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Practice Guidance for Chronic Pelvic Pain Treatment

The Society of Interventional Radiology (SIR) published new practice guidance for the treatment of chronic pelvic pain (CPP) in women who suffer from a pelvic venous disorder. The guidance was published online in the Journal of Vascular and Interventional Radiology.

Pelvic venous disorders encompass a range of symptoms caused by conditions such as venous reflux or obstruction of the inferior vena cava, ovarian, iliac, and/or left renal veins. Many women with these conditions suffer from CPP, which can be treated by an interventional radiologist. Because venous-origin pelvic pain is often confused with gynecological issues, many women go undiagnosed or misdiagnosed, prolonging their suffering.

This document provides evidence-based guidance for health care providers on the clinical evaluation of venous-origin CPP, appropriate diagnostic and preprocedural imaging, and appropriate treatments tailored to the diagnosis—ranging from pharmacological treatment to interventions, such as embolization or stenting.

“While many people assume chronic pelvic pain is gynecological in nature, studies show that more than 80% of women with CPP do not have a gynecological problem,” says SIR President Robert A. Lookstein, MD, FSIR. “Because of the misconceptions about the causes of CPP, it can be hard for women to obtain a diagnosis and find treatment. We hope this guidance changes that dynamic and ensures that women get access to the care they need without delay.”

The document was developed by SIR’s Women’s Health Clinical Specialty Council and Venous Clinical Specialty Council, in collaboration with the SIR Guidelines and Statements Division.

— Society of Interventional Radiology

A Minimally Invasive Alternative to Hemorrhoid Surgery

Hemorrhoids are common—more than half of people over 50 have them. Often, they can be managed with dietary and behavior changes, but when hemorrhoids become painful or cause bleeding, your physician may recommend treatment.  

The broad range of hemorrhoid treatments now includes a minimally invasive procedure called hemorrhoid artery embolization, performed by an interventional radiologist. Patients are treated in an office setting with moderate sedation and go home after their procedure, with little or no recovery time.

“This procedure is a great option for people who are not having success with other treatments and want to avoid surgery or who have delayed getting treatment for their symptomatic hemorrhoids,” says John Filtes, MD, an interventional radiologist at Columbia University Irving Medical Center, adding that the procedure is particularly effective for people who are experiencing bleeding from their hemorrhoids.

“Surgery for hemorrhoids can be painful and involves a significant recovery time. It also comes with an unfavorable risk profile,” Filtes says. “Hemorrhoid artery embolization fills an important gap in the list of treatments available to patients with this common condition.”

Filtes and his IR colleagues use X-ray and other imaging techniques to deliver localized treatments from inside the body, avoiding the need for large incisions. Most of the time, the only visible sign of an IR procedure is a tiny nick on the skin—usually on a patient’s wrist or groin—where the physicians access the patient's veins and arteries. 

During a hemorrhoid artery embolization procedure, blood flow is blocked in the small arteries that feed the hemorrhoidal tissue. Under live X-ray, an interventional radiologist guides a catheter to these blood vessels and injects tiny coils and/or beads. The coils and beads serve to dramatically decrease the blood flow to the swollen tissue. Deprived of blood, the hemorrhoid shrinks over the next days and weeks, relieving symptoms. “Our patients have been very happy with the results,” Filtes says.

Studies have shown that more than 90% of patients experience significant improvement after hemorrhoid artery embolization, with many patients benefiting from long-lasting results. Interventional radiologists have used embolization for decades to treat everything from fibroids and enlarged prostates to cancer.  

“The best part of any interventional radiology treatment is the recovery,” Filtes says. “For this procedure, we will ask you to avoid heavy lifting for a few days, but you can otherwise resume your daily activities almost immediately.”

— Columbia University