Pelvic Congestion Syndrome
More than 30% of women complain about lower abdomen pain in their lifetime. Most of these women are between the ages of 20 – 45 having a history of multiple pregnancies and have a condition known as Pelvic Congestion Syndrome (PCS). It is believed that this condition is associated with varicose veins in the pelvis. The varicose veins usually develop during pregnancy and become larger as time progresses. In veins functioning normally, blood flows in only one direction, and is prevented from flowing backwards. When the valves in the veins are defective, blood starts to flow backwards and engorge the veins in the pelvis. As the blood pools, the vein walls are stretched and the veins get larger. These are known as varicosities.
Symptoms of Pelvic Congestion Syndrome include:
- varicose veins (vulva, buttocks and legs)
- swollen vulva / vagina
- abnormal and painful menstrual bleeding
- tenderness to touch the lower abdomen
- pain during intercourse
- vaginal discharge
- general lethargy and feelings of depression
Sometimes the diagnosis of Pelvic Congestion Syndrome can be difficult as many other conditions can mimic the same symptoms. The specific diagnosis of Pelvic Congestion Syndrome can be made using several imaging tests such as Ultrasound, CT Scan or MRI.
In the last few years, there has been a new radiological method of treating Pelvic Congestion Syndrome called embolization. Embolization is performed by an interventional radiologist and usually requires an overnight stay in the hospital. However, this procedure is much less invasive than surgery and with little downtime. The procedure itself involves plugging the blood vessels with embolics so they do not become engorged with blood anymore, and the varicosities subside with time thus eliminating the pain and discomfort.
Many women with chronic pelvic pain spend years suffering and trying to get an answer. Living with this pain and discomfort is difficult and affects not only the woman directly, but also her interactions with family and friends.
If you have pelvic pain that worsens throughout the day when standing, you may want to seek a second opinion with an interventional radiologist, who can work with your gynecologist. You can get a referral from your physician or call Raleigh Radiology’s Vein Clinic at 919-781-1437.
Frequently Asked Questions
Pelvic venous congestion is a condition in which veins that normally surround the uterus and ovaries become stretched, swollen, and tender. These pelvic “varicose veins”, similar to the varicose veins that commonly occur in the legs, can cause severe pressure on the female pelvic organs. The blood in the large veins that drain the ovaries normally flows in an upward direction towards the heart. In the case of varicose veins in the pelvis, the valves in the veins that control the blood flow are not working properly. The blood pools in the veins around the ovaries, the uterus and other pelvic structures, causing pressure and pain.
Abnormal veins do not grow back. But, abnormal veins can sometimes develop in another area of the pelvis causing a recurrence of symptoms. If needed, the embolization procedure may be repeated to treat this new source of pelvic pain.
There are many veins in the pelvis that “take over” the process of returning blood back to the heart. The dilated pelvic veins and pelvic varicosities serve no purpose other than allowing blood to collect and pool, causing pain. Embolizing the dilated pelvic veins/pelvic varicosities relieves pelvic venous congestion and does not interfere with blood return to the heart.
The risks of the pelvic venogram with ovarian / pelvic vein embolization are as follows:
- Migration of a coil from the ovarian / pelvic vein to the lung. This is an uncommon occurrence and typically the coil can be easily retrieved using a special catheter.
- Non-target embolization with the medical glue used to help block off the congested pelvic / ovarian veins. This means an area other than the congested vein becomes blocked. This is an uncommon occurrence.
- Hematoma or bruising around the site where the puncture was made (in the neck or groin area).
- A reaction to the special dye used during the procedure to help visualize the veins. This is a rare occurrence.
The benefits of the procedure:
- It is a minimally invasive procedure with a short recovery time.
- 50 – 80 % of all patients have significant reduction of their pelvic pain symptoms.
- Typically, the symptoms do not recur.
- It is an outpatient procedure with a short recovery time.
Typically, we recommend a week off of work. If you do heavy lifting with your job, we recommend approximately 2 weeks off of work or returning to work with a restriction on heavy lifting.
It takes time for the distended, stretched pelvic veins to shrink and relieve symptoms. It may take up to six months following the procedure to for optimal pain relief to occur. If symptoms do continue after the procedure, they are usually milder than previously experienced.
Chronic pelvic pain is often the result of several co-existing conditions. If pelvic venous congestion is not identified, then this condition is ruled out as a source for the pelvic pain and other medical conditions will need to be explored.
Andrew B. Weber, MD
Vascular & Interventional Radiologist
Expertise in vascular/interventional radiology and MR angiography
Nothing to eat or drink after midnight. If you are on blood pressure medications, you may take your AM dose with a small sip of water, otherwise hold off on taking your other medications. Discontinue taking aspirin, coumadin, or plavix 5 days prior to procedure. Make sure a driver is available post procedure to take you home.