What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome is a condition where there are varicose veins in the lower abdomen and pelvis. Many women are affected by this condition, but may not know that their pelvic pain, heaviness and pressure are caused by varicose veins.

Symptoms

Symptoms of Pelvic Congestion Syndrome (PCS) are: heavy, achy, (anywhere from a dull ache to significant achiness), and/or pressure in the pelvis, pelvic pain that gets worse during a woman’s cycle, leg pain that accompanies the pelvic pain, back pain, and pain after intercourse.

Diagnosis

In our office, a Nurse Practitioner, Physician’s Assistant, or Physician will discuss pelvic symptoms with you. They will determine whether you present with pelvic congestion syndrome symptoms and order an ultrasound to look for varicose veins in the pelvis, labial area and upper thigh. This gives information regarding the sizes of the varicose veins in the pelvis and whether they have propagated to other parts of the body. Once these veins are found, they will also order a CT scan to show the origin of the varicose veins.

Treatment

For treatment of pelvic varices, the doctor will perform a pelvic venogram.
Embolization of a vein: After using an anesthetic to numb a small area of the neck, 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, into the vein to block the flow of blood into these varicose veins.

Sclerotherapy: Occasionally, due to the size or position of the veins, the doctor may need to inject the veins with a chemical to close the varicose veins along with the embolization.

Follow Up

We always follow-up with the patient approximately one month post venogram to see if some you the patient’s symptoms have resolved. It may take 1-2 menstrual cycles before significant relief is noticed. Most women we have seen in the office for their post venogram follow-up have described some cramping for the first few days post procedure, and with significant relief in the weeks and months after.

Read More: Pelvic Congestion Syndrome

Women, Pregnancy and Leg Pain

Many women come into IVC with leg pain that increases in intensity during their menstrual cycle. As an ultrasonographer, when a patient mentions that to me I start to thinking of pelvic congestion syndrome. Some of the symptoms include a heavy or full feeling in the pelvic area, lower back pain, and an increase in pain in the leg during their menstrual cycle.

Unfortunately women do not only deal with the hereditary factor of varicose veins but many women develop varicose veins that get worse with pregnancy. ” Britney Spears today is the equivalent of the average American woman- a single mother of two with dashed hopes, little faith in romance and varicose veins.” (The Varsity 2007) http://www.veindirectory.org/blog/2007/10/celebrity_varicose_veins_britn.html#ixzz1d2zvDKgA

We know that you are not Britney Spears and the quote seems humorous however, there is validity to the quote. Pregnancy can increase the size and the amount of varicose veins in the pelvic area as well as in the legs. There are treatment options out there for you! Please feel free to call us if you have any questions.

How is Pelvic Congestion Syndrome Diagnosed and Treated?

The diagnosis of Pelvic Congestion Syndrome is best confirmed using pelvic venography performed in the hospital. A pelvic ultrasound or other imaging study is performed prior to the venogram to rule out any anatomical abnormalities. A venogram is performed on an outpatient basis, and takes about two and a half hours from the time the procedure is started to the time you will leave the hospital. The procedure consists of inserting a thin plastic, flexible catheter about the size of a strand of spaghetti into the jugular vein in the neck. Dye is then injected into the veins of the pelvis and x-rays are taken. With the injection of dye, the interventionalist can visualize the abnormal reflux in pelvic varicosities. PCS is treated by placing tiny coils into the faulty veins to seal them off and relieve the aching pressure. The catheter is then removed and a small dressing is applied. After treatment, patients can often return to normal activity immediately.

Embolization is much less invasive than surgery. It also offers a proven, safe and minimally invasive treatment option to the traditional surgery such as hysterectomy. Although pelvic venogram is a viable treatment, other options do exist for treatment of pelvic congestion syndrome. Birth control pills or hormones may be used to stop menstrual cycles which may be beneficial in decreasing symptoms. Analgesics may be used to decrease pain. Surgical treatment is also available which includes a hysterectomy and tying off or removing the varicose veins.

Pelvic venogram offers a less expensive and less invasive effective treatment for pelvic congestion syndrome when compared to surgical treatment. Approximately 75 percent of women experience an improvement in their symptoms after the procedure. Although women’s symptoms usually improve, additional treatments may be necessary because veins in the groin or legs are still dilated and bulging.

If you are interested in this treatment or have questions, please call 801.379.6700 or send us a message.

What Is Pelvic Congestion Syndrome?

There are many different causes of pelvic pain, but sometimes it is related to the existence of ovarian and pelvic varicose veins. Varicose veins are a result of valves in the veins that don’t work correctly. Valves are designed to help veins return blood to the heart by preventing back-flow of blood down the vein. When the valves don’t work, this lets the blood pool resulting in vein bulging and pressure.

Studies show that up to 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a primary cause of their pelvic pain. The majority of women with PCS are less than 45 and are in their childbearing years. Risk factors for PCS include multiple pregnancies, polycystic ovarian syndrome, hormonal dysfunction and leg varicose veins. Women with PCS usually complain of a dull ache and heaviness in the pelvis that is worsened by standing, pregnancy, and menstruation. Sometimes this pain may be experienced in the lower back. There may also be visible varicose veins in the groin area, buttocks and upper thigh.

What should I address first, my pelvis or my legs?

Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”

The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.

There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.