Pelvic Congestion Syndrome
Pelvic Congestion Syndrome Overview
Pelvic congestion syndrome (PCS) is a common but often overlooked condition that most often affects women in their 20s-40s.
Veins in the pelvic area can become overstretched and twisted due to excess blood flowing backward.
Causes chronic pain in the lower abdomen, hips, and inner thighs of some women, difficulty controlling urination, pelvic swelling, and more.
Symptoms of Pelvic Congestion Syndrome (PCS)
Common symptoms of pelvic congestion syndrome include the following:
chronic pelvic pain
pelvic pressure or sensation of heaviness in the abdomen or pelvic area
a dull ache or burning sensation
pelvic swelling
discomfort during sexual intercourse
Other symptoms include the following:
frequent urination
difficulty emptying the bladder completely
pelvic tenderness or heaviness that's sensitive to pressure
bulging veins (varicose veins) visible on the outside of the legs or near the vagina
irritable bowel syndrome
Also, you may notice pain on one side of your pelvis. The pain with PCS may feel worse at the end of the day, before and during your period, during intercourse, or when you stand/sit for long periods.
What causes pelvic congestion syndrome?
The exact cause of pelvic congestion syndrome is not well understood, and researchers are still looking to find answers.
However, because we understand what's happening to the body, we know there is something happening to the blood flow in your ovarian veins and the veins in your pelvis.
Veins in that area can become overstretched and twisted due to excess blood flowing backward. This may lead to an uncomfortable build up which presses against nerves nearby, causing harm as well as uneasiness.
Estrogen
Because pelvic congestion syndrome is so rarely found in women who have reached menopause, it makes experts think that estrogen has some affect.
Pregnancy
Some believe that because blood vessels in a woman increase by 50% during pregnancy, they never fully recover from that dilation, which leads to this condition.
Other causes include polycystic ovaries and hormonal problems.
What are the risk factors for PCS?
Women with the following may be more at risk:
In childbearing age, around 20-45-years-old. It's rare for those in menopause to experience this condition.
Have gone through multiple pregnancies
Other risk factors include having polycystic ovaries, varicose veins, hormonal changes, and a family history of the condition
How is PCS diagnosed?
Physical Exam
First, a physical exam will be done to look for pelvic varicosities and pinpoint where the pain is located. Then, usually one of the following methods are used:
Ultrasound
Ultrasound is one of the primary diagnostic tools used to diagnose pelvic congestion syndrome (PCS).
Used to create pictures of internal organs within the body, providing diagnostic imaging for pelvic congestion syndrome.
It’s non-invasive and involves transmitting sound waves through the body.
Enables doctors to gain a better understanding of the pelvic region and identify any visible appearance of pelvic congestion syndrome, such as enlarged veins (varicose veins) that are causing patients discomfort.
Overall, ultrasound is a safe and non-invasive diagnostic tool that can help to confirm the presence of PCS and guide further treatment.
How is it performed?
The patient lies on a table and a gel is applied to the lower abdomen and pelvis to help transmit the sound waves from the ultrasound transducer.
The technician or radiologist then uses the transducer to produce images of the pelvic area, including the ovaries, fallopian tubes, and blood vessels.
The images produced by the ultrasound can show the presence of varicose veins in the pelvic area, which is a key symptom of PCS.
The technician or radiologist may also perform a Doppler ultrasound, which can detect abnormal blood flow in the pelvic veins, another symptom of PCS.
The patient may be asked to perform certain movements, such as deep breathing or coughing, to help the technician or radiologist better visualize the blood vessels.
Magnetic resonance imaging (MRI)/CT Scan
Magnetic resonance imaging (MRI) is a crucial tool in diagnosing.
MRI is a non-invasive diagnostic tool that can produce detailed images of the pelvic area, which can help to confirm the presence of PCS and guide further treatment.
By generating detailed images of the pelvic and abdominal areas, doctors can get an accurate snapshot of the pelvic veins, allowing them to discover varicose veins and pelvic venous insufficiency.
In some cases, intravenous contrast dyes are used to further define pelvic anatomy and aid in diagnosis.
When needed, MRI also helps doctors plan for surgery that may be necessary for patients who have pelvic congestion syndrome.
