What is pelvic congestion syndrome (PCS)?
Chronic pelvic pain is a common problem in the United States. Chronic pelvic pain is defined as “non-cyclic” pain, or pain not related to the menstrual cycle, lasting greater than six months. It is estimated that more than one-third of all women are affected by this problem. Dozens of conditions can result in chronic pelvic pain. In many cases, the root cause is never discovered, despite numerous tests and operations. For some women, however, pelvic pain is caused by a condition known as pelvic congestion syndrome (PCS), which are varicose veins in the pelvic region. This condition may go undiagnosed simply because the symptoms are often overlooked or ignored.
A common sign of pelvic congestion syndrome is that the woman may feel pelvic pain while standing but not when lying down. That can sometimes make it difficult to diagnose because women are usually asked to lie down for a pelvic exam, relieving the painful pressure that brought them to the doctor in the first place.
What causes pelvic congestion syndrome?
Pelvic congestion syndrome occurs when varicose veins develop around the ovaries, similar to varicose veins that occur in the legs. The valves in the veins no longer function normally, so that blood backs up and the veins become engorged or "congested,” which can be very painful. In men, a similar condition can cause varicose veins to form on the scrotum, which is known as a varicocele. In women, however, these varicose veins are internal. Rarely do veins appear on the vulva, thighs or buttocks, which is why PCS is often missed.
Who is most prone to develop pelvic congestion syndrome?
- Women between the ages of 20 and 45 in their child-bearing years
- Women who have had multiple pregnancies
- Women who have experienced hormonal increases
- Women with hormonal dysfunction
- Women with polycystic ovaries
- Women who experience fullness of veins in legs
What are the symptoms of pelvic congestion syndrome?
Pelvic pain is the number one complaint in women with PCS. This pain may occur:
- Just before the onset of the menstrual cycle
- At the end of the day
- After prolonged standing
- During or just after intercourse
- During later stages of pregnancy
Other complaints that may indicate PCS include:
- Irritable bladder
- Varicose veins on vulva, buttocks and/or legs
- Swollen vulva/vagina
- Abnormal menstrual bleeding
- Tenderness to touch in lower abdomen
- Pain during intercourse
- Painful menstrual periods
- Vaginal discharge
- General lethargy
- Feelings of depression
What other conditions can mimic PCS?
In most cases, the diagnosis of pelvic congestion syndrome is not obvious and the diagnosis can only be made after ruling out some other disorders. Other disorders that cause pelvic pain and may have the same symptoms as PCS include:
- Uterine prolapse
How is pelvic congestion syndrome diagnosed?
- Ultrasound: This is the first test of choice because it is painless, effective and only takes about 30 minutes. It can assess the uterus and other organs in the pelvis. It can also help visualize the blood flow and assess the presence of varicosities in the pelvis.
- CT Scan: CT scan is frequently used in the diagnosis of PCS. It can look at the entire anatomy of the lower pelvis and identify varicosity of the pelvic veins.
- MRI: This is a very useful test in the diagnosis of pelvic congestion syndrome because it doesn’t use radiation as in a CT Scan or contrast dye and it is painless. The images are clear and concise. The test takes approximately 15 minutes.
- Venogram: This procedure takes about 30-45 minutes and is painless. The test involves injecting a dye into one of the veins in the groin and obtaining X-rays. There is some radiation exposure and the risk of allergy to the dye is ever present.
What are the treatment options for pelvic congestion syndrome?
Embolization is a non-surgical treatment for pelvic congestion syndrome. During this outpatient procedure, a catheter is inserted into a vein in the groin and is threaded to the affected vein using X-ray guidance. To seal the enlarged vein and relieve painful pressure, the physician inserts tiny coils, often with a sclerosing agent (the same type of material used to treat varicose veins), to close the vein. No incisions or stitches are requires and there is no sensation inside while this is happening. After treatment, patients typically return to work and light activities the following day, and to full activities a few days later.
In addition to being less expensive and less invasive than surgery, embolization offers a safe, effective, minimally invasive treatment option for pelvic pain that restores patients to normal. It successfully blocks abnormal blood flow in 95 to 100 percent of cases, and 85 to 95 percent of women experience improvement in their symptoms after the procedure. Although symptoms are improved, the veins are never normal, and in some cases other pelvic veins may require further treatment.
Hormonal medications are another treatment for PCS that can also reduce blood flow and congestion of the varicose veins to relieve pelvic pain.
How can you tell if you have pelvic congestion syndrome?
Ask yourself these questions if you have pelvic pain and think you may have pelvic congestion syndrome.
- Have you been evaluated by a vein center for varicose veins of leg/groin?
- Do you have pelvic pain?
- Is your pain worse at the end of the day?
- Does your pelvic pain decrease when you are lying flat on your back?
- Do you have visible varicosities in the area of the groin or labia?
- Does your pelvic pain affect your daily quality of life or normal daily activities?
If you answered yes to any of these questions, you may have pelvic congestion syndrome.
We advise you to seek an appointment with one of Cooper’s vascular surgeons, who can work alongside your gynecologist to get you the help you need. You may either ask your gynecologist for a referral to our office or you may contact us directly and we will obtain the referral for you.
Evaluation by a vascular surgeon must first be preceded with a complete evaluation by a gynecologist in order to ensure common causes of pelvic discomfort have been eliminated.