Selected Podcast
Treating Pelvic Pain and Restoring Comfort
Dr. Arun Jagannathan shares what causes pelvic pain and the different treatment options available.
Featured Speaker:
Arun Jagannathan, MD
Arun Jagannathan, M.D. received his medical degree from the University of Illinois College of Medicine in Peoria, Illinois. He completed his Transitional Internship and Diagnostic Radiology Residency at St. Luke's Medical Center in Milwaukee. He went on to complete a fellowship in Vascular Interventional Radiology at Massachusetts General Hospital in Boston. He is a board-certified radiologist who specializes in interventional radiology procedures. Transcription:
Treating Pelvic Pain and Restoring Comfort
Introduction: Well Within Reach is brought to you by Riverside My Chart, your simple secure and confidential online health connection. With just a click Riverside My Chart lets you stay well connected to the same information your doctor sees. You can request prescription refills, pay your bills, schedule your next appointment, and more. Manage your care from your laptop, tablet or phone, whether for yourself, your kids, or the grandparents, My Chart makes your busy life just a little easier. Learn more and enroll today at Riversidemychart.org. Just another way to stay well connected from Riverside Healthcare. Riverside Healthcare puts the health and wellness information you need well within reach.
Kaleb Miller: Hello and welcome from wherever you are tuning in. This is the Well Within Reach Podcast Series by Riverside Healthcare. My name is Kaleb Miller and I'm going to be talking to you today about a really important topic, and that is how we can treat pelvic pain, common pelvic pain, and help patients restore comfort. Today I am joined by Dr. Arun Jagannathan. Dr. Jagannathan is an Interventional Radiologist here at Riverside Healthcare in Kankakee, and he's going to walk us through some solutions that our patients and our community can find via Riverside Healthcare for pelvic pain. Dr. Jagannathan, thanks for joining me today.
Dr. Jagannathan: Thank you Kaleb. Thanks for having me.
Host: Yeah, absolutely. So for our listeners, tell us a little bit about yourself and then your role here at Riverside.
Dr. Jagannathan: So Kaleb, I am a vascular and interventional radiologist. I received four years of medical school training after which I did five years of radiology training, followed by a year of vascular and interventional radiology super specialization, after which I came to Riverside in July of 2008. And I've been here for almost 12 years since then.
Host: Great. And so Dr. Jagannathan, I talked a little bit about pelvic pain and this is something that many women in our community experience, but they may not know where to find their relief for their symptoms. So, and I know there's a lot of complications that come with pelvic pain. So what can you tell us about this issue?
Dr. Jagannathan: So chronic pelvic pain is a very, very common disorder. A very large number of women experience chronic pelvic pain. The difficulty in diagnosing and treating chronic pelvic pain is there is a number of different underlying pathologies that can cause this. Some of these could include endometriosis, kidney stones, uterine fibroids, Adenmeiosis, Ovarian cysts. And what we're going to talk about a little more today, which is pelvic venous congestion or pelvic congestion syndrome.
Host: Yeah. And so how many women would you say, you know, in our country are experiencing this issue?
Dr. Jagannathan: Chronic pelvic pain, anywhere from 20 to 50% of women at some point or another experience chronic pelvic pain. The number of those that experience pelvic venous congestion is smaller probably in the order of five to 10%. But it's still a not insignificant a number of women.
Host: That is, yeah, that's, that's a significant. So what are some of the signs and symptoms that women should be aware of to know if they are at risk for this?
Dr. Jagannathan: So the classic symptoms of chronic pelvic venous congestion syndrome are heaviness and aching in the lower pelvic region after sitting or standing for long periods of time. This type of a pain tends to get worse over the course of the day, worse with the amount of time that the woman is standing, and tends to be relieved when the woman is lying down or at night. Pain after intercourse is very common, visible varicoceles also very common and these can be varicoceles in the labial region. Varicosities in the upper thighs. Women could also develop a bilateral lower extremity swelling, especially left sided leg swelling is common with this.
