Pelvic Congestion Syndrome: Symptoms, Causes, and Treatments

Discover the causes, symptoms, diagnosis, and treatments for Pelvic Congestion Syndrome, a commonly misunderstood cause of chronic pelvic pain in women.

Introduction

Pelvic congestion syndrome (PCS) is a common yet often misunderstood cause of chronic pelvic pain in women. The presence of varicose veins in the pelvis, which causes pelvic vein insufficiency and a variety of distressing symptoms, is what distinguishes this condition. In this blog, we will explore the causes, symptoms, diagnosis, and treatment options for pelvic congestion syndrome.

Pelvic congestion syndrome occurs when veins in the pelvic region become enlarged and engorged, leading to chronic pelvic pain. Similar to varicose veins in the legs, these pelvic varicose veins fail to adequately return blood to the heart, resulting in blood pooling in the veins and causing discomfort.

Symptoms of Pelvic Congestion Syndrome

The symptoms of PCS can include a range of symptoms, including:

1) Chronic pelvic pain

The hallmark symptom of PCS is chronic pelvic pain that lasts six months or longer. This pain is often described as a dull ache in the lower abdomen, but it can also be sharp, throbbing, or cramp-like. It may worsen with prolonged sitting or standing and be relieved by lying down.

2) Lower back pain

Pressure from engorged varicose veins due to blood pooling and the chronic inflammation associated with PCS can extend to surrounding areas, including the lower back. Inflammation can irritate the nerves and tissues, causing pain and discomfort in the lower back region.

3) Varicose veins in the pelvic area

These are enlarged and twisted veins that may be visible through the skin, especially in the vulva or buttocks area.

4) Pain during or after sexual intercourse

Some individuals with PCS may experience pain during or after sexual intercourse. This can be due to increased blood flow to the pelvic region during arousal, which exacerbates the symptoms of PCS.

5) Irritable bladder and bowel symptoms

Irritation of bladder and bowel from swollen pelvic veins can lead to:

1. bladder spasms and a strong urge to urinate
2. Frequent bouts of diarrhoea alternating with constipation

6) Worsening of symptoms during menstruation

For some individuals, PCS symptoms may worsen during their menstrual cycle. This is due to hormonal changes that increase the blood flow and volume in the pelvic region.

Causes of Pelvic Congestion Syndrome

The exact cause of pelvic congestion syndrome is not entirely understood, but several factors are believed to contribute to the condition:

1) Hormonal changes:

High oestrogen levels, particularly during pregnancy, can weaken vein walls, leading to varicose veins.

2) Multiple pregnancies:

Increased blood flow and pressure during pregnancy can cause pelvic veins to enlarge.

3) Genetics:

may also play a role in the development of PCS. Some individuals may be predisposed to weak vein valves, absence of valves or other abnormalities in their blood vessels, making them more susceptible to developing this condition.

4) Secondary pelvic vein incompetence

This is a condition where the veins in the pelvis are unable to efficiently transport blood back to the heart due to external compression. The nutcracker syndrome, also known as left renal vein entrapment syndrome, is one of many factors that can cause this external compression. This phenomenon occurs when the left renal vein, which carries blood from the left kidney to the heart, is compressed between the superior mesenteric artery and the abdominal aorta. Similarly, May-Thurner syndrome can also lead to pelvic vein incompetence due to the compression of the left common iliac vein by the right internal iliac artery.

Diagnosing Pelvic Congestion Syndrome

Diagnosing PCS can be challenging due to the overlap of symptoms with other conditions. A thorough medical history and physical examination are essential. Diagnostic tests that may be used include:

A) Pelvic ultrasound:

Pelvic ultrasound is the first-line imaging study for PCS.  This non-invasive imaging allows healthcare providers to visualize any abnormalities in the pelvic veins. It can also rule out the presence of pelvic masses or uterine problems as the underlying cause of pelvic pain

Pelvic ultrasound scan: dilated pelvic veins

B) Computed Tomography Venogram (CTV) and Magnetic Resonance Venogram (MRV)

CTV and MRV are useful for providing detailed images of pelvic structures and blood vessels. They can rule out pelvic masses and compression of the veins in the abdomen and pelvis. They are both minimally invasive imaging techniques with low risk.

MRI of the abdomen and pelvis: dilated left ovarian vein and pelvic varicose vein

CT scan: varicose veins in the pelvis

C) Contrast Venography:

Contrast venography is the gold standard for diagnosing pelvic congestion. This procedure involves injecting contrast dye into the pelvic veins and taking X-ray images to identify any areas of blood pooling or vein abnormalities. Venograms provide a more detailed view of the pelvic veins and can help guide treatment decisions.

Contrast venography: Left-sided pelvic varicose veins

Treatment Options for Pelvic Congestion Syndrome

The treatment options for pelvic congestion syndrome can vary depending on the severity of symptoms and individual patient factors. The goal of treatment is to alleviate pain, improve quality of life, and reduce the risk of complications associated with PCS.

1. Conservative management:

In mild cases of PCS, conservative management may be recommended as a first-line treatment. This approach includes lifestyle modifications such as regular exercise, avoiding prolonged sitting or standing, and wearing compression stockings to improve blood flow in the legs and pelvis.

2. Medications:

Painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help manage pelvic pain associated with PCS. Hormonal medications, such as birth control pills or hormonal therapy, may also be prescribed to regulate hormone levels and reduce symptoms.

3. Minimally invasive procedures:

For individuals with more severe symptoms, minimally invasive procedures, namely Ovarian Vein Embolization, may be recommended to alleviate pain and improve blood flow in the pelvic veins.

In this procedure, a catheter (tube) is placed directly into the abnormal ovarian and pelvic veins. Sclerosing agents (chemicals that induce irritation or inflammation) are injected into the pelvic varicose veins and cause them to collapse. Small metal coils or plugs are then placed to block flow into the ovarian vein. This prevents the reversal of flow in the abnormal veins, which reduces the pressure within the enlarged pelvic veins.

      Embolization of left ovarian vein

4. Surgical intervention:

In rare cases, surgical intervention may be necessary to remove or repair damaged veins or valves in the pelvic region. This option is typically reserved for individuals with severe and refractory symptoms who have not responded to other treatments.

It is important to consult with a healthcare provider who specialises in the management of pelvic pain and vascular conditions to determine the most appropriate treatment approach for your situation.

Conclusion

Pelvic congestion syndrome is an often overlooked and misunderstood condition that causes chronic pelvic pain. By understanding the causes, symptoms, and available treatment options for PCS, individuals can take proactive steps towards finding relief and improving their quality of life.

To address chronic pelvic pain or suspect pelvic congestion syndrome, consult with a healthcare provider specialising in pelvic pain or vascular conditions. They can assist in diagnosing the condition and directing you towards a suitable treatment option

Remember, you are not alone in your journey with pelvic congestion syndrome. There is support available, and with the right treatment and lifestyle modifications, you can manage your symptoms and reclaim your life from the grip of this invisible illness. Don’t let pelvic congestion syndrome silence your voice. Seek the help you deserve and take the first step towards finding relief today.