Pelvic Congestion Syndrome

*Photo courtesy of Dr. Sidhu

CAUSES

Ovarian or pelvic veins that become dilated are the underlying cause of PCS. This causes the valves in the veins to fail and initiate pooling of blood in the veins in the pelvic region. Medical research is trying to find the reasons why some women have enlarged veins and experiences no symptoms while others do.

During pregnancy, veins enlarge in the pelvic region to support increased blood flow to the uterus and the fetus. In some women, the veins become permanently enlarged, leading to symptoms. Female hormones may also be involved.

Four primary veins are involved in this condition: the ovarian veins and the internal iliac veins on the right and left sides of the body. The purpose of these blood vessels is the same as with others in the torso, namely to pump blood back to the heart. Blood from areas such as the anus, vulva, perineum and the vagina goes through the internal iliac. Blood from ovaries and uterus goes through the ovarian veins. Just as with veins in the leg, the movement of blood in this area of the body is slow and requires valves to move it forward. When the valves work improperly, blood backs up and pools, causing veins to dilate and ultimately resulting in pelvic pain.

Risk Factors Include:

• Two or more pregnancies
• A uterus that tilts back toward the anus
• Legs that feel full
• Polycystic ovaries
• Hormone dysfunctions

Typical symptoms can include pain that lasts at least six months in the pelvis or lower back and feels heavy and aching or sharp. Women who stand at length during the day are particularly affected, especially around the time of menses. The pain often changes with shifts in position. Others may experience a sudden need to urinate along with bladder leakage. An irritable bowel is also common, alternating with constipation. Some women experience deep discomfort during intercourse. Still, others have varicose veins that appear on the vulva or vagina, on the back of the thighs and on the inner thighs.

Certain activities can make the pain worse, including:

• Posture changes
• Sexual intercourse
• Standing for hours
• Walking

ASSOCIATED SYMPTOMS

In addition to pelvic pain, you may also suffer from accompanying symptoms. As with pain, these symptoms can vary widely among individuals and can include:

• Painful menstruation
• Abnormal bleeding during menstruation
• Backache
• Depression
• Fatigue
• Swelling of the vagina or vulva
• Abdominal tenderness
• Increase urination
• Irritable bowel

DIAGNOSIS AND TREATMENT

Pain in the pelvis is common due to many different conditions, so diagnosing it can be downright difficult. Problems with the urinary or gastrointestinal systems, your uterus and ovaries, even the muscles and bones near the pelvis can produce significant pain. Even your mental health, such as when you are depressed, can contribute to or even cause pain.

Pelvic venous reflux is a passive condition that occurs when you stand or sit. Gravity makes the blood pool in lower veins. Patients often find relief when lying flat because the blood returns to the heart in a normal manner. Your symptoms may disappear even more if you lie with your head down and your pelvic area raised above your chest. If symptoms worsen during the day when you are up and about but improve after sleeping in bed at night, then PCS is likely.

Diagnosis can be made by a vascular ultrasound designed to look at the veins in the pelvis. The ultrasound has the ability to detect and see reflux in pelvic veins while also identifying veins that are dilated. 

Other tests you may undergo, some of which may rule out other problems include:

• Urine tests
• Blood tests to check for pregnancy, sexually transmitted infections, anemia and other conditions
• Ultrasounds to look for growths in the pelvis
• CT scan or MRI
• Diagnostic laparoscopy to rule out other causes of pelvic pain

The most definitive way to determine if you have PCS is through a pelvic venogram. A vascular specialist uses a tube inserts a tube into your groin and neck to reach your venous system. X-rays that we have taken are used to guide a catheter into the pelvic veins. The procedure obtains images via an iodine-based dye injected into the area. The minimally invasive procedure can be used simultaneously as a treatment depending on what the ultrasound discovers.

Aspelvic vein embolization delivers tiny filaments that cauterize affected veins and close them off causing them to die and eventually be assimilated into the body. Recently developed sclerosing agencies irritate or inflame areas in the affected veins and can reach small veins that previously were unable to be treated. In addition, our surgeon will place plugs or coils in the affected veins to block blood flow. Aspelvic vein embolization is done as an outpatient with about three-quarters of patients gaining symptom improvements. Afterward, you can return to normal activities in just a few days.

For more information on PCS or to make an appointment, call us today at 425-250-9999. For your convenience, you can use our online Request an Appointment form.