Pelvic Congestion Syndrome

Overview

Pelvic congestion syndrome (PCS) is a chronic condition that results from the development of varicose veins within the collection of veins that drain the pelvis. Varicose veins are veins that have become dysfunctional over time, resulting in a defect in the venous circulation. Most people associate varicose veins with those large ropey veins some people have on their legs. In the case of PCS, those varicose veins are actually inside the pelvic cavity.

Typically associated with women, PCS presents as a dull pain or pressure in the pelvic area that is said to worsen at different times and in varying situations. Seen more commonly in mothers, many experts believe it is the source of discomfort in up to 30 percent of women who suffer with chronic pelvic pain.

What are the symptoms?

Women with PCS generally report that the dull pain and pressure is chronic but that it worsens in certain situations, including:

  • At the end of the day
  • after prolonged standing
  • In the days leading up to their menstrual period
  • In the late stages of pregnancy
  • During and after sexual intercourse

Many women experience other PCS symptoms as well, including different combinations of symptoms. Symptom severity also appears to vary widely among individuals. Some commonly reported symptoms include:

  • irritable bowel symptoms
  • dysmenorrhea (painful menstruation)
  • fatigue
  • abnormal menstrual bleeding
  • abnormal vaginal discharge
  • backache
  • depression
  • varicose veins around the vulva, buttocks, and legs
  • vaginal or vulvar swelling
  • abdominal tenderness
  • increased urination
  • hip pain

Causes and risk factors

Many experts believe pregnancy is the most common cause of PCS. There are many reasons why experts hold this belief:

  • It is well documented that pregnancy is a high estrogen state. Estrogen is essential to the entire pregnancy process but is also a known vasodilator. During a pregnancy, it is essential for the blood vessels in the pelvis to vasodilate (expand) to allow for the increase in blood flow necessary to maintain a pregnancy. Persistent dilation of the veins in the pelvis may weakens the veins over time and thus increase the possibility that they will become varicotic post pregnancy.
  • Pregnancy causes many changes to take place in the female pelvis. Some are vascular and some are structural in nature. The vascular changes seen with pregnancy, predispose women to the development of pelvic varicosities over time. The more pregnancies, the greater the potential for development.
  • Fluid and weight gain during pregnancy is often seen as another potential risk factor in the development of PCS. An increase in intravascular fluid volume seen in pregnancy, results in a compensatory dilation in the vein structure surrounding the pregnant uterus. The venous dilation and increased fluid volume subjects the venous structure to added pressure which can result in the vein failing and eventually becoming a varicose vein over time.

Women who have had a previous pregnancy are more likely to develop PCS, and the risk is thought to increase the more pregnancies a woman has.

How is it diagnosed?

PCS can be quite difficult to diagnose, and therefore is often seen as a diagnosis of exclusion. This means that physicians will order multiple diagnostic procedures to eliminate other more easily diagnosable causes for a person’s symptoms. These procedures can include:

  • Laparoscopy (a surgical procedure that uses small cameras to look inside the pelvis)
  • CTscan
  • Venogram
  • MRI scan
  • Ultrasound

The ultrasound is the preferred initial step in diagnosing PCS due to its ability to detect varicosities while also evaluating venous blood flow.

Treatment options:

Treatment for PCS is aimed at reducing and alleviating symptoms. Unfortunately, there is no definite cure for the condition, and it remains a challenge to treat.

Medications available to help relieve PCS symptoms can include:

  • NSAIDs (nonsteroidal anti-inflammatory drugs)
  • chronic pain medications (such as gabapentin and amitryptyline)

Currently, the most common treatment outside of a pharmacologic treatment is a minimally invasive surgical procedure called pelvic vein embolization (PVE). This procedure blocks off certain varicose veins that are believed to be the source of the PCS pain. Studies have shown PVE to be successful in improving some of the symptoms of PCS. As with any procedure, there are risks, and not all women may be appropriate for this treatment option.

An alternative treatment that is also starting to show benefit to PCS sufferers revolves around treating the varicose veins in and around the groin region of PCS sufferers. By eliminating these more superficial varicose veins, the physician is able to eliminate the varicose veins on the surface that are generating the actual pain and discomfort that most women with PCS report.  Intrapelvic varicose veins unlike their more superficial counterparts, lack the tactile nerve sensations found at the skin level. What this means is that the reported pain arising in the groin area of PCS sufferers cannot be directly caused by the intrapelvic varicosities. They are in fact due to the more superficial varicose veins that extend directly to the skin surface where the tactile nerves reside. Eliminating these surface varicose veins in the groin, in turn, help to eliminate many women’s PCS complaints. Keep in mind. Most experts still view vein disease thru cosmetic glasses when in fact it is an inherited venous circulatory defect. Circulatory issues when present in sufficient amounts, will cause symptoms. In this case PCS symptoms.

Pelvic congestion syndrome in pregnancy

The symptoms of PCS often believed to be magnified in the late stages of pregnancy as the baby gets bigger and heavier. Unfortunately, it is difficult to quantify precisely how much of the pregnant woman’s discomfort is due directly to PCS and how much is actually due to the bigger baby starting to push on everything in the pelvis. I suspect it may be a combination of both.

Outlook

PCS is not believed to be associated with any chronic medical conditions that my prove detrimental to a woman’s life expectancy, but it does have the potential to significantly affect the sufferer’s quality of life. Symptoms such as chronic pain, pain during sexual intercourse, and dysmenorrhea can lead to a decrease in physical activity, loss of function, and even depression.

A diagnosis of PCS is not a terminal diagnosis. In fact, PCS manifests itself in each individual is highly variable in terms of its symptoms and its level of severity. Keep in mind that there are treatments available to help minimize symptoms and help women to cope with this condition. Call The Sheen Vein Institute today at 314.942.3330 to learn more about Pelvic Congestion Syndrome and schedule your free consultation so that you can take your first steps towards a pain free life.

Before and after picture of a women receiving Botox® injections

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