A health condition that causes chronic (long-lasting) pelvic pain, but it is not related to menstruation or pregnancy, is called pelvic congestion syndrome (PCS). It often occurs due to problems with blood flow in the pelvic veins. It begins to flow backward, which causes swelling and twisting of the pelvic veins. Nowadays, researchers are not sure what exactly causes this condition, but they think changes during pregnancy and Estrogen could play a role. Furthermore, this disorder is also known as pelvic venous insufficiency.
In addition, about 40% of gynecological visits involve chronic pelvic pain complaints. Some research has shown that about 30% of them are related to PCS.
Symptoms
While the primary symptom of this condition is pain that you may feel dull, achy, or heavy, PCS may also cause other symptoms. Rarely, the pain caused by this disorder is sharp and intense. More commonly, PCS causes pain on the left side only, but it may also cause pain on the right side of the body or both sides. Usually, pain starts during or after pregnancy. Furthermore, pain caused by PCS often worsens in the following cases. For example:
- In the evening
- Before and during pregnancy
- Dyspareunia (during or after intercourse)
- When you stand or sit for a long time
Check below for other PCS symptoms:
- Varicose veins in the pelvic area, butt, thighs, vulva, and vagina
- Frequent bouts of constipation or diarrhea
- Dysuria (painful urination)
- Stress incontinence (urinating accidentally when laughing, coughing, or other movements that cause stress to the bladder)
If you experience any of the symptoms listed above, do not hesitate to visit a doctor.
Causes
Healthcare providers do not know what causes PCS. However, they think there is a problem with blood flow in the ovarian veins and the veins in the pelvic area. In normal circumstances, the blood flows upward from the pelvic veins to the heart via the veins in the ovaries. Therefore, in the veins, there are some structures (valves) that prevent blood from flowing backward (reflux). However, in people with PCS, these veins are widened, and the valves cannot prevent reflux, so blood can flow backward, causing them to be overly filled and twisted. As a result, when it occurs, people often begin to experience symptoms. Check below some reasons that veins can become structurally unsound with PCS:
- Pregnancy – Some healthcare professionals believe that PCS is related to blood vessel changes that occur during pregnancy. Usually, blood vessels expand 50% of their normal size during pregnancy to make sure the developing fetus gets enough blood. In some cases, these changes may cause damage to the blood vessel walls, which causes the veins to remain dilated even after delivery.
- Estrogen – In general, PCS occurs rarely in people after menopause, which suggests that Estrogen could play a role. Commonly, Estrogen levels decrease during menopause. Therefore, the effects of this hormone on the blood vessel walls can make you more likely to develop PCS.
Furthermore, this disorder can occur from various interrelated factors. For more details, discuss it with your healthcare professional.
Risk Factors
While this condition can affect anyone, there are some factors that could increase your risk of developing PCS. Check below some of them:
- Age – This condition often occurs in women between the ages of 20 and 45, especially those who have given birth more than once.
- Varicose veins
- A family history of varicose veins
- PCOS (polycystic ovary syndrome)
In general, PCS affects people after menopause quite rarely.
What Are The Possible Complications of Pelvic Congestion Syndrome?
People with PCS may also experience some complications, especially if they do not get treatment. For example:
- Dyspareunia (pain during sexual activity)
- Irregular menstrual cycle
- Endometriosis
- Urinary problems (including frequent urination, urinary incontinence, and others)
- Deep vein thrombosis (DVT)
- Blood clots
- Pelvic organ prolapse
- Chronic fatigue (extreme tiredness)
- Mental health problems (such as anxiety or depression)
This document does not contain a complete list of PCS complications. In any case, you can consult with your doctor about ways to reduce the risk or prevent previous complications. Additionally, this disorder cannot be prevented.
Diagnosis
First, doctors will perform a pelvic examination to check for irregularities linked to the disease. During a pelvic examination, doctors will check your ovaries, cervix, and uterus. They may also evaluate your medical history and ask some questions about your symptoms. Your doctor may also perform the following imaging tests to exclude other disorders that also cause chronic pelvic pain and get more clues about the disease. These include:
- Ultrasound – This is often the primary test performed when PCS is suspected by doctors. It helps see vein dilation and other irregularities that cause your pain.
- MRI (magnetic resonance imaging) or CT (computed tomography) scans – These tests are used to get detailed images of the veins in the pelvic area. They often help identify twisted or widened veins in the ovaries and pelvis, as well as abnormal growths that may also cause chronic pain.
- Pelvic venography – This test is considered the gold standard for PCS imaging. While it is invasive compared to MRI and CT scans, doctors often perform it when other imaging tests do not provide enough evidence. During this test, doctors will use a catheter (a long and flexible tube with a lighted camera on the end) that is inserted into a vein in the neck or groin area. Thereafter, they use an X-ray to guide the catheter to the ovarian veins on the right and left sides of the body. This test usually helps identify the dilated and twisted veins.
- Laparoscopy – This test is used to determine the exact location of widened veins. While it cannot confirm PCS, it helps rule out other disorders that cause chronic pelvic pain.
Generally, it is quite difficult to diagnose PCS because there are a lot of conditions that also cause pain in the pelvic area. According to some studies, many people have chronic pelvic pain without distorted blood vessels and backward blood flow.
Treatment
Unfortunately, this condition cannot be cured. That’s why the treatment goal is to reduce the symptoms, prevent serious complications, and improve your quality of life. Usually, people with PCS need a healthcare team to address the symptoms. For example, gynecologists, physical therapists, pain specialists, and others. Check below some treatments often recommended for people with PCS:
Medicines
The following medicines are used to reduce Estrogen production, which may reduce pain linked to the PCS. Check below some medicines that doctors often prescribe:
- Etonogestrel implant
- GnRH agonists
- Goserelin
- Medroxyprogesterone acetate
Procedures
The following options are recommended by doctors when medicines do not relieve pain caused by PCS. Examples include:
- Ovarian vein embolization or sclerotherapy – These procedures are used to block blood vessels that cause blood to flow backward.
- Laparoscopy – During this procedure, doctors will tie off the veins to prevent reflux.
- Bilateral salpingo-oophorectomy – This treatment is used to remove the pelvic organs (including uterus, fallopian tubes, and ovaries). However, this surgery is rarely used for people with PCS.
Frequently Asked Questions
Is pelvic congestion syndrome life-threatening?
This disorder is not life-threatening, but it may cause severe symptoms and interfere with daily activities. If you think you have a PCS, do not hesitate to see a doctor.
What is the most common cause of pelvic congestion?
This condition often affects women with enlarged veins in the pelvic area. Healthcare providers do not know what exactly causes enlargement of these veins, but they think pregnancy and Estrogen could play a role.
What foods should you avoid with pelvic congestion syndrome?
Usually, doctors recommend avoiding the following foods if you have PCS. These include refined carbohydrates, highly processed foods, high-sodium foods, caffeine, alcohol, and sweeteners. If you have additional questions, ask your healthcare provider.
