Pelvic Venous Congestion Syndrome

According to the Society of Interventional Radiology, a third of women suffer from chronic pelvic pain at some point in their lives, and pelvic congestion syndrome is the sole cause of chronic pelvic pain in 30% of all patients. Pelvic congestion syndrome is most common among women, but many cases in male patients have also been documented.

Definition

• Pelvic venous congestion syndrome, more commonly known as pelvic congestion syndrome (PCS), is a condition that causes chronic pelvic pain when varicose veins develop near major nerves in the pelvis. Varicose veins are veins that have been enlarged, swollen and often twisted by excess blood pooling and stretching their walls. They usually develop in the legs and can be extremely painful, especially when persons stand or walk. Varicose veins in the legs or elsewhere in the pelvic region that interfere with the function of nearby nerves and cause chronic pelvic pain are the main pathology for pelvic venous congestion syndrome.

Causes

• The exact causes of pelvic venous congestion syndrome remain unknown, but it is most common in women between 20 and 45 years old who have been pregnant at least once, and especially in women who have had multiple pregnancies. Women with polycystic ovary syndrome and hormonal imbalances are also at greater risk for developing pelvic congestion syndrome.

Symptoms

• The most frequent symptom of pelvic congestion syndrome is dull, aching pain or pressure, usually concentrated around the lower back and abdomen. Other common symptoms include abnormal vaginal discharge or bleeding, prominent varicose veins in the pelvic region, increased pain during sexual intercourse, vaginal swelling and feelings of general depression and malaise. Symptoms are worse during menstruation and pregnancy, and while sufferers are standing for long periods or when they are tired, especially at the end of the day. Many women may also notice sudden weight gain similar to that experienced during pregnancy.

Diagnosis

• Pelvic or transvaginal ultrasounds can be used to rule out other conditions with similar symptoms, but are not usually detailed enough to fully examine the pelvic veins that could be causing pelvic congestion syndrome. Carefully focused MRIs are the most noninvasive method, and are much more effective than ultrasounds for identifying problem nerves, but still aren't accurate 100 percent of the time. Pelvic venograms and CT scans are the most effective diagnostic tools for pelvic congestion syndrome, but both involve greater risks. Pelvic venograms require the injection of IV contrast dye into lower abdominal organs, and violent allergic reactions to the dye are common and potentially fatal. CT scans involve greater exposure to radiation and are not safe for pregnant women.

Treatment

• Treatment of pelvic congestion syndrome can be very difficult due to its unpredictable manifestation from patient to patient, but several options are available. According to the Society of Interventional Radiology, embolization is the most effective nonsurgical treatment available, and is "successfully performed in 95-100 percent of cases." It is performed by inserting a catheter into the femoral vein and using a sclerosing medicine to shrink blood vessels and close the vein, relieving painful pressure and swelling.

  Common analgesics (painkillers), hormone therapy drugs and prescription narcotic painkillers can provide some relief, but most drugs have proven ineffective in fully treating pelvic congestion symptoms in many patients. Antidepressants are often used as an alternative, for their powerful nerve pain relieving properties and to help manage the anxiety and depression frequently associated with chronic nerve pain disorders.