Pelvic Congestion Syndrome

*Photo courtesy of Dr. Sidhu

CAUSES of PELVIC Congestion Syndrome (PCS)

The underlying cause of PCS is ovarian or pelvic veins that become dilated. This causes the valves in the veins to fail and initiate the pooling of blood in the pelvic veins. Medical research is trying to find the reasons why some women have enlarged pelvic veins and experience 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 enlarged veins become permanent, leading to symptoms of pelvic congestion. Estrogen levels may also be involved.

Four primary veins are involved in this condition: the ovarian and 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 vagina goes through the internal iliac. Blood from the 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. Improperly working valves cause blood to back up and pool, leading to vein dilation and causing veins to dilate and, ultimately, resulting in chronic pain.

Risk Factors Include:

• Multiple previous pregnancies
• A tipped or retroverted uterus
• Legs that feel full
• Polycystic ovaries
• Hormone dysfunctions
• Family history of the disease

Typical symptoms can include pain, heaviness or discomfort 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. 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. Some pelvic congestion syndrome patients also experience hemorrhoids, vaginal discharge or abnormal vaginal bleeding.

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
  • Increased urination
  • Irritable bowel

DIAGNOSIS AND TREATMENT

Pain in the pelvis is common due to many different conditions, so getting pelvic congestion syndrome diagnosed can be downright tricky. Urinary or gastrointestinal system problems, issues with your uterus and ovaries, and even the muscles and bones near the pelvis can produce significant pain. Mental health issues, including depression and anxiety, can contribute to or even cause pain.

Pelvic venous insufficiency is a passive condition that occurs when you stand or sit. Gravity makes the blood pool in the lower veins. Patients often find relief when lying flat because the blood returns to the heart in a normal manner. Your symptoms may even disappear 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 at night, then PCS is likely.

Healthcare providers believe pelvic venography is the most accurate way to diagnose pelvic congestion syndrome. This minimally invasive procedure works by injecting an iodine-based dye into pelvic blood vessels to identify enlarged veins and find veins with reflux. 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 minimally invasive procedure can be used simultaneously as a treatment, depending on what the procedure discovers.

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 pelvic growths
• CT scan
• Magnetic resonance imaging (MRI)
• Diagnostic laparoscopy to rule out other causes of pelvic pain

Aspelvic ovarian 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 could not be treated. In addition, our surgeon will place plugs or coils in the affected veins to block blood flow. Pelvic 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.