Pelvic Congestion Syndrome (PCS)
What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome (PCS) is a medical condition in which chronic pelvic pain occurs secondary to abnormal swelling of the veins in the pelvis. Strongly linked to increasing age and prior pregnancy, this condition is due to abnormal leaky valves in the veins of the pelvis. This causes an increase in pressure in the pelvic veins which causes pain. It can also be associated with varicose veins in the thigh, buttocks and labia. In fact, PCS is similar in causes, symptoms and management to typical varicose veins in the legs.
Up to one-third of women suffer from chronic pelvic pain secondary to PCS. PCS is increasingly recognised as a treatable cause of chronic pelvic pain, in part as greater awareness of the underlying cause of and diagnosis of the condition leads to more women being offered effective treatment. Many women who have suffered in silence with chronic ache and pain may have a treatable cause.
Pelvic Congestion Syndrome Symptoms
PCS generally presents with a dull, but ongoing pain and can worsen during certain situations, such as:
- Standing for extended periods
- In the days preceding menstruation
- In the late afternoon or evening
- During and after sex
- During the late stages of pregnancy
Besides the pain, some women may experience other symptoms, including:
- dysmenorrhea (painful menstruation)
- abnormal bleeding during menstruation
- backache
- depression
- fatigue
- varicose veins around the vulva, buttocks, and legs
- abnormal vaginal discharge
- swelling of the vagina or vulva
- tenderness of the abdomen
- increased urination
- irritable bowel symptoms
- hip pain
What Causes Pelvic Congestion Syndrome?
The exact cause of PCS is unknown, but it’s thought that enlarged veins in the pelvis play a major role. For this reason it is commonly thought to be caused by pregnancy:
- Pregnancy can change the structure of the pelvis, which affects blood vessels and increases the risk of developing varicosities.
- Increased fluid and weight from pregnancy can put pressure on the veins. They then become enlarged and blood can’t flow back through them.
- An increase in estrogen can weaken the blood vessel walls.
It is also believed estrogen plays a role in widening the veins, and this theory is supported by the fact that the condition is uncommon in women who have gone through menopause when estrogen levels naturally decrease.
The condition is uncommon in younger women or those who have not had children.
Who is Most at Risk of Developing Pelvic Congestion Syndrome?
It appears that women of childbearing age who have had more than 1 child have the highest risk factor for developing PCS.
How is Pelvic Congestion Syndrome Diagnosed?
The symptoms of PCS are often very characteristic and when explored thoroughly, patient symptoms can strongly suggest the diagnosis. Supporting evidence can be obtained from imaging scans which show abnormal veins, i.e., pelvic venous incompetence.
An ultrasound of the pelvis or CT can identify pelvic incompetence but only if the radiologist reading the scan is aware of this condition. It is common to diagnose and successfully treat women who have had the diagnosis missed for years because of lack of awareness amongst medical professionals.
When actively searching for the diagnosis, a dedicated pelvic ultrasound or MRI scan are excellent methods of showing abnormal veins. The gold standard for diagnosis of incompetence, however, is venography, when dye is injected into the abnormal veins under x-ray guidance, proving they are.
PCS remains underdiagnosed and often misdiagnosed entirely. One study looked at over 2,000 patients and found that 8% of them had PCS but were not formally diagnosed with the condition. This can lead to issues with incorrect treatment that results in sub-optimal outcomes.
How to Manage and Treat Pelvic Congestion Syndrome
PCS is a condition caused by abnormal swelling of the veins in the pelvis. This is usually due to a problem with the valves in these veins. Treatment options in the past involved surgical management of these veins. This has given way to modern minimally invasive treatment in which the abnormal dilated veins are embolised. Embolising, or blocking, these abnormal veins removes this increased pressure in the pelvis and can improve pain.
- Medical – painkillers can be used but are often ineffective. As there is hormonal influence on the pain, the contraceptive pill can also be used to reduce pain.
- Embolisation – this procedure identifies the abnormal veins responsible for the pain and blocks them
- Surgery – many women have unnecessary surgery for their chronic pain, including hysterectomy, when in fact they have a condition treatable without the need for major surgery.
Only patients who are symptomatic need treatment. If you have chronic pain for which no cause has been found, then PCS may be a cause. If your symptoms do not respond to medical management then you may consider embolisation. Undoubtedly symptoms are best managed by an individual patient-centred approach and some women are best managed medically. When you are seen in rooms by the IR specialist you can trust that you will be only offered treatment if it is thought to be your best option.
Pelvic Congestion Syndrome and Pregnancy
It is common for PCS symptoms to worsen during the late stages of pregnancy as the baby gets larger and heavier, placing more pressure on the pelvis.
Ovarian Vein Embolisation
When it comes to treating Pelvic Congestion Syndrome (PCS) we offer a minimally invasive treatment option known as ovarian vein embolisation. It’s a procedure used to close off faulty veins so that they can’t continue to deliver blood and become enlarged, which relieves the pain and symptoms of PCS.
Learn more about Ovarian Vein Embolisation and discover if this treatment is right for you.
Safe, effective treatments with less pain and quicker recovery.
Ensure you know all your options prior to invasive surgical treatment, schedule a consult with Dr Shaun Quigley.
