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

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.