Pain When Bending or Squatting?

Vein compression affects women…and men, too!

Being a full-time manager at a national auto parts chain, Rich Fitzgerald works 55 hours a week, and most of that time is spent on his feet. The New York native believes those long hours standing had a negative effect on his legs.

Photo by Fred Bellet.

Rich can now bend and squat to work on his car without pain.

“I was having a lot of pain in my legs,” he recounts. “At the end of the day, they would be throbbing, and it was just unbearable to stand. My legs also felt heavy, like they had weights on them. I’ve always suffered from poor circulation, so sometimes there was a kind of numb feeling in my legs, but there were those pressure points on them that would throb.
“I didn’t have cramps too badly, but my legs would swell. If I bent down to pick up something, within a few seconds I would lose feeling in one of my legs. I also had visible varicose veins on my thighs. They were high enough that they never showed when I wore shorts, but I had some spider veins in my calves that bothered me.”
The discomfort in Rich’s legs made it difficult for him to get through a workday without elevating his feet. He realized he had a problem that needed to be resolved. A friend recommended Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating vein disorders. Dr. Magnant’s practice, Vein Specialists, which has offices in Fort Myers and Bonita Springs, is dedicated to the comprehensive modern evaluation and minimally invasive treatment of vein disorders.
Rich made an appointment with Dr. Magnant, who performed an ultrasound examination of his legs. The ultrasound confirmed Rich had venous insufficiency, which occurs when the one-way valves inside the leg veins that assist blood flow against gravity become stressed and begin to leak. While getting Rich’s medical history, Dr. Magnant learned about other symptoms Rich had been experiencing.
“I had bad abdominal pain,” discloses Rich. “I went to my regular doctor and to gastroenterologists, who did all the scans and tests. They couldn’t figure out why I was having the pain. I also had pain when I bent down or squatted. I even had a lot of issues with pain in my feet and had gone to a foot doctor.”
During his physical exam, Dr. Magnant noticed Rich’s right leg was several inches larger in circumference than his left leg. That, along with his patient’s abdominal symptoms, made the physician suspicious that Rich was suffering from a less recognized but more-prevalent-than-most-physicians-realize vein condition, iliac vein compression syndrome.
“Dr. Magnant wanted to do an ultrasound of my abdomen, so he used his new technology to see if there was any blockage in my pelvic veins,” notes Rich. “He went in through my jugular vein and used a small ultrasound catheter to check it out. He discovered I had a seventy percent blockage in my left common iliac vein.”
“I diagnosed Rich with a condition called May Thurner syndrome, a subcategory of a disorder known as pelvic congestion syndrome,” observes Dr. Magnant. “This syndrome occurs when the right iliac artery compresses the left common iliac vein, blocking its blood flow and resulting in symptoms of venous congestion in the abdomen, buttocks and legs.
“Most often, doctors think of pelvic congestion syndrome as a female disorder, but men can suffer from it as well. They essentially have the same circulatory anatomy, just different reproductive organs, but the presenting symptoms in men may be different.”
Symptoms of pelvic congestion syndrome in men include nonspecific pelvic pain, thigh and buttock pain, recurrent varicose veins, pain with bending or squatting, abnormal abdominal pressure and varicoceles, which are enlargements of the veins of the scrotum. The condition is confirmed using an advanced diagnostic tool called intravascular ultrasound, or IVUS.

