum and uterus, vagina vein anastomosis with each other. Hemorrhoidal plexus congestion would inevitably lead to the uterus vaginal plexus congestion, habitual constipation is prone to pelvic congestion.
(E) the broad ligament laceration: broad ligament fascia laceration made structure on the weak, lack of flexibility, the lack of inherent vascular sheath of the vein to lose support, and the formation of varicose veins, but also makes the uterus and pour.
(F) tubal ligation: With the extensive development of family planning, tubal ligation is the most commonly implemented family planning surgery one. In recent years, many of the magazine published successively lower abdominal pain, menstrual disorders, secondary dysmenorrhea and other reports of complications related to ligation.
Tubal ligation is a minor operation, in theory, may not produce the above-mentioned complications. But in fact do some ligation women's pain and, allowing physicians to difficult complications.
Fourth, autonomic disorders.
Notwithstanding the above species at the reasons and the anatomical lesions, but has a lot of obstetrics and gynecology workers argue that some of the symptoms of pelvic congestion syndrome, such as: depression, sadness, feelings of irritability, fatigue, chronic pain, back pain, sexy unhappy a large extent with the patient's mental state. Department may be due to autonomic dysfunction results.
Five other
Clinical uterine fibroids, chronic pelvic inflammatory disease (especially the formation of tubal ovarian cysts), lactational amenorrhea, severe cervical erosion and other patients in doing pelvic venography, and some also show that the phenomenon of pelvic venous stasis ; while the long-term depression, chronic illness, insomnia and other spiritual influence, and by the pre-estrogen, progesterone levels fluctuate, there are also similar to pelvic congestion symptoms. Pelvic venous stasis scene of the former type of situation can be regarded as a concurrent change; the latter category could be considered aggravating factors for pelvic congestion syndrome.
Pelvic congestion syndrome - pathological changesPelvic congestion syndrome pathologic findings: genital vein and filling as well as varicose vaginal mucosa purplish coloring, cervical hypertrophy, edema, neck mucosal the Changcheng eversion erosive surrounding mucosa purplish coloring, and sometimes the cervix after lip look to the filling of small veins and cervical secretions. Surgical findings, the vast majority of patients with endometriosis and pour in the sacral concave surface of the purple-blue stasis-like or yellow-brown bleeding spots and subserosal edema, can be seen filling the varicose veins of the uterus, ovarian vein on both sides of plexus like a bunch of earthworm-shaped bend in the Palace side of the body side and pour it, may be one side than the other side of the heavier, sometimes like varices, abnormal thick. Tubal membrane of the vein than normal thickening, filling in diameter up to 0.8 ~ 1.0cm, and some were intravenous tumor-like. To move the uterus into anterior, may see the both sides of the broad ligament depression peritoneal laceration, laceration minority like the wide open eye fissure, laceration inwards to the sacral ligament like absence. The laceration some smaller, there's the posterior lobe of peritoneal meager, can be seen filling bulge bulging varicose veins of the uterus from the laceration Department. Typically, no more than 10 minutes, you can see the move into the anterior uterus by the violet-blue restored to the normal pink. Microscope, the endometrial stromal edema, venous filling and expansion. Ovarian general, cystic, showing edematous. Breast gland edema, hyperemia, resulting in breast tenderness. Case of broad ligament laceration and III of the uterus backward, light blue, ranging from 30 ~ 80ml serous fluid within the depression of the uterus rectum.Pelvic congestion syndrome - clinical manifestationsMainly of pelvic congestion syndrome, pelvic congestion syndrome is a wide range of chronic pain, extreme fatigue and some symptoms of neurasthenia. Among them, chronic abdominal pain, low back pain, pleasure and displeasure, extreme fatigue, excessive vaginal discharge and dysmenorrhea is the most common, almost 90% of patients with varying degrees of these symptoms. So-called chronic pain, refers to various forms of pain which lasted more than six months, a frequency of at least five days a week, every day the pain lasted less than four hours. In addition, patients also often menorrhagia, premenstrual breast tenderness, premenstrual defecation pain, bladder irritation and vaginal pain, fall anus fall pain. These symptoms are aggravated in the afternoon, evening or standing, after sexual intercourse, menstruation Pro to even more.First, lower abdominal pain
The majority of chronic ear bones joint on diffuse pain or lower abdominal pain for both sides, often on one side heavier, and at the same time involving the ipsilateral or leg, especially thigh or hip pain, weakness, began in midcycle. A small number of patients occasionally acute onset of abdominal pain, often misdiagnosed as acute appendicitis, follicle rupture, ruptured ectopic pregnancy.
