For many women, chronic pelvic pain goes undiagnosed and untreated. Surprisingly, however, a large percentage of pelvic pain can be attributed to issues with the pelvic veins. When pelvic pain is attributed to the pelvic veins, it is known as pelvic congestion syndrome.
Pelvic Congestion Syndrome is thought to be responsible for up to 40% of pelvic pain women experience.
PCS is a chronic pain condition characterized by swollen, bulging and painful ovarian and pelvic veins, also called pelvic varicose veins.
These enlarged veins cause a number of painful symptoms that often worsen with sexual activity, lifting heavy objects, standing or walking.
When a vein valve is damaged or weakened, blood cannot flow from the vein back to the heart in an efficient manner. As a result, blood backflows and pools in the vein, causing congestion and swelling.
When the veins in the ovaries and uterus become damaged or weakened, blood pools in the veins, causing the vein walls to become distended. This can cause severe pain and an overall feeling of heaviness in the pelvis and abdomen.
Pelvic veins can be damaged by a number of events, including weight gain, hormonal fluctuations and multiple pregnancies. Damaged pelvic veins can become so swollen, in fact, that they press on surrounding organs, including the bladder, intestines and rectum.
Here are the main risk factors for developing PCS:
Pregnancy. The veins in the uterus and ovaries dilate during pregnancy to accommodate a significant increase in blood flow. After a pregnancy is over, these veins don’t always return to their previous size. This can cause vein malfunction and lead to PCS. PCS is more likely in women who have experienced multiple pregnancies.
Hormonal imbalance. Excess estrogen can cause ovarian veins to widen. This can contribute to vein malfunction and congestion.
Being of childbearing age. The majority of women diagnosed with PCS are between 20 and 45 years of age.
Risk of developing pelvic congestion syndrome may also increase if a close family member has been diagnosed with the condition.
The main symptoms of PCS include:
- Pelvic pain - Pain in the pelvis, abdomen, buttocks and hips
- Dragging sensations in the pelvis
- Feeling of heaviness in pelvis or abdomen
- Pelvic pain that gets worse when sitting or standing
- Pain during sexual intercourse
- Pain in the lower back and legs
PCS is difficult to diagnose because many women (especially those who have had children) will display enlarged pelvic blood vessels on a standard ultrasound or MRI but will have no painful symptoms. Only women who have enlarged pelvic veins and chronic pelvic pain are given a diagnosis of pelvic congestion syndrome.
In order to provide a diagnosis of PCS, your doctor will collect information about the nature and duration of your pain. For a diagnosis of PCS, pain must be present for a minimum of 6 months.
The following tests are instrumental in helping provide a PCS diagnosis:
- Radiological imaging
- Blood tests
- Diagnostic laparoscopy
- Pelvic and transvagical ultrasound
- Pelvic venography - This procedure involves the injection of contrast material into a vein to observe how blood flows through the vein.
Depending on the nature and severity of your pain, your doctor may recommend additional diagnostic measures.
If ovarian varices (varicose ovarian veins) are found on radiological images or in a venogram, your doctor can recommend a minimally invasive procedure to provide pain relief.
If you have been diagnosed with pelvic congestion syndrome, you have more treatment options than ever before.
One of those treatment options is a minimally invasive procedure called ovarian vein embolization. During this procedure, an interventional radiologist uses guided imaging and a catheter to place coils and embolic agents in damaged ovarian veins. Once the blood supply to these veins is closed off, blood can no longer pool in the veins. This provides relief from pain, heaviness and pressure associated with pelvic congestion syndrome.
After ovarian veins are closed off, additional veins may also need to be treated. This is typically done at a later appointment.
Other treatment options for pelvic congestion syndrome include hormone regulating drugs or sclerotherapy.
The Vein Center at Georgia Vascular Institute is one of the premier centers for vein treatment in Stockbridge, Georgia and surrounding areas.
Dr. Kevin L. Carson and Dr. Sendhil K. Subramanian at Georgia Vascular Institute specialize in interventional radiology and the treatment of varicose veins.
Schedule your appointment at Georgia Vascular Institute today.