Pelvic Congestion Syndrome
What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome (PCS) is a medical condition that causes chronic pain in the pelvis. The pain is due to a buildup of blood in pelvic veins that are stretched and twisted, similar to varicose veins in the legs. Women who suffer from PCS experience severe, dull, aching pain lasting more than 6 months in duration.
What are the symptoms?
Typically, the pelvic pain is a dull ache, but it may also present as a sharp or throbbing sensation. It is made worse by long periods of sitting or standing, menstruation, or sexual intercourse. The pain may diminish when lying down. PCS is often accompanied with:
- Lower back pain
- Aches in the legs
- Abnormal vaginal bleeding
- Vaginal discharge
Other symptoms may include:
- Urinary frequency
Who is at risk?
Pelvic Congestion Syndrome (PCS) is one of the leading causes of chronic pelvic pain, afflicting millions of women worldwide.
- The typical age of women diagnosed with PCS ranges from 20 to 45. It is unclear whether there is a genetic or ethnic predisposition to PCS.
- The risk of developing PCS is higher among women who have had multiple pregnancies.
- The majority of women affected are premenopausal. Research indicates that PCS might be caused by naturally-existing estrogen, which is known to weaken vein walls.
- Studies have shown that PCS accounts for 16-31% of chronic pelvic pain cases.
PCS is challenging to diagnose because the cause of chronic pelvic pain may not be apparent during a physical or gynecological exam. To rule out other pelvic venous conditions, imaging tests can be performed to make a specific diagnosis:
- A pelvic ultrasound produces images of pelvic varicose veins and blood flow.
- A CT scan produces images of the pelvic varicose veins.
For most outpatient visits, either a pelvic ultrasound or CT scan may only take 20 to 30 minutes to complete.
- A venogram is the most accurate imaging technique to diagnose PCS because it shows real-time dynamic blood flow and a complete view of the pelvic venous anatomy.
An interventional radiologist may be consulted for additional evaluation and treatment of PCS.
What are the treatment options?
When a diagnosis has been confirmed, treatment options may be discussed with an interventional radiologist. These options include:
- Hormone therapy can reduce blood flow and congestion of the varicose veins, providing short-term pelvic pain relief.
- Ovarian Vein Embolization is an outpatient, minimally invasive procedure that can block blood flow to the enlarged veins. The physician uses local anesthesia to numb a small area of the groin. Then, a small incision is made to insert a thin, flexible tube called a catheter into the femoral vein of the leg. Using fluoroscopy, an x-ray imaging technique, the physician threads the catheter through the femoral vein into the varicose veins. The catheter is used to insert platinum coils into the distended veins to close off blood flow.
Enlarged pelvic vein due to build-up of blood
Coils block blood flow to enlarged pelvic vein
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Black CM, Thorpe K, Venbrux A, et al. Research reporting standards for endovascular treatment of pelvic venous insufficiency. J Vas Interv Radiol. 2010;21(6):796 – 803. doi:10.1016/j.jvir.2010.02.017.
Laborda A, Medrano J, de Blas I, et al. Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol. 2013;36:1006–1014. doi:10.1007/s00270-013-0586-2.
Meissner MH, Gibson K. Clinical outcome after treatment of pelvic congestion syndrome: Sense and nonsense. Phlebology. 2015:30(1)(suppl):73 – 80. doi:10.1177/0268355514568067.