Pelvic Congestion Syndrome
What is pelvic congestion syndrome?
Pelvic congestion syndrome (PCS) is a medical condition that affects women and is characterized by chronic pain or aching in the lower abdomen, hips, or inner thighs that lasts more than 6 months.
PCS is often associated with impaired blood flow and increased pressure in the pelvic veins, leading to veins that are twisted and overfilled with blood.
Chronic pelvic pain accounts for 10-15% of outpatient gynecologic visits in the United States.¹
Symptoms of pelvic congestion syndrome
Common symptoms of pelvic congestion syndrome include the following:
pelvic, back, or leg aching/pain, which can feel severe and sharp
abnormal vaginal bleeding
migraine headaches
frequent urination
difficult, irregular, or painful menstrual cycles
varicose or prominent veins on the external female genitalia, inner thighs, or buttocks
pelvic pressure or sensation of heaviness in the abdomen or pelvic area
a dull ache or burning sensation
pelvic swelling
pain during or after sexual intercourse, which can last for hours or days after
*Note that pain might feel worse at the end of the day, before and during your period, or when you stand or 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.
Risk factors for pelvic congestion syndrome
Being in your childbearing years
Women around 20-45-years-old are at increased risk. It's rare for those in menopause to experience this condition.
Multiple pregnancies
Each delivery can strain the pelvic veins, leading to the enlargement and dysfunction of these vessels.
Family history of varicose veins
Varicose veins are often genetic, so you may inherit poor vein structure and function, leading to weaker vein walls and faulty valves, including those in your pelvis.
How is pelvic congestion syndrome diagnosed?
Physical exam
During this assessment, the provider looks for signs of vulvar and leg varicosities, which often indicate venous insufficiency. Additionally, the provider checks for pelvic tenderness as a key symptom. The combination of these findings helps establish a diagnosis, guiding further evaluation and potential treatment options for individuals experiencing chronic pelvic pain.
Ultrasound
Ultrasound is a crucial tool in identifying pelvic congestion syndrome. It allows for your provider to see how blood is flowing through the pelvic blood vessels and if there are any abnormalities, like enlarged veins.
MRI
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. However, it helps by generating detailed images of the pelvic and abdominal areas, specifically if there any irregular growths.
Venography
A contrast dye is injected into a vein in the leg followed by X-ray imaging to capture the flow of the dye through the venous system. This allows healthcare providers to identify where blood is pooling.
Is pelvic congestion syndrome life-threatening?
Although pelvic congestion syndrome is painful, it is not life-threatening. However, if not treated, the pain can go on for years and affect your quality of life. If the above symptoms are experienced for more than two weeks, then contact us today.
Treatment for pelvic congestion syndrome
At MIMIT Health, we offer pelvic vein embolization (also called ovarian vein embolization). The goal of the procedure 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.
References:
1. Robinson J C. Chronic pelvic pain. Curr Opin Obstet Gynecol. 1993;5:740–743.
