Pelvic Congestion Syndrome

Pelvic venous insufficiency at IVC Interventional and Vein Center

Pelvic Venous Insufficiency

What is Pelvic Venous Insufficiency?

Pelvic congestion syndrome, also called pelvic venous congestion, falls under a broader range of pelvic venous disorders which are a known, but often unrecognized cause of chronic pelvic pain. Varicose pelvic veins develop when the valves in veins are not working correctly, or occasionally when critical deeper veins are obstructed, causing blood to pool and distend pelvic veins.

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Symptoms

It is estimated that up to 30% of patients with chronic pelvic pain of an unknown cause actually suffer from symptomatic pelvic venous congestion. So how do you know if you have Pelvic Congestion Syndrome? Classic symptoms and signs of pelvic congestion include:

  • Dull achiness and heaviness in the pelvis, often made worse by prolonged standing
  • Bloating sensation
  • 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 intercourse

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Common Recognized Associations

Although the causes of pelvic venous congestion are complex and poorly understood, a few commonly recognized associations include:

  • Family history of venous disease
  • Multiple pregnancies
  • Estrogen
  • Pelvic or renal vein compression

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How is Pelvic Venous Congestion Diagnosed?

Unfortunately, pelvic venous congestion often goes unrecognized and untreated. Symptoms, physical exam and ultrasound findings have a high combined predictive value in diagnosing pelvic venous disorders. The ability of duplex ultrasound (DUS) to image real time makes it an important tool in the evaluation of possible pelvic venous congestion. Because there are many other potential causes of chronic pelvic pain, medical professionals may conduct multiple exams and tests including:

  • Pelvic exam
  • Pelvic duplex ultrasound
  • CT or MRI scan
  • Laparoscopy

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.

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Treatment of Pelvic Congestion Syndrome

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.

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    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.