Second, low back pain
Patients referred to the location of the pain is equivalent to the sacral the buttocks regional level, a few in the lower part of sacrum, often accompanied by lower abdominal pain. Premenstrual increase the long standing and after sexual intercourse.
Third, dysmenorrhea
Almost half of patients have this symptom. Is characterized by a few days before menstruation begins to lower abdominal pain within the bulge, lumbosacral pain or pelvic pain, some turning into a spasm of pain, to menstruation to the day before or the first day of the most powerful, the next day after menstruation significantly reduced.
Fourth, the sexy offensive
Asked patients often complained of the different degrees of pain during intercourse, deep intercourse pain, and some almost unbearable, not only was pain, abdominal pain, back pain, vaginal discharge and other symptoms the next day under significantly heavier, and thus the patient sex life boring.
5, extreme fatigue
Patients often all day was very tired, almost unable to complete the work undertaken by their own (including home).
VI leukorrhagia
More than half of patients have symptoms of leukorrhagia. The leucorrhea The characters are mostly clear mucus of no infection symptoms.
Seven, the period change
Part of patients with menorrhagia change, often because of uterine hypertrophy was misdiagnosed as uterine fibroids or uterine hypertrophy. There are some patients menstrual flow counter than before to reduce. But associated with premenstrual breast pain.
Stasis breast pain
Pelvic congestion syndrome for more than 70% of patients with bleeding and breast pain, swelling. Patients themselves to touch the breast induration, and tenderness at the same time with the above symptoms after more than midcycle, to the day before menstruation or menstrual cramps the first day and reached a peak after menstruation, along with the above symptoms eased or disappeared completely. Some patients whose breast pain compared with pelvic pain as the most important, as well as to patient's chief complaint.
Nine, vulvovaginal swelling, pain, fall
The pelvic congestion syndrome patients often have swelling, fall within the vulva and vagina pain, vulvar burning, itching. The vulva can be expressed coloring, labia swelling or hypertrophy, as well as some degree of vein filling, engorgement, or varicose.
X., bladder and urinary tract symptoms
More than about 1/3 of patients with premenstrual obvious meaning of the urinary symptoms of frequency number and urination pain, are suspected urinary tract infection, but urine examination was normal. Some patients with severe symptoms further to do cystoscopy can be found in the bladder trigone vein filling, hyperemia and edema. Individual patients can lead to stasis of small vein rupture hematuria.
11, rectal pain, fall
Part of patients with varying degrees of rectal fall sense rectal pain, rectal pain or bowel movements, compared with premenstrual, especially in the position in the uterus Ⅲ were more common.
XII of the autonomic nervous system symptoms
The vast majority of patients with pelvic congestion syndrome are associated with certain symptoms of the autonomic nervous system. Its performance and severity vary, but confined to the following aspects:
(A) the general nervous system symptoms: irritability, mood, irritability, anger, crying tears, depression or depressive mood, Night's Dream, daytime fatigue and the feeling of impotence on the mental strength is often very severe, frequent headaches, multi-pillow back pain, rather than the type of premenstrual headaches.
(B) cardiovascular: palpitation, precordial Fullness discomfort.
(C) Respiratory: shortness of breath feeling, which require big mouth breathing.
