Pelvic congestion syndrome (PCS), also known as pelvic venous congestion syndrome, is where the veins in the pelvis widen (dilate) allowing excessive blood to stay in the area. In women this is mostly concentrated around the ovaries, and in men it occurs in the scrotum and is called varicocele. The affected veins are classified as varicose veins, often with weak valves that allow blood to flow backwards and pool in the pelvis, instead of moving up and away to the heart. The extra blood often causes painful pressure that gets worse when the pelvis moves or is touched.
PCS is a common cause of chronic pelvic pain in women, reports suggest it affects more than 1/3 of women. Most of which have had multiple pregnancies and are aged between 20-45. Varicoceles occur in 15% of men, and only 2-10% of them will have any symptoms. Not all women suffer with the painful symptoms of PCS, and some may not even be aware they have the condition as they show no symptoms (asymptomatic).
To diagnose the cause of chronic pelvic pain, your doctor will discuss your medical and personal history, and do a pelvic examination to rule out any obvious inflammation or abnormality. If there is no obvious cause for the pain, further examination can be done through an ultrasound scan or laparoscopy (key hole surgery) with a small camera inserted. The final diagnosis of PCS usually comes after a positive MRI or venogram/venography, which uses a real-time x-rays to look at the flow of blood and any clots within the veins of the pelvis.
If you have a positive diagnosis of PCS you will undergo treatment to resolve the pain. Usually through a combination of pain relief medication and a minimally invasive surgical procedure to reduce the blood flow in the pelvis.
What are the Symptoms of Pelvic Congestion Syndrome (PCS)?
If you are a women suffering with PCS, you may experience the following symptoms which change in severity throughout you menstrual cycle. You may have PCS and experience no symptoms (asymptomatic).
The pain may:
- be a dull, aching and sometimes throbbing pain, often in a non-specific area
- occasionally be a sharp stabbing pain after an area has been touched
- begin at one side of the pelvis, but shift between both sides throughout the course of the day
- be worse during or just before a period
- develop during or after pregnancy, and get worse with each following pregnancy
- be worse during or after exercise and at the end of the day
- be worse during or after sex
Other symptoms include:
- a feeling of fullness or heaviness in the lower abdomen and back
- a degree of relief from the pain when you lie down and elevate your legs
- visible varicose veins in the vulva, thighs and/or buttocks, accompanied by aches in these areas
- haemorrhoids and general rectal discomfort
- persistent genital arousal
- abnormal vaginal bleeding
- clear or watery vaginal discharge
- fatigue and mood swings
- tenderness and bloating in the abdomen
- a swollen vulva
What Causes Pelvic Congestion Syndrome (PCS)?
The most common cause of PCS is pregnancy, however it can also occur in women that have never been pregnant. Causes include:
- Pregnancy - When you are pregnant, there is an increased blood flow in your pelvis (by up 60%) and an increased pressure on your pelvic floor. This can permanently increase the symptoms of pelvic congestion as the damage to these structures remains even after childbirth. Each further pregnancy increases the blood flow further as your ovarian veins will continue to widen.
- Oestrogen - High oestrogen levels are thought to contribute to the veins dilating and alter the flexibility of blood vessels. Therefore undergoing oestrogen therapy may increase your risk of developing PCS.
- Careers that require prolonged standing or heavy lifting - These activities weaken your pelvic floor and leave you more vulnerable to developing a host of pelvic floor disorders due to the presence of continual weight on the pelvic muscles.
- Abnormal ovarian vein valves - You may have an absence of vein valves, or they may be incompetent in stopping blood from flowing back and pooling. 10% of all women have incompetent ovarian vein valves, and 60% of those develop PCS.
- Genetics - You may be more vulnerable to developing varicose veins if other members of your family suffer.
- Vein obstructions - If your veins obstruct other organs, or their blood flow is obstructed by organs, you can develop PCS.
- Ovarian vein reflux/syndrome - This condition is caused by dilated varicose veins in the ovaries, often obstructing the ureter (tubes connecting the kidney to the bladder). It usually occurs following pregnancy and may induce PCS or occur alongside it, increasing pressure in the area.
- Ovarian varicoceles - Masses of varicose veins, called ovarian varicoceles, often develop before or during PCS.
To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.
How to Treat Pelvic Congestion Syndrome (PCS)
The aim of treatment for PCS is to reduce the blood flow to the varicose veins in the pelvis, thus reducing any pain.
- Painkillers (usually non-steroidal anti-inflammatory drugs) - Pain relief is provided to relieve the symptoms, whilst the cause of the pelvic congestion syndrome is resolved.
- Hormone therapy - To suppress the menstrual cycle you may be subscribed with a course of progesterone tablets or injections. This treatment cures 73% of patients, with another 5% showing a great improvement. However, these benefits are rarely sustained once the treatment ends.
- Vein embolisation - The blood supply can be reduced or cut off to the affected veins to relieve pressure. A thin flexible tube (catheter) is inserted through a small incision on the thigh, into the varicose veins. Tiny particles are sent through to block the veins blood supply. This is a minimally invasive surgical procedure and has a quick recovery rate and high success rate.
- Sclerotherapy - Similar to above, a liquid solution is inserted through the catheter to block the veins.
- Surgical ovarian vein ligation - Usually through a keyhole (laparoscopic) route, the damaged sections of vein are cut and removed. Potential complications include cutting the nerves, which can lead to a recurrence of symptoms. Surgeries, such as this, are rarely recommended due to the effectiveness of other, less invasive treatments.
- Surgical removal of the ovaries - With or without removal of the uterus.
To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.
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