IVUS and Angioplasty

IVUS is a catheter-based ultrasound technology. The catheter is a very slender tube with an ultrasound probe at its tip. Unlike the ultrasound used on the legs, which evaluates the veins from the outside through the skin, IVUS goes directly into the veins.
“During a diagnostic evaluation, the IVUS catheter is inserted into the femoral vein in the leg or, more rarely, through the jugular vein in the neck. A guide wire and IVUS catheter are negotiated through the venous system down to the designated iliac vein,” explains Dr. Magnant. “This is all done using fluoroscopy guidance under local anesthesia.
“When the catheter is in place, the information from the ultrasound probe is sent to a monitor that displays the image of the vein. IVUS allows me to look at the vena cava and iliac veins from the inside to identify blockages or compression.”
Once compression is identified, Dr. Magnant can insert a stent inside the area of compression, often at the same time as the diagnostic IVUS procedure, to open up the compressed vein and restore normal venous blood flow.
“We usually use a balloon to expand the stent to its appropriate diameter,” offers Dr. Magnant. “This aids in keeping the vein open.”
“The stent procedure was easy and went smoothly,” remarks Rich. “It was simple and not really painful at all. It only took about forty minutes, and as soon as I left Vein Specialists, I felt relief from my pain.”

Neighborly Advice

Kyle Kuhn made a home for himself in Sanibel after serving in the United States Air Force. In Sanibel, he works at a local restaurant doing a little bit of everything, but mostly working as a server and bartender. Like Rich, Kyle’s job keeps him on his feet for hours, and he believes that contributed to the changes he experienced in his legs.
“I had some pretty bad problems with my legs,” relates Kyle. “I’m also a personal trainer, so I work out a lot and stay pretty fit, but with these problems in my legs, my circulation would slow down and my legs would hurt.

Photo by Fred Bellet.

Kyle can now play with Tank without any discomfort.

“I also had restless legs, my veins were bulging and my legs were discolored. I had a lot of swelling and a lot of cramps, and I always had to elevate my legs at the end of the day. It was really hard to be on my feet as a personal trainer and server. I had to wear compression stockings every day.” He also labored against the pain to take his dog, Tank, out for walks.
Kyle’s neighbor had suffered with leg vein issues and had them successfully treated by Dr. Magnant. She recommended the physician to Kyle, so he made an appointment at Vein Specialists for a consultation.
“Dr. Magnant and I hit it off immediately,” recalls Kyle. “He had a soft spot for me because I was a veteran and had served our country. He told me he would try his best to help me out because I did not have insurance.
“I went to the Veterans’ Administration, and they weren’t going to approve my vein treatment, but Dr. Magnant personally wrote them a letter that got it approved. That was eight years ago.”
At that time, Dr. Magnant treated Kyle’s venous insufficiency with a minimally invasive procedure called endovenous ablation, a method of using heat to seal the leaky veins. It corrected the existing problems. Unfortunately, Kyle experienced a recurrence of his venous insufficiency, causing Dr. Magnant to become suspicious of a larger problem.
“I had two surgeries on both of my legs,” confirms Kyle. “Then, my left leg started giving me problems again, so I went back to Dr. Magnant. He did an ultrasound and said I had another leg vein that was growing fast and going to be a problem for me. He suggested we try the IVUS and abdominal venous stent.”
“Kyle presented initially with skin discoloration around his ankles and several varicose veins that appeared about to hemorrhage,” reports Dr. Magnant. “He also had swelling and pain and other typical symptoms of venous insufficiency. I performed ablation procedures on him, but we were both frustrated when that did not totally solve his problem.
“When IVUS became available, I believed he was an ideal candidate for it to see if he had something going on above his groin that was affecting his leg veins.
“We performed a pelvic ultrasound first through the abdomen, which suggested a severe left iliac vein narrowing. This was subsequently confirmed on Kyle’s diagnostic IVUS, which revealed an eighty percent narrowing in his left common iliac vein.”
When Dr. Magnant told Kyle about his findings, other symptoms he was experiencing suddenly came to Kyle’s mind. He never associated them with a vein condition until Dr. Magnant diagnosed him with pelvic congestion syndrome and explained its signs and symptoms.
“I’d been having cramps in my pelvis,” shares Kyle, “and my stomach and back were a little tight. I could feel it when I worked all day, then sat for a long period of time, or when I got up and down from a chair. I also had a lot of pressure in my abdomen and legs. I really had not experienced that before.”