Host: Yeah. And that just has me thinking, are there any, is there any correlation I should say with this and pregnancy for women?
Dr. Jagannathan: There definitely is. With pregnancy there is increased blood flow to the pelvic organs, to the gynecological organs and after this increased blood flow, after the woman is delivered, there is still persistent abnormalities to the venous structures in the pelvis.
Host: Yeah. I had wondered if maybe there were some kind of connection between the two. So what causes this to be such an issue for women besides obviously, you know, it's painful, it's not comfortable, but does it lead to any other problems or complications with quality of life or, you know?
Dr. Jagannathan: Absolutely it can, it can be a debilitating problem. We've treated a number of women, um, who have been gone undiagnosed for a number of years. And that's largely because it's a invisible disorder in that you can, in a lot of patients that suffer from it, not be able to tell what the abnormality is without some type of imaging exam to look at the veins of the abdomen and pelvis. So there's a number of women that are suffering from this that just have been told they have chronic pelvic pain and there is no cause. But the reason is because we just have not been able to delineate the cause by imaging them appropriately.
Host: Yeah. And so for women who are experiencing this, obviously not comfortable, not something that they want to have to experience. So what are treatment options for our listeners who want to receive care here in their community at Riverside?
Dr. Jagannathan: So women that are experiencing chronic pelvic pain. My recommendation would be to discuss this first with your primary care provider and or your gynecologist, if they feel and or you feel, that you could be suffering from pelvic venous cause of chronic pelvic pain, then an evaluation in our interventional radiology clinic would be appropriate.
Host: Yeah. And so it's, it's great to be able to have this treatment option here at Riverside, you don't have to travel up North. Like I think maybe some people may think you have to, to receive this treatment. So walk us through this, you know, the, the process of finding relief for this and this procedure and what you're able to do for patients.
Dr. Jagannathan: So there are a number of patients that actually we incidentally find on another type of imaging tests such as an ultrasound or a cat scan. We find abnormal veins within their abdomen or pelvis that lead us to believe they may be suffering from pelvic venous insufficiency. Those patients, we will potentially recommend that they be evaluated for this by our clinic. Other patients that have chronic pelvic pain that we don't know for a fact actually have venous abnormalities, we will recommend imaging with either ultrasound, CT or MRI prior to seeing them in our clinic.
Host: Is there a specific age range of women who may experience this more than another?
Dr. Jagannathan: The general age range where women are more symptomatic with this is around 30 to 55.
Host: Hmm, okay. That's interesting. You know, you may think, you know, some people may think, Oh, maybe younger women get it, maybe older women get it, but that's kind of right there in the middle.
Dr. Jagannathan: Yeah. It's interesting and I could go into this in a lot more detail, but the, the causes of this can vary. In some women as we talked about women that have this develop after pregnancy, it's related to the increased blood flow from the pregnancy. There are other women that develop this at earlier ages because they have a compression syndrome in their abdomen or pelvis where there is some difficulty in drainage of the pelvic organs because there may be a blockage, due to an anatomic structure. So in those women, they can actually develop these symptoms even younger anywhere, you know, from their early twenties to even upper teens.
Host: Yeah. And that's definitely some good information to know as well. So what kind of benefits or relief are there to be found from patients who are seeking this treatment option? How, what, how will their life change, or their symptoms change from this procedure?
Dr. Jagannathan: Their symptoms can significantly improve to completely resolve after the procedure depending on the particular cause of their pelvic venous congestion. Generally women that develop pelvic venous congestion related to reflux of blood or blood moving the wrong direction and the ovarian veins will respond very, very well to this. Women that have pelvic venous congestion related to compression syndromes, maybe a little bit more challenging and may require a little bit more time, and potentially multiple procedures to improve their symptoms, but they can also significantly improve after evaluation and treatment.
Host: Yeah. And this procedure I should mention is also an outpatient procedure, correct?
Dr. Jagannathan: Correct.
