Pelvic Venous Disorder was causing her so much pain but doctors didn't believe her

Pain in her mid-section left Siti Haiza unable to sit or stand. No treatment worked until she was diagnosed with pelvic venous disorder

By Akshita Nanda - 2 Jul 2022

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Chronic pain in her mid-section made it impossible for Madam Siti Haiza to sit or stand for long periods of time, let alone play with her three kids. She took painkillers daily and would even wake up cold and shivering because of the pain. Yet, the GP doctor she consulted in 2020 could find nothing wrong and suggested she was imagining things.

Luckily, her gynaecologist was more understanding. Further investigations revealed that Madam Haiza had pelvic venous disorder (PVD), similar to having varicose veins in the pelvis.

She no longer needs daily painkillers. She still feels discomfort on occasion but has gone back to doing low-impact exercises and dancing and playing with her three children. “I don’t blame the GP, my condition was something new,” says the full-time homemaker. “But the part where he thought I was overthinking and imagining the pain was quite hurtful.”

Her experience is not rare. Other women have suffered chronic, severe pain in the pelvis, and as scans show nothing significant, their concerns are dismissed. But studies in Britain and the United States have found that PVD, also known as pelvic congestion syndrome or PCS, accounts for up to 30 per cent of patients with pelvic pain. There is no local data for Singapore.

PVD affects only the female reproductive system

Credit: Mdm Siti Haiza was in chronic pain from Pelvic Venous Disorder

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People at risk include women aged 18 to 50, who usually have given birth to two or more children. In PVD, compression damages the valves of the veins leaving the pelvis, affecting blood flow. Low-oxygenated and more acidic blood pools in the area.

Patients complain of pelvic heaviness and severe pain which worsens after sitting or standing, or after and during intercourse. This pain is known as dyspareunia.

Dr Benjamin Chua, vascular surgeon at the Thomson Surgical Centre says: “Some patients have described the pain as a deep tearing one that ‘rips’ through them each time they have intercourse. There are some patients who also describe the pain as that of persistent and painful cramps associated with their menses or periods.

He adds that the condition is “frequently misdiagnosed or not diagnosed at all due to myriad symptoms it can be presented with”.

Doctors may suspect the pain is due to endometriosis

Credit: Model photo:123RF

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Doctors may suspect this painful disorder in which tissue from the uterus or womb grows outside of the uterus. Or they may suspect fibroids, non-cancerous growths in the uterus. Yet, standard scans find nothing significant.

Since nothing shows up in such investigations, patients’ concerns are often dismissed, adding mental anguish to their chronic severe pain. Dr Chua says: “Many women have had multiple other investigations and unnecessary surgical procedures to evaluate the source of their pain. Some have had repeated colonoscopies, CT scans, exploratory surgery or even their wombs removed in attempts to solve their pain issues, but to no avail.”

He adds: “The pain these women experience is very severe and debilitating. I have had patients who have been put on anti-depressants. I have also had patients whose social relationships are in shambles – unable to go out of the house due to pain or have marriages breaking down due to dyspareunia.”

Counselling is important, so women don't blame themselves

Credit: Model photo: 123RF

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Counselling is as important as addressing the physical symptoms, according to Dr Sriram Narayanan, consultant vascular and endovascular surgeon at The Venus Cli nic.

“These women’s concerns have likely been dismissed by others and they blame themselves for what they’re going through. Some go cold three to four days before a period because they know what’s coming.” Dr Ram uses a duplex ultrasound scan of the pelvic region before making a diagnosis and recommendations for treatment. This scan examines the structure of the veins in the pelvic region as well as blood flow through the veins and organs.

Non-invasive treatment includes targeted pelvic floor physiotherapy to correct weakness in the pelvic floor, he says. Medication may be given to improve blood flow and ultrasonic shockwave therapy may be recommended to enhance blood circulation and control pain and discomfort.

Surgical and non-surgical treatments are available

Credit: Model photo: 123RF

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Surgical treatments include ovarian vein embolisation, balloon-controlled sclerotherapy to reduce the blood volume in the pelvis, or vein stenting to relieve the obstruction.

Dr Ram says: “My advice is, don’t rush into getting surgical procedures unless we’ve pinned down the abnormalities responsible. Treatment must be conservative as far as possible, with procedures reserved only for the severe cases.”

For Madam Haiza, the surgery has made all the difference to her life. Though familiar with menstrual discomfort, she says: “This pain was a first.” She adds: “I couldn’t even point to the doctor where the pain was, whether it was on the left or right side. It alternated and I felt the pain daily, at different times. “Luckily, my gynecologist, who I’m close to, told me not to worry and knew I wasn’t overthinking.”

This article was first published in The Straits Times.