What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome, also known as PCS, is a pattern of pelvic pain in women due to varicose veins located inside or around the pelvis area. There are several reasons that varicose veins may form.
Symptoms of PCS
Unfortunately, the symptoms of PCS can often be confused with other conditions. If you go to see a Gynecologist, Urologist, Gastroenterologist or other medical professional they may be unsuccessfully treating the symptoms. Having a hemorrhoidectomy, cystoscopy or colonoscopy will not relieve the pain or return negative test results. Your symptoms may be slightly relieved upon lying down and worsen upon standing or sitting. If you experience any of the following symptoms and have seen other doctors with no success Vein Specialists of the Carolinas can help.
- Heaviness, fullness, or bloating with aching or throbbing in the pelvic area
- Worsening pain during menstruation
- Pain and aching during or after intercourse
- The urge to urinate
- Rectal fullness or the urge to have a bowel movement
- Hemorrhoids, varicose veins of the rectum, are present
External Signs of Pelvic Congestion Syndrome
If you are experiencing varicose veins in the following areas this may indicate that you have pelvic congestion syndrome.
- Above the pubic bone
- Inner or upper thighs
- Lower abdomen
- On the labia
- Under the buttock
Causes of PCS
There are many things that can occur in your body that will lead to pelvic congestion syndrome.
- Ovarian Vein Reflux. Also known as reverse flow can cause PCS when one way valves no longer function. This causes blood to flow backwards into the pelvis.
- May-Thurner Syndrome. Blockage of the leg veins can result in pelvic problems with or without leg problems. This happens because the veins of the bladder, uterus, vagina, and rectum all join together and then join into the leg veins.
- Nutcracker Syndrome. This occurs when your left kidney vein is blocked. When the left ovarian vein drains into the left kidney vein the blood flow is diverted into other veins, most commonly the ovarian vein. This damages the ovarian vein valves and causes varicose veins to form in the pelvis. This kidney vein blockage can also cause left flank pain or blood or protein in the urine.
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Diagnosing Pelvic Congestion Syndrome
There are some ultrasound and internal methods that will not give you a clear enough look at what is going on with your pain. Ultrasounds for the abdominal and pelvic area do not investigate the veins to the required degree. On the other hand, a transvaginal ultrasound may show the pelvic varicose veins but most Gynecologists are more focused on the ovaries and uterus so they will not diagnose the syndrome. A laparoscopy can be performed but may turn out negative since the pelvis is elevated to allow the intestines to come out of the pelvis. This results in the varicose veins being emptied and not seen.
Other procedures prove to be more effective in diagnosing PCS. A transabdominal ultrasound in the hands of an experienced vein specialist can show the varicose veins, the kidney vein, the ovarian vein and the leg vein. CT or MRI scans can also show the varicose veins, but is not usually designed to show other veins that may contain problems. Finally, a venogram, in which you fill the kidney, ovarian and leg veins with ray dye will give you the most accurate information.
There are several methods to treating Pelvic Congestion Syndrome. Stenting or open surgery are some of the surgical methods. An intravenous ultrasound is used to get the most accurate measurements of the vein. Then the leg or kidney vein that is blocked is opened with a stent to return proper vein function. Another surgical option is a hysterectomy. While not the main goal of the procedure, veins can become ligated when the uterus is removed.
Medication options are available if the above procedures are not the right route for you. In the case that the ovary veins are refluxing a specialist will close the veins with coils and implement medication to seal them. There is also new medication that is in the trial stages. The goal of the medication, Vasculera, is to relieve symptoms in order to postpone or avoid surgery.