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 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.