Pelvic congestion syndrome (PCS)

Pelvic congestion syndrome (PCS) is a chronic condition that occurs in women when varicose veins form below the abdomen within the pelvic region. The syndrome itself often causes a constant dull pain in the pelvic area that worsens at different times and in varying situations. It is more likely to develop in women who have previously given birth. Experts believe it to be the source of pain in up to 30% of women who have chronic pelvic pain.

Women with PCS generally report dull pain is chronic that worsens in certain situations, including:

• after standing up for a long time
• in the days leading up to menstruation
• in the evenings
• during and after sexual intercourse
• in the late stages of pregnancy

Besides pain, women may experience other PCS symptoms as well as combinations of symptoms. The severity can also vary widely between individuals.

These symptoms can include:

• dysmenorrhea (painful menstruation)
• abnormal bleeding during menstruation
• backache
• depression
• fatigue
• varicose veins around the vulva, buttocks, and legs
• abnormal vaginal discharge
• swelling of the vagina or vulva
• tenderness of the abdomen
• increased urination
• irritable bowel symptoms
• hip pain

Pregnancy is believed to be the most common cause of PCS. There are many reasons why pregnancy might bring this condition on:

• Pregnancy can cause structural alterations in a woman’s pelvis. These changes can affect some blood vessels, and that increases a woman’s risk of developing varicosities.
• During pregnancy, a woman’s body gains fluid and weight to support her baby. Sometimes the veins cannot handle the extra fluid volume and they become engorged to the extent that the valves are damaged, and blood can then flow backward through them.
• Additionally, the rise in estrogen weakens the blood vessel walls. Therefore, women who have had a previous pregnancy are more likely to develop PCS, and the risk is thought to increase the more pregnancies a woman has.

PCS can be quite difficult to diagnose, and doctors often need to carry out multiple diagnostic procedures to eliminate other possible causes for your symptoms. These procedures can include:

• ultrasound
• CT scan
• venogram
• MRI scan
• laparoscopy (a surgical procedure that uses small cameras to look inside the pelvis)

Ultrasound is often preferred as the first step in diagnosing PCS as it’s possible to detect the varicosities as well as assess the blood flow.

The goal of treatment for PCS is to reduce and alleviate symptoms. Unfortunately, there is no definite cure for the condition, and it can be challenging to treat.

Medications available to help relieve your symptoms can include:

• NSAIDs (nonsteroidal anti-inflammatory drugs)
• Chronic pain medications (such as gabapentin plus amitriptyline)

Currently, the most successful treatment is a minimally invasive surgical procedure called pelvic vein embolization (PVE). This procedure blocks off certain varicose veins that are the source of pain.

Many studies have shown significant improvement of symptoms in women who have had pelvic vein embolization. As with any medical procedure, there are risks involved and this treatment option may not be appropriate for everyone.