Host: And how long she patients experience or expect to experience being inpatient or in, you know, with you for this procedure?
Dr. Jagannathan: So in general, the procedures take anywhere from one to two hours. They're done in our angiography suite. We have a brand new high tech angiography suite, which is a room that allows us to visualize the blood vessels in real time using x-ray. These procedures are done under conscious intravenous sedation, so Twilight anesthesia with our nurses. Our, we have an excellent team of trained nurses that will keep you very comfortable during the procedure. And we have our excellent interventional radiology technology staff, which will also make the procedure as pleasant as possible for you. It'll take about a couple of hours to finish the procedure. We will recover the patient for anywhere from two to four hours and then generally get them home the same day.
Host: Yeah, so really pretty simple and pretty quick for these patients to get in and find that relief. And I'm glad that you mentioned the staff as well. You're working with a pretty great nursing staff and support staff around you and some, some pretty high tech, high quality, innovative, you know, spaces as well. So, definitely great to know that patients can feel secure and safe and confident in receiving that care. So Doctor, how can listeners who are maybe interested in finding this relief, contact you or your office about, you know, scheduling a time to get this procedure?
Dr. Jagannathan: You can always call us directly. Direct patient referrals are definitely acceptable and we're available to be reached at 815- 802-7577, which is the direct number to our interventional radiology clinic. Or you can discuss your symptoms with your primary care provider or gynecologist and have them refer you to us.
Host: Yeah, absolutely. So again, that number for listeners is (815) 802-7577. Dr. Jagannathan, is there anything else you'd like our listeners to know about this really great procedure?
Dr. Jagannathan: I just want them to know that there is a number of people out there that have undiagnosed pelvic venous congestion syndrome. And that's not unusual. It's largely because it's difficult to diagnose without imaging. And just because you suffer from chronic pelvic pain and no other abnormalities have been seen on a physical exam or even an ultrasound test doesn't mean that you may not be suffering from this. If the symptoms are consistent with pelvic venous congestion, then I think, you should definitely, you definitely deserve an evaluation for this.
Host: Absolutely. Again, another really innovative way that Riverside is able to bring this relief to our community Dr. Arun Jagannathan again, here with us on the Well Within Reach Podcast. Dr. Jagannathan, thank you for joining us today.
Dr. Jagannathan: Thanks for having me, Kaleb.
Treating Pelvic Pain and Restoring Comfort
Introduction: Well Within Reach is brought to you by Riverside My Chart, your simple secure and confidential online health connection. With just a click Riverside My Chart lets you stay well connected to the same information your doctor sees. You can request prescription refills, pay your bills, schedule your next appointment, and more. Manage your care from your laptop, tablet or phone, whether for yourself, your kids, or the grandparents, My Chart makes your busy life just a little easier. Learn more and enroll today at Riversidemychart.org. Just another way to stay well connected from Riverside Healthcare. Riverside Healthcare puts the health and wellness information you need well within reach.
Kaleb Miller: Hello and welcome from wherever you are tuning in. This is the Well Within Reach Podcast Series by Riverside Healthcare. My name is Kaleb Miller and I'm going to be talking to you today about a really important topic, and that is how we can treat pelvic pain, common pelvic pain, and help patients restore comfort. Today I am joined by Dr. Arun Jagannathan. Dr. Jagannathan is an Interventional Radiologist here at Riverside Healthcare in Kankakee, and he's going to walk us through some solutions that our patients and our community can find via Riverside Healthcare for pelvic pain. Dr. Jagannathan, thanks for joining me today.
Dr. Jagannathan: Thank you Kaleb. Thanks for having me.
Host: Yeah, absolutely. So for our listeners, tell us a little bit about yourself and then your role here at Riverside.
Dr. Jagannathan: So Kaleb, I am a vascular and interventional radiologist. I received four years of medical school training after which I did five years of radiology training, followed by a year of vascular and interventional radiology super specialization, after which I came to Riverside in July of 2008. And I've been here for almost 12 years since then.
