Pelvic Congestion Syndrome

Pelvic Congestion Syndrome

Introduction

Pelvic Congestion- overviewThe causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart
against gravity become weakened and don’t close properly, this allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva. Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms. The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure on the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing. Many women with pelvic congestion syndrome, spend many years trying to get an answer to why they have this chronic pelvic pain.

Symptoms

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:

The pain often increases during the following times:

  • Following intercourse
  • Menstrual periods
  • When tired or when standing (worse at end of day)
  • Pregnancy

Other symptoms include:

  • Irritable bladder
  • Abnormal menstrual bleeding
  • Vaginal discharge
  • Varicose veins on vulva, buttocks or thigh.

Treatment

Pelvic Congestion - treatmentOnce a diagnosis is made, if the patient is symptomatic, an embolization should be done. Sometimes if there is a high suspicion for pelvic varices, a venogram may also be performed to confirm the diagnosis. Embolization is a minimally invasive procedure where thin catheter, about the size of a strand of spaghetti, is inserted into the femoral vein in the groin. The catheter is guided to the affected vein using X-ray guidance. Once the diagnosis is confirmed, a combination of a sclerosing agent and coils are deployed to close the abnormal veins.

Through this procedure, pelvic pain and congestion can be dramatically reduced thereby improving women’s symptoms. This treatment can be performed in under two hours and on an outpatient basis without the need for long hospitalizations. Patients can return to normal activities almost immediately. Previously, women needed to have the uterus removed to treat pelvic pain caused by PCS, and with no guaranteed relief from their symptoms.

In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal. The procedure is successfully performed in 95-100 percent of cases. Between 85-95 percent of women are improved after the procedure.

Pelvic Congestion Syndrome

Important points to consider:

  • Pelvic Congestion Syndrome can be treated on an outpatient basis with no open surgery. This can provide women with a more cosmetic outcome (only a small 2mm puncture is required in the neck and/or groin area)
  • Many patients will be able to return to normal activities much sooner and with less pain (when compared to traditional open surgical treatments)
  • Women frequently suffer from symptoms for years before the diagnosis is made and treatment is offered.
  • Precision’s Board Certified Vascular Specialists are recognized regional experts in the treatment and diagnosis of Pelvic Congestion Syndrome.

Diagnosis and Assessment

Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods:

Pelvic venography

Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contrast dye in the veins of the pelvic organs to make them visible during an X-ray. To help the accuracy of diagnosis, certain breathing maneuvers (Valsalva) may be used to increase the venous filling in the pelvis.

Pelvic Congestion - MRIMRI

May be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.

Pelvic ultrasound

Usually not very helpful in diagnosing pelvic congestion syndrome unless done in a very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.

Transvaginal ultrasoundTransvaginal ultrasound

This technique is used to see better inside the pelvic cavity. As with a pelvic ultrasound, it is not very good at visualizing the pelvic veins unless the woman is standing. However, it may be used to exclude other problems.