MRI can be less available and more expensive than ultrasound, and it may not be suitable for some patients, such as those with certain medical conditions or who are pregnant.
How is it performed?
The patient lies on a table that is then slid into the MRI machine.
A contrast agent may be injected into the patient's bloodstream to help enhance the visibility of blood vessels in the pelvic area.
The patient will be asked to hold still while the MRI machine takes detailed images of the pelvic area, including the ovaries, fallopian tubes, and blood vessels.
The images produced by the MRI can show the presence of varicose veins in the pelvic area, which is a key symptom of PCS.
The radiologist can also measure the size and number of pelvic veins and evaluate the blood flow in these vessels.
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Is pelvic congestion syndrome serious?
It can slightly vary in severity depending on the individual, but pelvic congestion syndrome should always be taken seriously.
In some cases, pelvic congestion syndrome is followed by varicose veins on women's hips or low abdomen. This might cause further distress and require additional treatment.
Pelvic congestion syndrome can last for many years if untreated and is one of those conditions that can worsen over time. As such, it is important to seek medical help if the above symptoms are experienced for more than two weeks at a stretch, as it may signal pelvic congestion syndrome.
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Can pelvic congestion syndrome cause infertility?
If you have pelvic congestion syndrome, one of your concerns may be whether it will affect your ability to have children in the future.
While pelvic congestion syndrome can lead to infertility issues like pelvic pain, abnormal menstrual bleeding and even miscarriage, there are treatments available that could help improve your chances of having children.
Even without treatment, many people are still able to conceive despite their pelvic congestion syndrome - it is just important to take proper precautions and consult with a medical professional before trying to become pregnant.
In some patients, pelvic congestion syndrome can be treated with medication or minimally invasive procedures to repair the varicose veins associated with this condition.
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What is the difference between pelvic congestion syndrome and varicose veins in the legs?
The main difference between the two is the area of the body that they affect: varicose veins on the legs occur when veins become swollen, twisted, and enlarged due to weakened valves while PCS occurs when varicose veins form in the pelvic region.
In addition, varicose veins often cause symptoms such as aching or heaviness in the lower legs, thickening of the skin around them and pain from standing for long periods of time. Conversely, PCS causes chronic pelvic pain and discomfort as well as other non-specific symptoms like fatigue and lower back pain.
Fortunately, both varicose veins in the legs and PCS can be managed through lifestyle changes such as avoiding standing for extended periods and wearing compression stockings.
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What can I do to prevent pelvic congestion syndrome?
Pelvic congestion syndrome can be a pesky and uncomfortable condition. Fortunately, there are a few things you can do to prevent it from occurring in the first place.
It is important to avoid lifting heavy objects, maintain an active lifestyle, and elevate your legs for 15 minutes daily when possible.
Additionally, working with your doctor to determine if pelvic varicose veins might be a contributing factor is another worthwhile step too.
Finally, wearing loose clothing and avoiding tight waistbands can also assist in avoiding pelvic congestion syndrome. A little prevention now can save you from a lot of pain later.
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How common is pelvic congestion syndrome?
What can I do to prevent pelvic congestion syndrome?
Living with pelvic congestion syndrome can be challenging and cause significant discomfort, but there are lifestyle changes you can make to help manage your symptoms.
Walking
An important step is to stay active and consider walking for 30 minutes each day as this can help promote good circulation which, in turn, can lead to relieving pelvic congestion syndrome pain.
Eat a balanced diet
Eating a balanced diet with plenty of fruits and vegetables and exercising regularly will also improve your energy levels and could possibly reduce pelvic congestion symptoms.
Other changes
Additionally, while the occasional indulgence is okay, it’s best to reduce your intake of caffeine, alcohol and sodium as these can increase pelvic pressure.
Finally, when possible try to elevate your feet above the level of your heart—ideally by sleeping with a pillow underneath—as this helps improve pelvic blood flow. With a combination of lifestyle modifications such as these, you should be able to find some relief from pelvic congestion syndrome symptoms.
Treatment options for pelvic congestion syndrome
Pelvic Vein Embolization
Also called ovarian vein embolization, the goal of pelvic vein embolization is to close off those faulty pelvic varicose veins so they don't swell with blood anymore, which will provide pain relief and relieve symptoms. Embolization is the ideal treatment because it's minimally invasive.