Host: Great. And so Dr. Jagannathan, I talked a little bit about pelvic pain and this is something that many women in our community experience, but they may not know where to find their relief for their symptoms. So, and I know there's a lot of complications that come with pelvic pain. So what can you tell us about this issue?
Dr. Jagannathan: So chronic pelvic pain is a very, very common disorder. A very large number of women experience chronic pelvic pain. The difficulty in diagnosing and treating chronic pelvic pain is there is a number of different underlying pathologies that can cause this. Some of these could include endometriosis, kidney stones, uterine fibroids, Adenmeiosis, Ovarian cysts. And what we're going to talk about a little more today, which is pelvic venous congestion or pelvic congestion syndrome.
Host: Yeah. And so how many women would you say, you know, in our country are experiencing this issue?
Dr. Jagannathan: Chronic pelvic pain, anywhere from 20 to 50% of women at some point or another experience chronic pelvic pain. The number of those that experience pelvic venous congestion is smaller probably in the order of five to 10%. But it's still a not insignificant a number of women.
Host: That is, yeah, that's, that's a significant. So what are some of the signs and symptoms that women should be aware of to know if they are at risk for this?
Dr. Jagannathan: So the classic symptoms of chronic pelvic venous congestion syndrome are heaviness and aching in the lower pelvic region after sitting or standing for long periods of time. This type of a pain tends to get worse over the course of the day, worse with the amount of time that the woman is standing, and tends to be relieved when the woman is lying down or at night. Pain after intercourse is very common, visible varicoceles also very common and these can be varicoceles in the labial region. Varicosities in the upper thighs. Women could also develop a bilateral lower extremity swelling, especially left sided leg swelling is common with this.
Host: Yeah. And that just has me thinking, are there any, is there any correlation I should say with this and pregnancy for women?
Dr. Jagannathan: There definitely is. With pregnancy there is increased blood flow to the pelvic organs, to the gynecological organs and after this increased blood flow, after the woman is delivered, there is still persistent abnormalities to the venous structures in the pelvis.
Host: Yeah. I had wondered if maybe there were some kind of connection between the two. So what causes this to be such an issue for women besides obviously, you know, it's painful, it's not comfortable, but does it lead to any other problems or complications with quality of life or, you know?
Dr. Jagannathan: Absolutely it can, it can be a debilitating problem. We've treated a number of women, um, who have been gone undiagnosed for a number of years. And that's largely because it's a invisible disorder in that you can, in a lot of patients that suffer from it, not be able to tell what the abnormality is without some type of imaging exam to look at the veins of the abdomen and pelvis. So there's a number of women that are suffering from this that just have been told they have chronic pelvic pain and there is no cause. But the reason is because we just have not been able to delineate the cause by imaging them appropriately.
Host: Yeah. And so for women who are experiencing this, obviously not comfortable, not something that they want to have to experience. So what are treatment options for our listeners who want to receive care here in their community at Riverside?
Dr. Jagannathan: So women that are experiencing chronic pelvic pain. My recommendation would be to discuss this first with your primary care provider and or your gynecologist, if they feel and or you feel, that you could be suffering from pelvic venous cause of chronic pelvic pain, then an evaluation in our interventional radiology clinic would be appropriate.
Host: Yeah. And so it's, it's great to be able to have this treatment option here at Riverside, you don't have to travel up North. Like I think maybe some people may think you have to, to receive this treatment. So walk us through this, you know, the, the process of finding relief for this and this procedure and what you're able to do for patients.
Dr. Jagannathan: So there are a number of patients that actually we incidentally find on another type of imaging tests such as an ultrasound or a cat scan. We find abnormal veins within their abdomen or pelvis that lead us to believe they may be suffering from pelvic venous insufficiency. Those patients, we will potentially recommend that they be evaluated for this by our clinic. Other patients that have chronic pelvic pain that we don't know for a fact actually have venous abnormalities, we will recommend imaging with either ultrasound, CT or MRI prior to seeing them in our clinic.
