If you are a woman and have chronic pelvic pain, you may have pelvic congestion syndrome, also known as PCS. Pelvic congestion syndrome (PCS) is a chronic condition that occurs in women when varicose veins form below the abdomen within the pelvic region. Varicose veins are veins that become swollen, twisted, and lengthened as a result of poor vein function.
Many women of childbearing age have varicose veins in their pelvis, but not all of them have symptoms. Why some women develop symptoms is unknown. Although not every woman with such veins experiences symptoms of PCS. Many women with PCS do not realize they have a treatable condition.
How Pelvic congestion syndrome develops
PCS affects veins, which are part of the circulatory system that delivers blood. Arteries carry oxygen-rich blood from your heart to the far reaches of your body; veins carry blood back up towards your heart. Gravity helps your arteries carry blood downwards to your lower torso, but gravity makes it hard for veins to carry the blood back upward. Tiny valves in your veins open and close with every heartbeat, and this traps blood in small segments of the vein so it does not flow backward.
Sometimes the valves can fail, though, and this allows blood to flow backward and accumulate in veins surrounding the ovaries. The accumulation of blood causes the veins to become bloated, or “congested.” These congested veins press against nearby nerves to cause pain.
Symptoms of Pelvic congestion syndrome
Symptoms of PCS often do not develop until a woman becomes pregnant, in many cases, and then the symptoms often continue after the pregnancy.
Pelvic pain is the main symptom of PCS. The pain is usually a dull ache, although it can be throbbing or sharp. PCS pain typically worsens throughout the day, particularly for women who sit or stand all day. The pain of PCS usually goes away after sleeping at night.
The pain of pelvic congestion syndrome can also worsen during intercourse or the following sex and around menstrual periods. PCS pain may worsen after engaging in certain activities, such as horseback riding or bicycling.
Low back pain often accompanies pelvic pain. You might also have aching in your legs and abnormal vaginal bleeding alongside your low back pain. Some women occasionally experience clear or watery vaginal discharge with pelvic pain. PCS may also cause mood swings, fatigue, headaches, and abdominal bloating.
Diagnosis Of Pelvic congestion syndrome
Doctors may suspect pelvic congestion syndrome when women have pelvic pain but a pelvic examination does not detect inflammation or another abnormality. For doctors to diagnose pelvic congestion syndrome, pain must have been present for more than 6 months and the ovaries must be tender when they are examined.
Doctors use imaging tests, such as ultrasound and magnetic resource imaging (MRI) to diagnose PCS.
Ultrasonography to check for varicose veins in the pelvis can help doctors confirm the diagnosis of pelvic congestion syndrome. However, another imaging test may be needed to confirm the diagnosis. These tests may include venography (x-rays of veins taken after a radiopaque contrast agent is injected into a vein in the groin), computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance venography.
Generally, if the pain is troublesome and the cause has not been identified, 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.
Treatment of PCS
Medroxyprogesterone is usually used first to provide pain relief. It is a progestin (a synthetic form of the female hormone progesterone). Nonsteroidal anti-inflammatory drugs (NSAIDs) or gonadotrophin-releasing hormone (GnRH) agonists (synthetic forms of a hormone produced by the body), such as leuprolide and nafarelin, may also help relieve the pain.
If these drugs are ineffective, doctors may block blood flow to the varicose veins and prevent blood from accumulating there. Two procedures are available:
- 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.
Embolization Procedure for PCS
During the embolization procedure, the clinician will insert a thin flexible tube into a large vein through a tiny opening in the groin. The doctor will advance the tube, or catheter until it reaches the affected vein. The practitioner will use imaging, such as ultrasound, to guide the catheter to the correct position.
The physician will then inject a special chemical, known as a sclerosant, through the catheter. Vein specialists use sclerosants to treat varicose veins in other parts of the body. The chemical sclerosant irritates the inside of the treated vein; the irritation causes the vein to swell shut.
Generally, the embolization procedure requires only local anesthesia, so you don’t face the risks associated with general anesthesia. You may opt for mild sedation to help you relax.
After treatment, the doctor will cover the catheter insertion site with a bandage. Your doctor may recommend over-the-counter pain medication to relieve mild discomfort from the embolization procedure.
Interventional specialists perform embolization on an outpatient basis, so you can go home after the procedure. Embolization has a short recovery time, which means you can get back to your regular routine soon after the procedure.
What to Expect?
Generally, Embolization is successful in 98 to 100 percent of all PCS cases, according to Clinical Advisor. Thus the procedure brings relief within two to four weeks; research shows that most patients remain symptom-free for many years after embolization. When blood can no longer flow to the varicose veins in the pelvis, the pain usually lessens.
For the most part, if you think you have PCS, talk with your doctor. Pelvic congestion syndrome is an uncomfortable condition that can negatively affect your quality of life. Fortunately, treatment for PCS can help you live free from pelvic pain.