Pelvic Venous Congestion: Symptoms

Written by
Michael Cumming, MD, MBA

Pelvic congestion syndrome (PCS) is a condition that causes significant pain and discomfort for women.  It often goes unrecognized for years resulting in needless suffering.  PCS is similar to varicose veins of the legs except that the varicose veins develop in the pelvis.  Fortunately, the symptoms of PCS can often be fixed when patients are seen by experts that specialize in diagnosis and treating these patients.

 

Patients with PCS often complain of dull, heavy, and aching or throbbing sensation in the pelvis. They will often have  pelvic fatigue with low back and or hip pain.  These symptoms worsening during the daytime and are aggravated by standing.  Lying down often relieves symptoms.  Additional symptoms include painful intercourse, abdominal bloating, constipation, vaginal bleeding and discharge.

 

Patients that have PCS are often diagnosed by their gynecologist as having chronic pelvic pain.  They undergo extensive diagnostic testing including invasive laparoscopy without getting any answers.  Additionally, patients may receive treatments for other gynecologic conditions such as endometriosis when in fact their pain is being caused by PCS. 

 

Chronic pelvic pain is defined as pain in the area below your bellybutton and between your hips that lasts greater than 6 months that adversely affects your daily function and quality of life.  In over 30% of females, a cause for chronic pelvic pain is never identified.

 

 

Causes of Chronic Pelvic Pain

 

 

Studies show up to 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15 percent have PCS along with another pelvic pathology.  Since a significant number of medical providers, including gynecologists, have not been educated about how to diagnose this condition, a great many women suffer.  PCS is easily diagnosed by a simple endovaginal ultrasound - as long as the clinic has the expertise for identifying abnormal pelvic veins.   Instead many patients are put through expensive and needless tests such as MRI, CT and laparoscopy under general anesthesia and then being told nothing was found.

Symptoms of PCS

 

The symptoms of pelvic congestion syndrome are mainly those caused by the pressure of the venous blood in the dilated pelvic varicose veins pressing on the pelvic organs. As such they can include:

·         Heavy and tired feeling in the pelvis, often worse with standing and at the end of day

·         Pelvic aching worsening during the day

·         Irritable bladder and urinary frequency

·         Irritable bowel

·         Painful intercourse

·         Labial and vulvar varicose veins

·         Inner thigh and back of leg varicose veins

 

Endovaginal US with color flow demonstrating extensive varicosities adjacent to the uterus.

 

 

  Evaluation of the left ovarian veins shows continuous retrograde flow

 

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