What is Pelvic Congestion Syndrome
Pelvic congestion syndrome is long-lasting (chronic) pain in the lowest part of the torso (pelvis) caused by accumulation of blood in veins of the pelvis, which have distended (dilated) and become incompetent.
Pelvic congestion syndrome affects up to 23% of patients with varicose veins of the lower extremity. Common symptoms include chronic pelvic pain (pain lasting more than 6 months), pain during intercourse or pain in the pelvic or back of the upper legs during menstruation. The resulting pain can become debilitating. Hormones like estrogen may contribute to the development of these pelvic varicose veins. Not all women who have pelvic varicose veins have recognizable symptoms.
Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal vaginal bleeding. Some women occasionally have a clear or watery discharge from the vagina. Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.
Doctors may suspect pelvic congestion syndrome when women have pelvic pain but a pelvic examination does not detect inflammation or another abnormality.
Ultrasonography can help doctors confirm the diagnosis. Sometimes, particularly if doctors are considering other possible causes of pelvic pain, laparoscopy is done. In this procedure, doctors make a small incision just below the navel and insert a viewing tube to directly view the structures of the pelvis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) usually relieve the pain. If NSAIDs are ineffective, doctors may try to block blood flow to the varicose veins and thus prevent blood from accumulating there. Several procedures are available:
Stenting of the ilac veins: Recent advancements in testing and diagnosis including the use of IVUS has resulted in the increased manner in which iliac vein compression is diagnosed. Often Pelvic Congestion Syndrome is found in combination with iliac vein compression. The compression or obstruction causes flow to escape (see picture above) the common femoral vein into the pelvis, crossing the pelvis and continuing up the contralateral iliac vein.
Embolization of a vein: After using an anesthetic to numb a small area of the thigh, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, sponges, or gluelike liquids through the catheter into the veins to block them.
Sclerotherapy: Similarly, doctors insert a catheter and inject a solution through it and into the varicose veins. The solution blocks the veins.
When blood can no longer flow to the varicose veins in the pelvis, pain usually lessens.