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PELVIC CONGESTION SYNDROME
Pelvic Congestion Syndrome (PCS), also referred to as 'pelvic vein incompetence' or 'pelvic vein insufficiency' was first identified in the mid-1800s but was only understood to be connected to some types of pain affecting the pelvic area in the 1940s.
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It is caused by faulty valves in the ovarian veins (which supply blood to the ovaries) allowing blood to flow back into the pelvic veins – a process referred to as 'reflux'. Over time the veins subsequently become dilated and blood pools in the pelvis resulting in the symptoms of pelvic congestion syndrome.
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30% of chronic pelvic pain in women is believed to be caused by Pelvic Congestion Syndrome, and it is estimated that 15% of women of reproductive age are affected.
Causes
The condition only affects women, and the main risk factor for developing the condition is having previously given birth. Women who have had multiple pregnancies are also more at risk of developing PCS. Women aged 20-45 are more likely to develop the condition and it can also run in families.
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The reason why women who have given birth are more affected by this condition is that being pregnant causes a number of changes in the body, specifically:
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Some structural alterations to the pelvis itself, which may make the development of varicose veins more likely.
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An increase in body fluid levels during pregnancy can cause the veins to become engorged and then damage the valves (which normally make sure the blood flows in one direction only).
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Higher levels of oestrogen during pregnancy can cause weaknesses in walls of blood vessels.
Apart from pregnancy there are other potential conditions which
can contribute to PCS, for example:
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Renal vein thrombosis
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Larger uterus
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Thicker endometrium
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Tumour
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Fibroids
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Endometriosis
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Scarring
In most cases it is the extra blood pressure of these conditions on the veins that causes PCS.
Symptoms
The main symptom is chronic pain in the pelvis, often a dull ache which is worse later in the day and often worse:
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After sitting / standing for long periods
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After exercise e.g. walking / running
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During or after sexual intercourse
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Before a period
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In later stages of pregnancy
Other symptoms may include:
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Varicose veins in the legs, buttocks or genitals
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Pain in the thigh or the back
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Abdominal bloating or pain
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Period pain or menstrual cramps
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Abnormal bleeding during period
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Urination issues e.g. sudden need to urinate
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Irritable bowel symptoms
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Mood swings
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Fatigue
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Depression
Tests / Diagnosis
It can be difficult to diagnose Pelvic Congestion Syndrome, as lying down (as you would for a medical examination) often results in an easing of symptoms.
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The most common test used to diagnose PCS is an ultrasound, however other tests may be recommended, including:
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Laparoscopic examination (to determine if scar tissue, cysts or an infection are causing the symptoms)
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Pelvic venogram – a type of X-ray where contrast dye is injected into the veins
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CT scan
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MRI scan
Treatment
The condition may be treatable using non-surgical approaches such as:
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Medication for chronic pain
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Medication to suppress ovary function
Minimally invasive treatment approaches include:
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Ablation of damaged veins.