Pelvic Congestion Syndrome (PCS)
What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome (PCS) is a medical condition in which chronic pelvic pain occurs secondary to abnormal swelling of the veins in the pelvis. Strongly linked to increasing age and prior pregnancy, this condition is due to abnormal leaky valves in the veins of the pelvis. This causes an increase in pressure in the pelvic veins which causes pain. It can also be associated with varicose veins in the thigh, buttocks and labia. In fact, PCS is similar in causes, symptoms and management to typical varicose veins in the legs.
Up to one third of women suffer from chronic pelvic pain secondary to PCS. PCS increasingly recognised as a treatable cause of chronic pelvic pain, in part as greater awareness over the underlying cause of and diagnosis of the condition lead to more women being offered effective treatment. Many women who have suffered in silence with chronic ache and pain may have a treatable cause.
Pelvic Congestion Syndrome Symptoms
PCS generally presents with a dull, but ongoing pain and can worsen during certain situations, such as:
- Standing for extended periods
- In the days preceding menstruation
- In the late afternoon or evening
- During and after sex
- During the late stages of pregnancy
Besides the pain, some women may experience other symptoms, including:
- 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
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What Causes Pelvic Congestion Syndrome?
PCS is most commonly thought to be caused by pregnancy. This is because:
- Pregnancy can change the structure of the pelvis, which affects blood vessels and increases the risk of developing varicosities.
- Increased fluid and weight from pregnancy can put pressure on the veins. They then become enlarged and blood can’t flow back through them.
- An increase in estrogen can weaken the blood vessel walls.
The condition is uncommon in younger women or those who have not had children.
How is Pelvic Congestion Syndrome Diagnosed?
The symptoms of PCS are often very characteristic and when explored thoroughly, patient symptoms can strongly suggest the diagnosis. Supporting evidence can be obtained from imaging scans which show abnormal veins, i.e., pelvic venous incompetence.
An ultrasound of the pelvis or CT can identify pelvic incompetence but only if the radiologist reading the scan is aware of this condition. It is common to diagnose and successfully treat women who have had the diagnosis missed for years because of lack of awareness amongst medical professionals.
When actively searching for the diagnosis, a dedicated pelvic ultrasound or MRI scan are excellent methods of showing abnormal veins. The gold standard for diagnosis of incompetence, however, is venography, when dye is injected into the abnormal veins under x-ray guidance, proving they are.
How to Manage and Treat Pelvic Congestion Syndrome
PCS is a condition caused by abnormal swelling of the veins in the pelvis. This is usually due to a problem with the valves in these veins. Treatment options in the past involved surgical management of these veins. This has given way to modern minimally invasive treatment in which the abnormal dilated veins are embolised. Embolising, or blocking, these abnormal veins removes this increased pressure in the pelvis and can improve pain.
- Medical – painkillers can be used but are often ineffective. As there is hormonal influence on the pain, the contraceptive pill can also be used to reduce pain.
- Embolisation – this procedure identifies the abnormal veins responsible for the pain and blocks them
- Surgery – many women have unnecessary surgery for their chronic pain, including hysterectomy, when in fact they have a condition treatable without the need for major surgery.
Only patients who are symptomatic need treatment. If you have chronic pain for which no cause has been found, then PCS may be a cause. If your symptoms do not respond to medical management then you may consider embolisation. Undoubtedly symptoms are best managed by an individual patient-centred approach and some women are best managed medically. When you are seen in rooms by the IR specialist you can trust that you will be only offered treatment if it is thought to be your best option.
Embolisation for Pelvic Congestion Syndrome
Frequently Asked Questions
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How do I know if I am a candidate?
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Initial patient enquiries are welcome. Send us an email or call and we will email a patient information form for you to complete. Ask your GP to refer you for a consult. Note that consultations without a referral cannot be claimed from Medicare. After listening to your symptoms and taking a medical history we will discuss further investigations or scans needed to establish whether you are a candidate.
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What investigations or scans are needed?
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This will be discussed at time of consult but may include:
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Pelvic ultrasound
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MRI of the pelvis and pelvic veins – this can establish the presence of pelvic incompetence and also allows identification of other potential causes such as endometriosis
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Venography – this is often performed at the time of treatment but can be performed on its own for diagnostic purposes
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How long is the procedure?
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The pelvic vein embolisation procedure takes an hour or so.
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Do I need an anesthetic?
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Pelvic vein embolisation is performed using sedation and local anaesthetic. The procedure is usually not painful although some minor pelvic pain can occur at the time of procedure and in the following days.
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How is the procedure performed?
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This is a complex and difficult procedure performed by a specialist interventional radiologist – an expert in this area.
A tiny plastic tube is placed inside a neck or groin vein and under x-ray guidance is navigated towards the abnormal pelvic veins. Dye injection is used to confirm these veins are abnormal. Following this, a combination of tiny metal coils or special foam is used to block the veins from the inside.
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How long will I be in hospital?
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You will stay in hospital for a few hours afterward, until sedation has fully worn off.
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What is the recovery period?
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You will have to avoid exercise, heavy lifting etc for 2-3 days, this includes avoiding intercourse. You may feel tired for a few days.
You will almost certainly be able to return to work within a few days.
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Why should I choose pelvic vein embolisation?
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Embolisation for PCS is an excellent option if your symptoms are poorly controlled on medication, no other cause has been identified and you have imaging showing pelvic vein incompetence.
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What is the evidence embolisation for PCS works?
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Pelvic vein embolisation has a growing evidence base. 80% of women can expect symptom improvement.
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What are the downsides?
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Symptoms can recur if the vein reopens or new veins form.
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Is this treatment for everyone?
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No. Some women will have evidence of pelvic vein incompetence but not have symptoms.
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In summary
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A safe minimally invasive treatment option that can help women with chronic pelvic pain. Patients should undergo imaging by someone aware of the condition who can comment as an expert on the presence of pelvic vein incompetence. An interventional radiologist can establish in consultation with you whether your symptoms are due to PCS.
Safe, effective treatments with less pain and quicker recovery.
Ensure you know all your options prior to invasive surgical treatment, schedule a consult with Dr Shaun Quigley.