Host: Is there a specific age range of women who may experience this more than another?
Dr. Jagannathan: The general age range where women are more symptomatic with this is around 30 to 55.
Host: Hmm, okay. That's interesting. You know, you may think, you know, some people may think, Oh, maybe younger women get it, maybe older women get it, but that's kind of right there in the middle.
Dr. Jagannathan: Yeah. It's interesting and I could go into this in a lot more detail, but the, the causes of this can vary. In some women as we talked about women that have this develop after pregnancy, it's related to the increased blood flow from the pregnancy. There are other women that develop this at earlier ages because they have a compression syndrome in their abdomen or pelvis where there is some difficulty in drainage of the pelvic organs because there may be a blockage, due to an anatomic structure. So in those women, they can actually develop these symptoms even younger anywhere, you know, from their early twenties to even upper teens.
Host: Yeah. And that's definitely some good information to know as well. So what kind of benefits or relief are there to be found from patients who are seeking this treatment option? How, what, how will their life change, or their symptoms change from this procedure?
Dr. Jagannathan: Their symptoms can significantly improve to completely resolve after the procedure depending on the particular cause of their pelvic venous congestion. Generally women that develop pelvic venous congestion related to reflux of blood or blood moving the wrong direction and the ovarian veins will respond very, very well to this. Women that have pelvic venous congestion related to compression syndromes, maybe a little bit more challenging and may require a little bit more time, and potentially multiple procedures to improve their symptoms, but they can also significantly improve after evaluation and treatment.
Host: Yeah. And this procedure I should mention is also an outpatient procedure, correct?
Dr. Jagannathan: Correct.
Host: And how long she patients experience or expect to experience being inpatient or in, you know, with you for this procedure?
Dr. Jagannathan: So in general, the procedures take anywhere from one to two hours. They're done in our angiography suite. We have a brand new high tech angiography suite, which is a room that allows us to visualize the blood vessels in real time using x-ray. These procedures are done under conscious intravenous sedation, so Twilight anesthesia with our nurses. Our, we have an excellent team of trained nurses that will keep you very comfortable during the procedure. And we have our excellent interventional radiology technology staff, which will also make the procedure as pleasant as possible for you. It'll take about a couple of hours to finish the procedure. We will recover the patient for anywhere from two to four hours and then generally get them home the same day.
Host: Yeah, so really pretty simple and pretty quick for these patients to get in and find that relief. And I'm glad that you mentioned the staff as well. You're working with a pretty great nursing staff and support staff around you and some, some pretty high tech, high quality, innovative, you know, spaces as well. So, definitely great to know that patients can feel secure and safe and confident in receiving that care. So Doctor, how can listeners who are maybe interested in finding this relief, contact you or your office about, you know, scheduling a time to get this procedure?
Dr. Jagannathan: You can always call us directly. Direct patient referrals are definitely acceptable and we're available to be reached at 815- 802-7577, which is the direct number to our interventional radiology clinic. Or you can discuss your symptoms with your primary care provider or gynecologist and have them refer you to us.
Host: Yeah, absolutely. So again, that number for listeners is (815) 802-7577. Dr. Jagannathan, is there anything else you'd like our listeners to know about this really great procedure?
Dr. Jagannathan: I just want them to know that there is a number of people out there that have undiagnosed pelvic venous congestion syndrome. And that's not unusual. It's largely because it's difficult to diagnose without imaging. And just because you suffer from chronic pelvic pain and no other abnormalities have been seen on a physical exam or even an ultrasound test doesn't mean that you may not be suffering from this. If the symptoms are consistent with pelvic venous congestion, then I think, you should definitely, you definitely deserve an evaluation for this.
Host: Absolutely. Again, another really innovative way that Riverside is able to bring this relief to our community Dr. Arun Jagannathan again, here with us on the Well Within Reach Podcast. Dr. Jagannathan, thank you for joining us today.
Dr. Jagannathan: Thanks for having me, Kaleb.