Behind the Discomfort: Causes, Symptoms, and Treatment for Pelvic Congestion Syndrome

pelvic congestion syndrome

Do you experience pelvic discomfort that just won’t go away? Pelvic Congestion Syndrome (PCS) is a condition that affects up to 15% of females.

So, what exactly is PCS, and why does it cause such discomfort? And most importantly, what can be done about it?  At The Vein Center of North Florida, we understand how persistent pelvic pain can cause worry. Let’s examine PCS, its symptoms, causes, and available treatment options.

What is Pelvic Congestion Syndrome?

Pelvic congestion syndrome is a condition that causes persistent discomfort in the pelvic region due to vascular irregularities. It is located in the lower abdomen and occurs when the veins responsible for returning blood to the heart do not function properly, leading to blood accumulation and dilation of the pelvic veins.

This dilation is similar to varicose veins and causes pain and other symptoms of pelvic congestion syndrome.

What are the Symptoms of Pelvic Congestion Syndrome?

The primary symptom of pelvic congestion syndrome is persistent pelvic discomfort lasting at least six months, which typically begins during or after pregnancy and may worsen with subsequent pregnancies.

This discomfort may present as a dull, heavy ache or sharp pain, predominantly localized on the left side, though occasionally bilateral. Changes in posture, sexual activity (both during and after), extended standing, or walking can all aggravate pain, which frequently peaks toward the end of the day. Additionally, symptoms can worsen during menstruation. 

Additional symptoms may include:

  • Pain preceding or coinciding with menstrual cycles
  • Sudden urge to urinate
  • Presence of enlarged and distorted veins on the buttocks, external genitalia (vulva), or thighs.

What Causes Pelvic Congestion Syndrome?

While the precise cause of PCS remains unknown to experts, it is believed to stem from issues related to blood flow in the pelvic and ovarian veins. The pelvic discomfort characteristic of PCS arises from dysfunctional veins within the pelvic and ovarian regions.

Normally, blood flows upward from the pelvic veins to the heart through the ovarian veins. This is helped by valves in the veins that prevent blood from flowing backward, called reflux.

However, in the context of PCS, vein dilation or widening disrupts this process, rendering the valves ineffective in preventing backward blood flow. Consequently, the veins become engorged and twisted, accumulating blood in the pelvic veins and triggering discomfort as they stretch to accommodate the increased blood volume. 

Additionally, hormonal fluctuations, particularly those occurring during pregnancy, are believed to contribute to the development of PCS.

Who Does Pelvic Congestion Syndrome Affect?

Pelvic congestion syndrome (PCS) predominantly affects women between the ages of 20 and 45 who have undergone multiple childbirths. Other risk factors include:

  • A family history of varicose veins
  • Varicose veins themselves
  • PCOS (Polycystic Ovarian Syndrome)

It is worth mentioning that pelvic congestion syndrome is uncommon among postmenopausal women.

How is Pelvic Congestion Syndrome Diagnosed?

Diagnosing pelvic congestion syndrome is difficult because pelvic pain can have many different causes. This discomfort can stem from various bodily systems, including the reproductive system (such as the ovaries and uterus), the urinary system (including the bladder), and the gastrointestinal system (such as the large intestine). 

Additionally, issues with muscles or bones and mental health conditions like depression can contribute to chronic pelvic pain. As a result, healthcare providers need to carefully assess various potential factors before confirming a diagnosis.

A healthcare provider or an OB/GYN doctor will perform the diagnostic process. This involves an in-depth discussion regarding the patient’s medical history and symptoms, coupled with a comprehensive physical examination, often including a pelvic exam.

Additionally, the following tests may be necessary:

  • Urine tests to assess urinary system function
  • Blood tests to screen for pregnancy, sexually transmitted infections (STIs), anemia, and other underlying conditions
  • Pelvic ultrasound to identify any abnormalities or growths within the pelvis
  • Doppler ultrasound to evaluate blood flow in the pelvic blood vessels
  • CT scan or MRI for more detailed imaging of the pelvic region
  • Diagnostic laparoscopy to exclude other potential causes of pelvic pain
  • Venography, a procedure involving X-rays to visualize the pelvic veins, may also be required to aid in diagnosis

Treatment Options for Pelvic Congestion Syndrome

Treatment for pelvic congestion syndrome is individualized based on the patient’s specific symptoms. One of the most effective treatments for PCS is ovarian vein embolization (OVE), a minimally invasive procedure that blocks off affected veins and restores normal blood flow. 

OVE boasts a success rate of 98-100% in pelvic congestion cases, with quick relief typically occurring within 2-4 weeks post-procedure; however, there may be pain during the first few weeks/months post-procedure. Unlike surgery, OVE is safer, less invasive, and allows for a faster recovery, enabling patients to resume normal activities shortly after treatment.

Here are other options available:

  • Gonadotropin-releasing hormone drugs: These medications block ovarian function and may provide relief from pain associated with pelvic congestion syndrome.
  • Progestin hormone drugs: Progestin hormone therapy may also help alleviate pain.
  • Procedures to shut off damaged veins: Techniques such as sclerotherapy and embolization can be utilized to close off problematic veins, reducing symptoms.
  • Surgical intervention: In severe cases, surgery may be recommended to remove damaged veins or even the uterus and ovaries.

Your healthcare provider may initially suggest medication as a conservative approach. If medication fails to alleviate symptoms adequately, they may recommend other procedures to alleviate discomfort. 

It’s worth noting that the symptoms of pelvic congestion syndrome may diminish with the onset of menopause.

Next Steps for Chronic Pelvic Pain 

If you’re experiencing chronic pelvic pain or suspect you may have pelvic congestion syndrome, don’t suffer in silence. 

Make an appointment today with one of our vascular surgeons at The Vein Center of North Florida to find relief. Don’t let PCS dictate your life; reclaim your comfort and well-being with expert care and personalized treatment options.

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