Patient's question:
Detailed medical condition and purpose of consultation: Severe lower back pain after a total hysterectomy in 2003, with significant tenderness in both lower abdominal sides. Pelvic heaviness, lower back and sacral pain, pain above the pubic symphysis, and pain in both lower abdominal areas. Frequent urination and difficulty urinating, but normal urinalysis results. Breast tenderness, rectal fullness, abdominal distension, constipation, insomnia, and frequent dreams. After walking for more than ten minutes, bilateral hip joints ache until the heels, with swelling in the ankles, and weakness in the legs. Both sides of the vaginal walls have significant tender points (ultrasound results also indicated this), and the pain radiates from the tender points to the left coccyx near the anus. The left vaginal wall also frequently has...Doctor's answer:
Hello:Pelvic congestion syndrome is a gynecological disorder caused by chronic venous congestion in the pelvic area. It is a common gynecological condition, primarily affecting women aged 25-40 who have experienced pregnancy and childbirth. It is often associated with factors such as miscarriage, difficult labor, and tubal ligation. Its characteristics include chronic lower abdominal pain, low back pain, dyspareunia, extreme fatigue, excessive leukorrhea, congestive dysmenorrhea, and congestive breast pain. The external genitalia and vagina may show dilated veins, and the cervix may appear purplish-blue. Most of the uterus is retroverted and retroflexed, enlarged, with tenderness in the parametrium, but without obvious focal lesions. There is no history of significant acute pelvic infection in the past. This condition is often treated as pelvic inflammatory disease, but the results are usually unsatisfactory. The primary cause is the abundance of pelvic venous plexuses, including the pudendal plexus, vesicovaginal plexus, uterovaginal plexus, ovarian plexus, presacral plexus, and hemorrhoidal plexus. There are numerous veins; the venous plexuses of the bladder, reproductive organs, and rectum are interconnected, and the veins have thin walls and lack external sheaths, with no valves in small and medium-sized veins. Therefore, venous reflux obstruction in any one of these systems can affect the other two, causing delayed blood flow in pelvic veins. Additionally, the fascial base of the broad ligament may be torn during childbirth, leading to the bulging and varicosity of uterine veins at the site of the injury. Weakness of the cardinal ligaments can cause retroversion of the uterus, impairing blood flow from the uterine and ovarian veins, which is also a significant reason for the symptoms observed in pelvic congestion.
In terms of diagnosis, in addition to the above medical history and physical examination, laparoscopy may reveal no obvious pelvic inflammation or endometriosis, but instead dilated pelvic veins (normal ovarian vein diameter: 9.3-10.0 mm) or varicose veins of the broad ligament.