Higher Disease

Before IVUS and iliac angioplasty technology became available, most vein specialists focused only on vein problems below the groin that were detectable with conventional ultrasound, notes Dr. Magnant.
“Few vein specialists today consider vein disease above the groin because there is no accurate way to make the diagnosis other than IVUS,” he states. “The investment includes fluoroscopy equipment and specialized training, which is often prohibitive for most part-time vein doctors.”

“The pain and cramping in my pelvis are gone. The stent procedure definitely helped.”- Kyle

Dr. Magnant’s practice focuses 100 percent on venous health, and its patients command the latest and most comprehensive tools to treat all vein disorders.
“Think of the veins from the groin to the ankle as the inflow,” informs the doctor. “Then, the veins from the groin up to the vena cava and heart are the outflow. It has only been in the last two or three years that vein specialists have considered issues with the outflow and higher diseases, such as iliac vein occlusion or pelvic compression syndrome.
“Pelvic compression syndrome has traditionally been thought of as a condition occurring in women, and, in fact, it occurs more often in women. Many doctors do not even ask their male patients about symptoms that may point to pelvic compression. However, it affects men as well. They should not be ignored in the evaluation of this condition.”
When a new patient arrives at Vein Specialists with symptoms of venous insufficiency, Dr. Magnant uses standard guidelines when completing the patient’s medical history and physicals. The guidelines include questions focusing on the signs and symptoms of pelvic congestion syndrome.
“Physical signs, or the visible indications, of this syndrome include large varicose veins on the groin, vulva or gluteal fold,” states Dr. Magnant. “There may also be leg swelling, which can result in a thigh discrepancy, as in Rich’s case. Other signs include stasis dermatitis and non-healing leg ulcers.
“Symptoms, or the warnings that are felt, include pain in the pelvis and abdomen with squatting or crouching, deep pelvic pain with intercourse; pain in the buttocks, posterior thigh or knee with prolonged sitting or standing; and hip and flank pain.”
It’s important to diagnose pelvic compression syndrome in men because varicoceles are common. Those varicosities can negatively affect sperm motility and lead to infertility, adds the doctor.
“As physicians, we need to change our mindsets,” asserts Dr. Magnant. “We cannot exclude from our thought processes the possibility that males may have pelvic congestion syndrome. With the IVUS and angioplasty technology we now have available, we can easily evaluate patients for this higher level of vein disease and treat it – in women and men.”

Shared Experiences

Thanks to Dr. Magnant’s keen assessment, Rich and Kyle were diagnosed and treated for pelvic congestion syndrome. The men shared experiences with the IVUS and angioplasty procedures, and they shared positive results from their treatments.
“After my stent procedure, my abdominal pain went away,” describes Rich. “My circulation also improved, and I had been having trouble with that since I was eleven. Now, I can bend down in a squat position for twenty or thirty minutes, then get up and I’m perfectly fine. The procedure was life-changing.
“Since I had the procedure, I can go work out after work and work fifteen-hour days if I need to with no pain whatsoever. I don’t have any issues with my feet anymore, either.”

“Now, I can bend down in a squat position for twenty or thirty minutes, then get up and I’m perfectly fine. The procedure was life-changing.” – Rich

The IVUS and angioplasty were successful for Kyle as well. He says he no longer has trouble standing or walking around all day at work. And he doesn’t have to struggle through pain when he takes Tank out for a walk. Overall, he’s happy with the outcome of his procedure.
“The pain and cramping in my pelvis are gone,” he states with enthusiasm. “The stent procedure definitely helped. And the swelling in my legs is gone. My legs look and feel great now.”
“If I could talk to anyone thinking about the iliac stent procedure, I would tell them to do it because it definitely made a big difference in my life. And I would recommend Dr. Magnant in a second.”
Rich concurs.
“My time at Vein Specialists was a totally good experience,” he says. “I definitely recommend Vein Specialists and Dr. Magnant. I wouldn’t go to anybody else!”

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