(D) of the digestive system: uh gas, bloating and poor exhaust feeling. Perceived poor appetite, indigestion, but does not actually eat, not weight loss.
(E) other: the body everywhere Mo untold pain discomfort, such as shoulder pain, hip pain, fingers tight feeling, many people there are eye swelling and flu, etc..
13, signs
Not commensurate with the severity of the subjective symptoms. Abdominal examination the only finding is tenderness parts more in the pubic symphysis area, or the lower abdomen on both sides of a deep tenderness, in general, not significant, not even a constant is particularly evident in the tender point, even if the patient feel the most pain the site, and no abdominal tension and rebound. Gynecological bimanual be found in the uterus and more posterior, slightly larger than normal. Cervical hypertrophy, purple-blue, mostly smooth, also the erosion.
Some patients consciously breast induration, but check to see just below the nipple diffuse swelling of breast tissue, often accompanied with varying degrees of tenderness.

Pelvic congestion syndrome - treatmentPelvic congestion syndrome treatment before, we must first ascertain the cause of pelvic congestion syndrome patients, and determine the severity of the disease seriously.Treatment in patients with mild
Many patients with symptoms within 1 to 2 menstrual cycle first appeared shortly after the post-partum or post abortion or occasionally, and more without the use of medication. Can give health guidance for its etiology, in which patients have a full understanding of the formation and prevention of this disease. Such as daily noon, night rest, change habitual supine and prone position (Figure 1) for the side, correcting constipation, sexual restraint, appropriate physical exercise to improve pelvic muscle tone and improve pelvic blood circulation. General effect. Cervical erosion, timely cure cervical erosion, the effect is more satisfied.
Second, serious treatment of patients
Some patients have been years of pain, diagnosis and treatment of invalid after many doctors many times, it first so that patients have a full understanding of the disease, and establish the confidence to overcome the disease, and actively cooperate with the treatment. Daily at noon, evening, adhere conscientiously to do first of more than 10 minutes followed by the knee-chest position, and then take the side of the prone position to rest, to observe the effect, generally make serious pelvic pain and other symptoms significantly reduce or ease. According to the General does not hurt, "the truth, the principle of treatment of stasis (such as Salvia, safflower, Chuanxiong, parsley, walnuts, Typhae, Lingzhi, etc.) and massage therapy, there is a certain effect. Severe breast cancer and menorrhagia symptoms before the onset of symptoms to begin serving a small amount of methyl testosterone, is also effective.
Such as the side of the prone position therapy is effective and can not be consolidated, surgery may be considered in the choice of surgical approach should take into account the patient's age, the demand for fertility, the length of the duration of symptoms, and whether accompanied by organic disease, as appropriate, to use the following methods:
Pelvic congestion syndrome (a) the round ligament suspension technique: pour the uterus is maintained in the forward position with surgery, and more make the hypertrophy of the uterus and cervical narrowing, pelvic pain and other symptoms greatly reduced or disappeared, the effect better. The best approach is to round ligament around next to the groin inner rectus lateral margin pull out the extraperitoneal solid in the rectus sheath, between the rectus abdominis muscle belly and the rectus sheath, slit the inner surface. This method can be to Gilliams law to ensure that the minimum gap between the round ligament was taut and parietal peritoneum side, unlike the modified circle round ligament to pull the rectus sheath sewn solid outside of the front sheath, easy to postoperative abdominal wall pain. Already been proved that this pain is clearly confined to the place of the round ligament through the fascia. Palpation of this area can cause pain, but also touch the round ligament was pulled out of this.(B) of the broad ligament laceration repair: for the young, no longer need maternity broad ligament laceration with severe pelvic congestion syndrome patients. Doctor before surgery and can not conclude that patients with or without the broad ligament laceration, but after due to uterine Ⅲ degree tilting, severe pelvic pain, younger patients, though no longer need to fertility, but also reluctant to hysterectomy, and patients agreed that the line round ligament suspension surgery, and tubal ligation, laparotomy after the discovery of the broad ligament laceration (mostly in the posterior lobe), so the first laceration repair, and then OK to tubal ligation, and the round ligament suspension surgery. So, actually this is a group of surgery.
