FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

BACK PAIN, PELVIC VEIN: IT MAY RHYME BUT IT'S NOT FUNNY!

Question: I've been having trouble with lower back pain, so my gynecologist did a laparoscopy. He said that the veins that lay behind the uterus have become varicosed. I cannot find any information about this problem and why it makes my back hurt. Would you explain this?

Answer: Back pain can occur because of a number of causes. Injuries to the muscles, ligaments, bones or nerves of the back are the most common problems. These types of disorders are responsible for the back pain most of us have occasionally. I say "most of us" because 80 percent of Americans miss one week's work because of back pain at some time over their working career.

The gynecologist is often the first physician a woman may see for health care, but he or she isn't the specialty most choose when troubled by back pain. Therefore, I assume that you have experienced other symptoms that are common with the disorder you have -- specifically pelvic or vaginal discomfort.

Laparoscopy is a common surgery involving a small cut in the abdomen, usually in the belly button area, to allow a telescope-like instrument to be inserted. The surgeon can then look at organs of the abdomen and pelvis. The liver, gall bladder, appendix, uterus and ovaries are the most common ones that are examined this way. The appearance of these organs is often all that is necessary to establish an accurate diagnosis of the problem. This is what you had done. For some disorders, the surgeon is also able to insert other instruments to perform the repair or removal of diseased organs, but these surgeries are not part of simple laparoscopy.

The area "behind the uterus" has a number of veins ranging in size from very large ones, such as those that carry blood back from the legs to the heart, to very small ones that surround the ovaries, uterus and vagina. Any or all of these can become abnormally swollen and knotted. I'm sure that you have seen someone who has varicose veins in the legs. Well, the veins inside look much the same.

Veins have nerve endings in them, so the swelling and distortion that is characteristic of a varicose vein may irritate these nerves and cause pain. The tissues that surround veins are also stretched and distorted by the process of the vein becoming varicosed. This could also account for some of the discomfort you experience. Despite an agreement on these facts, experts don't agree that the type of varicose veins you have can cause back and pelvic pain.

The confusion about the role of varicosed pelvic veins in causing pain occurs because some women have varicosed pelvic veins but have no symptoms. Other women have symptoms like yours without these internal varicose veins. It seems that our understanding of this disorder is incomplete.

There have been scientific studies that treated the pelvic varicose veins of women with back and pelvic pain by tying or blocking off some or all of the abnormal veins. Fifty to 80 percent of these women reported good to excellent relief of symptoms. If your symptoms are to the point of being disabling, you may want your gynecologist to refer you to one of the research hospitals that is doing this type of surgery. Short of this type of cutting-edge surgical intervention (pardon the pun), there isn't much that can be offered for your condition today.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.