There's no need to suffer in 'vein'

It started with a dull ache in Mindee Thackeray's lower left abdomen. For a year, because it came and went, she didn't do anything about it.

Last September, the intermittent ache became a sharp, debilitating pain. Initially, her doctor suspected endometriosis, but a laparoscopic surgery found no trace of lesions in her pelvic region.

Further testing showed she had dilated veins around her ovaries, but hormone therapy didn't help much. By December, the pain was shooting down the top of her legs and she could "barely get out of bed because it was a bad, bad pain." Lying down brought relief, so the busy 31-year-old mother of two began spending most of her time in bed or on the couch. "It just about did me in."

She describes it as 10 times stronger than any cramps she'd ever had. And when it started down her legs, "I couldn't take it."

Thackeray's story is not uncommon. Many women suffer a type of chronic pain associated with dilated veins in their pelvis, a condition that goes by different names. Men can have similar dilation in the gonadal vein.

Dr. Colleen Harker, an interventional radiologist with Mountain Medical Vascular Clinic, calls it "pelvic congestion syndrome." Dr. Howard Sharp, an OB/GYN who directs the University of Utah's Women's Pelvic Pain Clinic, calls it "pelvic varicosity pain syndrome," a name used by the International Pelvic Pain Society.

But they agree that it's treatable and women need not suffer without help. And sooner is better than later, not only because of the pain but because pain can become entrenched and take on a life of its own.

"It's poorly understood," says Sharp of the syndrome. "By the time we see (patients), some have had it so long it's almost neuropathic pain and that's much harder to treat. Women need to get in early."

The society has four diagnostic criteria: a history of chronic pelvic pain, demonstrated enlarged veins of the uterus or ovaries, delayed blood flow through the vein and tenderness over the uterus and/or ovaries.

Veins have valves that keep blood flowing in their intended direction, back to the heart. Sometimes they malfunction and instead of opening and closing to propel the blood, blood is allowed to go backward, causing pooling, swelling and pain. The enlarged vein hurts when someone is upright, but feels better when the woman is prone and it decompresses. That's a key indication of the abnormally dilated veins, Harker says.

Lots of things can cause similar pain and it's often undiagnosed or misdiagnosed, but if being in a flat position relieves it, she says, "you can be very suspicious it can be related to large veins."