More than 30 years since first reported Allen and Master1995,,, after more than 10 scholars from more than 300 cases of surgical practice and exploration to prove that the surgery can make the vast majority of patients get good treatment, all patients the uterus is restored normal position and size, and the symptoms and signs disappear almost entirely.
This operation is simple, but the operation requires careful, abdominal. Do not have to trim the edge of the laceration, from the the peritoneum junction next to the cervix and cervical, with No. 1 silk sutured gradually outward, as long as the first needle to determine stitched the edge of the laceration, followed by suture, the boundaries of the laceration clear visible. Must pay attention to the whereabouts of ureteral suture must not be mistaken for sewing the ureter, even if it's sheath. Laceration suture after varicose veins bulge under the peritoneum disappeared, the main ligament to become a strong and vibrant and will also shorten the relaxation of the sacral ligament. In this way, the uterus will be able to maintain the front position. Then tubal ligation; do the round ligament suspension surgery.
(C) after abdominal hysterectomy and oophorectomy surgery; women over the age of 40, disease contraception situation serious, especially associated with menorrhagia or approaching menopause, undergoing abdominal hysterectomy and oophorectomy, the better. Transabdominal more advantages than transvaginal surgery, varicose pelvic veins, especially the uterine vein and ovarian vein, do more to cut off (this is one of the main purpose of the surgery), and repair of the broad ligament and uterosacral ligament damage , so that the vaginal cuff to get a better fixed. In addition, abdominal surgery is not easy to increased injury broad ligament varicose veins, bleeding. The need to retain the side of the ovary, the ovary of abdominal operation allows a more appropriate fixed.
(D) other procedures such as simple round ligament shortening, the general effect of the side of the tube oophorectomy or presacral sympathectomy poor. Ligation of varicose veins especially undesirable.
Pelvic congestion syndrome - Disease PreventionThe pelvic congestion syndrome implementing the principle of "prevention first", the cause of pelvic congestion syndrome, to take preventive measures to avoid or reduce its occurrence.To strengthen family planning publicity, to prevent early marriage, early childbearing, sexual intercourse frequency and fertility is more dense, and to promote a maximum of two children, two production should be at least 3 to 5 year intervals, so that not only genital anatomy, physiological functions, and the performance of the blood vessels had fully restored. The publicity of scientific methods of contraception, not onanism contraceptive method. Do not advocate abstinence.
Great importance to physical exercise, enhance physical fitness, improve the general health situation is particularly important for some weak constitutions.
Strengthen post-natal health promotion, the promotion of postpartum gymnastics, and of great benefit to promote the reproductive organs and supporting structures of the recovery. Avoid habitual supine rest or sleep, advocates on both sides of alternating lateral position to prevent uterine-bit. Prevent postpartum constipation, and Niaozhu tumors, contribute to the restoration of the reproductive organs and pelvic vein reflux.
Attention to work and rest to avoid fatigue has long been engaged in standing or sitting workers should work between operation and appropriate activities. In addition, irrespective of sleep, lying in bed at noon to take some time to eliminate fatigue in the morning. But it is worth mentioning is that bed rest or sleep, different posture to eliminate fatigue, improve pelvic blood supply have different effects. From the viewpoint of mechanics, the supine position, the position of the pelvic most of the vein below the inferior vena cava, the venous pressure compared with standing or sitting to reduce a lot, but significantly higher when compared side of the prone position. There in the previous cultivation power stations such as loose, sit like a bell, lying like a bow "dictum. Therefore, the promotion of the leg side of the blood song taken from the customary prone position to prevent or even treat some mild pelvic congestion syndrome, and has a good effect.