What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome is a condition where there are varicose veins in the lower abdomen and pelvis. Many women are affected by this condition, but may not know that their pelvic pain, heaviness and pressure are caused by varicose veins.

Symptoms

Symptoms of Pelvic Congestion Syndrome (PCS) are: heavy, achy, (anywhere from a dull ache to significant achiness), and/or pressure in the pelvis, pelvic pain that gets worse during a woman’s cycle, leg pain that accompanies the pelvic pain, back pain, and pain after intercourse.

Diagnosis

In our office, a Nurse Practitioner, Physician’s Assistant, or Physician will discuss pelvic symptoms with you. They will determine whether you present with pelvic congestion syndrome symptoms and order an ultrasound to look for varicose veins in the pelvis, labial area and upper thigh. This gives information regarding the sizes of the varicose veins in the pelvis and whether they have propagated to other parts of the body. Once these veins are found, they will also order a CT scan to show the origin of the varicose veins.

Treatment

For treatment of pelvic varices, the doctor will perform a pelvic venogram.
Embolization of a vein: After using an anesthetic to numb a small area of the neck, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, into the vein to block the flow of blood into these varicose veins.

Sclerotherapy: Occasionally, due to the size or position of the veins, the doctor may need to inject the veins with a chemical to close the varicose veins along with the embolization.

Follow Up

We always follow-up with the patient approximately one month post venogram to see if some you the patient’s symptoms have resolved. It may take 1-2 menstrual cycles before significant relief is noticed. Most women we have seen in the office for their post venogram follow-up have described some cramping for the first few days post procedure, and with significant relief in the weeks and months after.

Read More: Pelvic Congestion Syndrome

Women, Pregnancy and Leg Pain

Many women come into IVC with leg pain that increases in intensity during their menstrual cycle. As an ultrasonographer, when a patient mentions that to me I start to thinking of pelvic congestion syndrome. Some of the symptoms include a heavy or full feeling in the pelvic area, lower back pain, and an increase in pain in the leg during their menstrual cycle.

Unfortunately women do not only deal with the hereditary factor of varicose veins but many women develop varicose veins that get worse with pregnancy. ” Britney Spears today is the equivalent of the average American woman- a single mother of two with dashed hopes, little faith in romance and varicose veins.” (The Varsity 2007) http://www.veindirectory.org/blog/2007/10/celebrity_varicose_veins_britn.html#ixzz1d2zvDKgA

We know that you are not Britney Spears and the quote seems humorous however, there is validity to the quote. Pregnancy can increase the size and the amount of varicose veins in the pelvic area as well as in the legs. There are treatment options out there for you! Please feel free to call us if you have any questions.

How is Pelvic Congestion Syndrome Diagnosed and Treated?

Updated: October 2019

Pelvic venous insufficiency at IVC Interventional and Vein CenterPelvic Congestion Syndrome, also called Pelvic Venous Congestion, is a cause of chronic pelvic pain due to abnormally dilated varicose veins in the pelvis. Varicose pelvic veins develop when the valves in veins are not working correctly, causing blood to pool and pelvic vein distension. In some cases, pelvic venous congestion may also be due to obstructed blood flow from the pelvis. Similar to varicose veins in the legs, dilated or congested veins within the pelvis create pressure in the pelvis, vagina and pelvic floor. It is estimated that up to 30% of patients with chronic pelvic pain of an unknown cause actually suffer from symptomatic pelvic venous congestion.

As with all varicose vein disease, the causes of pelvic venous congestion are varied and complicated. Clinical research has shown the following associations:
● Genetic predisposition
● Multiple pregnancies
● Estrogen
● Polycystic ovaries
● Iliac or renal vein obstruction

Classic symptoms and signs of pelvic congestion include:
● Dull achiness and heaviness in the pelvis, often made worse by prolonged standing
● Pain in the lower back
● Visible varicose veins on the buttocks, vulva, and upper thighs
● Painful menstrual cycles with referred pain in the legs
● Increased frequency of urination
● Pain during and after sex

Since there here are many potential causes of pelvic pain, pelvic venous congestion unfortunately often goes unrecognized. As part of the assessment of patients with chronic pelvic pain, medical professionals may conduct multiple exams and tests such as:
● Pelvic exam
● Laparoscopy
● Pelvic and doppler ultrasound
● CT or MRI scans
● Pelvic venography

Pelvic ultrasound or other imaging studies such as CT are generally performed prior to treatment for pelvic venous congestion in order to exclude other possible pelvic disorders and to assess for anatomical variations which could affect treatment. It is important to note that a normal laparoscopy does not exclude the diagnosis of pelvic venous congestion.

The diagnosis of pelvic venous congestion is confirmed through an outpatient procedure called pelvic venography and treatment is typically carried out at the same time with a procedure called embolization. Embolization is a proven, safe and minimally invasive treatment option through which abnormal veins are closed using a combination of tiny coils and a sclerosing agent. Occasionally, pelvic venous congestion is caused by an obstructed iliac vein in the pelvis. In these cases, a stent may be required to open the abnormal iliac vein in order to restore normal flow out of the pelvis.

Treatment for pelvic venous congestion is performed in an outpatient setting and patients are discharged shortly after the procedure, typically returning to normal daily activity the same day. Approximately 85 percent of women with pelvic venous congestion will experience a significant improvement in their symptoms after appropriate diagnosis and treatment.

If you are interested in this treatment or have questions, please call 801.379.6700 or send us a message.

Resources:
Black, C.M. and Dillavou, E.D. “Endovascular Treatment for Pelvic Venous Congestion Syndrome.” Master Techniques in Surgery – Vascular Surgery: Hybrid, Venous, Dialysis Access, Thoracic Outlet and Lower Extremity Procedures. Ed. R. Clement Darling III, Ed. C. Keith Ozaki. Philadelphia. Wolters Kuwer, 2016, pp. 127-134. Print.

https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pelvic-congestion-syndrome.html
https://stanfordhealthcare.org/medical-conditions/womens-health/pelvic-congestion.html

What Is Pelvic Congestion Syndrome?

Pelvic Venous Embolization

What Is Pelvic Congestion Syndrome?

There are many different causes of pelvic pain, but sometimes it is related to the existence of ovarian and pelvic varicose veins. Varicose veins are a result of valves in the veins that don’t work correctly. Valves are designed to help veins return blood to the heart by preventing back-flow of blood down the vein. When the valves don’t work, this lets the blood pool resulting in vein bulging and pressure.

Studies show that up to 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a primary cause of their pelvic pain. The majority of women with PCS are less than 45 and are in their childbearing years. Risk factors for PCS include multiple pregnancies, polycystic ovarian syndrome, hormonal dysfunction and leg varicose veins. Women with PCS usually complain of a dull ache and heaviness in the pelvis that is worsened by standing, pregnancy, and menstruation. Sometimes this pain may be experienced in the lower back. There may also be visible varicose veins in the groin area, buttocks and upper thigh.

What should I address first, my pelvis or my legs?

Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”

 

The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.

 

There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.