Understanding Pelvic congestion syndrome: Causes, Symptoms, and Management

What is it?

Pelvic congestion syndrome is a chronic pain condition associated with blood flow problems in the pelvic veins.
The pelvic pain associated with PCS often involves faulty veins in the ovaries and pelvis. The veins dilate and may become twisted and overfilled with blood. As a result, blood may pool in the pelvis and feel painful.

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Additional names

This group contains additional names:
- Pelvic venous insufficiency

Signs & symptoms

The pelvic pain you experience with PCS may feel dull, achy or heavy. Less commonly, the pain may feel sharp and intense. You may notice the pain on the left side only (most common), on the right side of your body or both sides. Often, pain starts during or soon after pregnancy. It may worsen with future pregnancies.
The pain associated with PCS may feel worse:
* At the end of the day.
* Before and during your period.
* During intercourse and afterward (dyspareunia).
* When you stand or sit for long periods (but it feels better when you lie down).

Other symptoms include:
* Varicose veins in your pelvis, butt, thighs, vulva and vagina.
* Frequent bouts of diarrhea and constipation (irritable bowel).
* Peeing accidentally from laughing, coughing or other movements that stress your bladder (stress incontinence).
* Pain when you pee (dysuria).

Diagnosis

The doctor will ask about the medical history and symptoms. You’ll likely have a physical exam that includes a pelvic exam. the doctor will check for tenderness in your ovaries, cervix and uterus to try and pinpoint where the pain originates.
Imaging can help your provider rule out other conditions that cause chronic pelvic pain and identify any irregularities in the veins potentially related to PCS. Imaging procedures include:
* Ultrasound
* MRI or CT scan
* Pelvic venography
* Laparoscopy

Diagnosing pelvic congestion syndrome can be challenging because many people without pelvic pain have stressed veins similar to those who do experience pain. Imaging studies have shown that people with chronic pelvic pain and those without it may have distorted blood vessels and backflow of blood.
Even if imaging shows that your veins are dilated, you don’t need treatment unless you’re experiencing chronic pain.
Pelvic congestion as a cause of pelvic pain is a diagnosis that’s generally given after all other causes of pelvic pain have been excluded.

Treatment

There isn’t a cure for pelvic congestion syndrome, but medications and medical procedures can help ease the symptoms.
You may see different doctors for treatment, including a gynecologist, gastroenterology (GI) specialist, pain specialist and physical therapist. the doctor or care team will likely recommend medications to manage your symptoms before recommending surgery.
* Medications- Medications that suppress estrogen production can lessen the pain associated with pelvic congestion syndrome. They include: Medroxyprogesterone acetate, Etonogestrel implant, GnRH agonists, Goserelin.
* Procedures- the dcoctor may perform a medical procedure if medications don’t ease your symptoms. These include:
- Ovarian vein embolization or sclerotherapy: During this procedure, your provider blocks the blood vessels causing the blood to flow backward so that blood doesn’t pool. First, they place a catheter into the faulty ovarian vein and pelvic veins. Then, they send chemicals through the catheter to irritate or inflame the veins. Tiny metal coils, glue or foam are also inserted into these veins to prevent reflux.
- Laparoscopy: Your provider may perform a laparoscopy to tie off the veins, preventing the backflow of blood.
Bilateral salpingo-oophorectomy: Your provider may remove your pelvic organs (uterus, fallopian tubes and ovaries) if you’ve finished birthing children or don’t wish to give birth. This surgery is rare for PCS.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

Learn more about our editorial process for content accuracy.

Source of Information - We analyze big data of more than 23 million patients de-identified medical records from the following sources:

National Institution of Health ∙ World Health Organization ∙ University of Illinois hospital