About 10-15% of women who are referred to gynecologists for chronic pelvic pain are diagnosed with pelvic congestion syndrome (PCS). As pelvic pain is attributable to many factors, PCS is often undiagnosed. Another reason why PCS is often underdiagnosed is a lack of awareness about the condition among physicians. Fortunately, a number of imaging tests are available today to study pelvic veins and make an accurate diagnosis.
Experiencing Pelvic Pain?
Symptoms of Pelvic Congestion Syndrome
The primary symptom of PCS is pelvic pain. Often, the pain worsens as the day goes on, or when sitting or standing, and alleviates after lying down or after a night of sleep. Some patients may also experience pain during urination, before the onset of menstruation, or during or after sexual intercourse. The pain may also aggravate after activities like bicycling and horseback riding.
Signs that your pelvic pain may be PCS:
- A dull and aching pain in the pelvis or lower back around your periods, during pregnancy, after intercourse, or when you’re standing up after a tiring day.
- Painful menstruation
- Abnormal bleeding during menstruation
- Irritable bowel or bladder
- Varicose veins on the vulva, inner thighs, or the back of your thighs
Risk Factors
PCS is most often diagnosed in women who are younger than 45 years old, as ovarian veins grow in size during each pregnancy. It is frequently seen in women who have had two or more pregnancies. Other risk factors include polycystic ovaries, a retroverted uterus, and hormonal dysfunction.
Diagnosis
A number of tests may be used to diagnose PCS. They include an abdominal and pelvic ultrasound, CT, MRI, or pelvic venography, where a catheter and X-ray are used to produce images of the ovarian vein.
What Type of Treatment Can Be Done?
PCS can be treated with a minimally-invasive procedure known as ovarian vein embolization. It involves closing off the problematic veins to prevent them from enlarging, thereby relieving the pain. Embolization has a 95% success rate among women worldwide.
During the procedure, a catheter is inserted into the faulty veins through the femoral vein and X-ray is used to guide the catheter to the target area. The catheter delivers a synthetic agent that clots the blood and seals the problematic vein. Advanced foam agents allow even the smallest veins to be blocked.
The procedure offers minimal discomfort. You may feel a bit of pressure when the catheter is being inserted. Pain is the most common side effect and can be alleviated with medication administered orally or intravenously. You can resume activities a week after the procedure.
Causes of Pelvic Congestion Syndrome
Multiple factors may contribute to pelvic congestion syndrome. They include:
Venous Reflux
This is where the venous valves do not function adequately, causing blood to back up into the valves when sitting or standing.
Venous Obstruction
Venous obstruction is when the scar tissue in the vein damages the valves, causing a blockage in the vein.
Hormones
Hormones may also play a role as estrogen can make the veins wider.
