Global Health Asia-Pacific Dec 2021-Jan 2022 Dec 2021 - Jan 2022 - Page 94



Pelvic congestion syndrome ( PCS ) is one of the leading causes of chronic pelvic pain in women , second only to endometriosis in prevalence .
Yet , PCS is a poorly understood condition , with symptoms that are very similar to those of gynaecological disorders such as endometriosis , fibroids and ovarian cysts . These include a feeling of constant discomfort in the lower abdominal and pelvic area , heavy menstrual bleeding , pain leading up to ( and during ) menstruation , and pain during and after sex .
Medical experts now recognise that PCS is not a gynaecological condition , but a vascular one . Essentially , it is caused by varicose veins in the deep vein in the pelvis , and hence the condition has now been re-named as a Pelvic Venous disorder , or PeVD . These deep pelvic veins , which normally carry blood back to the heart , are damaged by a combination of pressure and hormones during pregnancy and this leads to a pooling of low-oxygen vein blood in the pelvic area . Damage to the pelvic floor muscles that occurs in many women during childbirth makes the condition worse , along with creating problems of urine leaks , the inability to hold the urine for long enough and even piles in some cases . The PeVD patient therefore suffers not just from pain and menstrual or sexual symptoms , but bladder and bowel problems as well .
The Venus Clinic at Camden Medical Centre in Singapore is conceptualised and led by Dr Sriram Narayanan ( Dr Ram ), a senior consultant vascular and venous surgeon , with the objective of helping women manage PeVD and
Dr Sriram Narayanan
its symptoms with a holistic , multidisciplinary approach . It is a unique , first-of-its-kind clinic in the region , and possibly world-wide , and is dedicated solely to managing this distressing condition .
Dr Ram is a recognised global thought leader and trainer in intravascular and duplex ultrasound , vein stenting and complex PeVD treatments . He is also the General Secretary of the Asian Venous Forum , where he represents Singapore .
Holistic , multi-disciplinary approach at The Venus Clinic The management of PeVD is a process , and not a single procedure . In fact , many patients do not require a procedure at all , and can be managed with simple medication and important targeted lifestyle changes and special- ised physiotherapy of the pelvis . At the Venus Clinic , we follow a stepwise approach beginning with a patient ’ s self-assessment of symptoms and quality of life . This is followed by the gold standard pelvic duplex ultrasound scan of the veins and pelvic organs and assessment of pelvic floor function , if required . Both of which are offered only at the Venus Clinic in the region . Tests like CT scans and MRI scans , which show internal anatomy but do not assess the severity of the functional disturbance to blood flow , are usually requested only after the diagnosis is established , and they should not be used alone to assess who needs a procedure .
Another highlight of our care is regular multi-disciplinary team meetings ( MDTs ), where the Venus Clinic brings together all the specialists involved in the patients ’ care such as the gynaecologist , urologist , family physician and collaborating specialist pelvic physiotherapists and clinical psychologists . Recommendations from MDTs are then shared and discussed with the patient to guide them through what may be their treatment options .
Once a patient is accurately diagnosed and the extent and severity of the disease confirmed , our team will recommend targeted , supportive treatments unique to each patient ’ s needs .
92 DECEMBER 2021 - JANUARY 2022 GlobalHealthAsiaPacific . com