Pelvic Congestion Syndrome - Symptoms, Risk factors and Treatment

Pelvic congestion syndrome is a condition in which there is chronic pain (usually more than six months) due to the enlargement and dilation of the veins in your pelvis. The pelvis is the part of your body between the hip bones, and it contains the urinary bladder, some parts of the intestines, and reproductive organs.

The veins are responsible for carrying blood away from different organs to the heart. Due to enlargement of veins, the blood tends to pool back and collect in the veins (congestion) that causes pain.

Risk factors for getting PCS:

Females are at a high risk of getting pelvic congestion syndrome. It is more common in women of childbearing age and those who have previously given birth. Pregnancy is thought to be the biggest risk factor due to the following reasons:

-Changes in the body:

As the pregnancy advances, there are structural changes that take place in the woman’s body. Also, the baby’s weight increases, and it puts pressure on different organs and veins. It can cause the development of varicosities in the veins of a woman’s pelvis.

-Fluid retention: 

In pregnancy, more fluid is retained in your body, and the blood volume increases to make up for the increased blood demands of the fetus. It can cause enlargement of the veins and damage to the valves of the veins that results in the accumulation of blood in the veins.

-Hormonal effects:

In pregnancy, your hormonal levels are changed greatly. Some hormones are low, while some are high. One such hormone- estrogen, is increased. Estrogen has many effects on the female reproductive system and the body. One of its effects is the weakening of the blood vessels, which can cause dilation of the veins causing pelvic congestion syndrome.

The risk of getting PCS increases with an increasing number of pregnancies.

Symptoms of pelvic congestion syndrome:

The primary symptom of pelvic congestion syndrome is pain. There is dull, aching pelvic pain, usually on the one side, and lasts more than six months. It may develop during pregnancy. The pain may increase by the following:

• Standing for a long time
• During or after having sex
• Walking
• Before menstruation
• In the last stages of pregnancy.

Other than pain, there may be other non-specific symptoms such as;

• Backache
• Fatigue
• Frequent urination
• Pain during periods (dysmenorrhea)
• Enlarged veins on the buttocks, vulva, or thighs
• Abdominal tenderness
• Vaginal discharge

Diagnosis of PCS:

Since there are a variety of different causes of pelvic pain, PCS is hard to diagnose. Your doctor may order the following tests to reach a definitive diagnosis:

• Pelvic ultrasound
• CT scan or MRI 
• Pelvic venography
• Doppler ultrasound
• Diagnostic laparoscopy
• Blood and urine tests to check for infections

Treatment of PCS:

The following treatment strategies may be used to treat pelvic congestion syndrome:

-Pain relief:

Pain relief is achieved by giving NSAIDS (Non-steroidal anti-inflammatory drugs) or other pain relievers like gabapentin.

-Surgery:

The surgical strategy most commonly used for treating PCS is a procedure called Pelvic vein embolization (PVE). In this procedure, selected veins in the pelvis are blocked that are thought to cause pain.

-Hormonal drugs:

Hormonal drugs may be given to relieve pain, such as Gonadotropin-releasing hormone drugs and progestin hormone drugs.

Conclusion:

Pelvic congestion syndrome varies in presentation, and a diagnosis does not mean that you will experience all the symptoms with the worst intensity. However, the quality of life may be affected as PCS can affect physical activity and your sex life which can cause frustration and depression. If you experience pelvic pain, which lasts more than six months and is aggravated by the factors listed above, it is highly advisable to see your healthcare provider soon.