It is estimated that one-third of all women experience chronic pelvic pain during their lifetime. Pain management doctors define chronic pelvic pain as “non-cyclic” pain lasting greater than six months. Chronic pelvic pain is a pervasive problem in the United States. It accounts for 10-15% of referrals to gynecologists and pain management clinics.
The vast majority of pelvic congestion cases occur with women, though rare cases have been reported in men. The cause of their pelvic pain is a condition known as pelvic congestion syndrome (PCS). Doctors sometimes refer to the condition as pelvic venous incompetence, pelvic venous insufficiency, or pelvic vein incompetence.
The women most affected are between the ages of 20 and 45 and have had multiple previous pregnancies. Unfortunately, this condition often goes undiagnosed, simply because many physicians are unfamiliar with it or fail to look for it.
In This Article:
- What Is Pelvic Congestion?
- What Causes Pelvic Congestion?
- What are the Symptoms of Pelvic Congestion?
- How is Pelvic Congestion Diagnosed?
- How is Pelvic Congestion Treated?
- Novus Spine & Pain Center
- Pelvic Congestion Resources
What Is Pelvic Congestion?
Pelvic congestion syndrome is a condition, similar to varicose veins in the legs, that affects the veins of the pelvis (lower part of the belly or abdomen).
In healthy veins, blood flows from the pelvis up toward the heart in the ovarian vein. Valves in the ovarian vein prevent the blood from flowing back toward the legs. When the ovarian vein dilates, the valves do not close properly resulting in a backward flow of blood. The condition, called “reflux” or “congestion,” causes blood to pool within the pelvic veins. The pooling of blood leads to varicose veins in the pelvis.
The condition causes chronic pain, often manifesting as a constant, dull ache that varies in severity. The pain is not related to the menstrual cycle, and is most common in premenopausal women.
Doctors believe the presence of estrogen in the body causes vasodilation (a widening of blood vessels) which decreases blood pressure and results in the accumulation of blood in the veins in the pelvic area. Estrogen can weaken the vein walls, leading to the changes that cause varicosities (a thickening, twisting, and enlarging) of the vein. Up to 15% of all women have varicose veins in the abdominal area, but not all have symptoms.
What Causes Pelvic Congestion?
Pelvic congestion syndrome occurs when varicose veins develop around the ovaries, a condition similar to varicose veins in the legs. Doctors do not fully understand the causes of the syndrome. Many women have enlarged veins in the pelvis with no symptoms.
Pregnancy seems to increase the risk of pelvic congestion syndrome due to the veins enlarging during pregnancy. The veins may remain permanently enlarged and lead to PCS symptoms. Hormones may also play a role since estrogen makes the veins wider (dilate). Lower estrogen levels may explain why the condition is not common after menopause. Other hormones may also cause the veins to grow and produce PCS symptoms.
Other factors that can cause PCS include venous outflow obstruction, such as May-Thurner syndrome, left renal vein thrombosis, and external compression from a tumor.
There are many different causes of chronic pelvic pain, making diagnosis difficult. Pelvic congestion syndrome must be considered if the pain worsens when sitting or standing, and is relieved with lying down. Some patients may also experience pain with urination (dysuria) or during/after sexual activity (dyspareunia).
What are the Symptoms of Pelvic Congestion?
The primary symptom of pelvic congestion syndrome is pelvic pain lasting at least six months. The onset of pain often begins during or after pregnancy. The pain may be a heavy or aching feeling; it can also be a sharp pain. Normally, the pain is only on one side, usually the left side. But at times, the pain may be on both sides.
The pain is usually worse at the end of the day and after long periods of standing, or in women who sit all day. Patients often finds relief by lying down.
Many times, PCS symptoms don’t appear until a woman becomes pregnant. The pain may continue after the pregnancy. Some women also experience symptoms such as:
- A more intense pain during or after intercourse (dyspareunia).
- Pain before or during a menstrual period.
- Varicose veins on the buttocks, thighs, or external genitals (vulvar varicose veins).
- Irritable bladder that sometimes leads to stress incontinence.
- Irritable bowel (recurrent abdominal pain and diarrhea alternating with periods of constipation).
Certain factors can make the pain more intense, including:
- Completion of specific physical activities, such as bicycling or horseback riding.
- Changing posture.
If the symptoms get worse, it is essential to see a healthcare provider. Pelvic congestion syndrome itself does not usually lead to a medical emergency. However, if you experience a sharp, sudden pain that doesn’t go away, see a doctor right away.
How is Pelvic Congestion Diagnosed?
Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common, and many things can cause it.
- Pelvic pain can result from problems with a woman’s reproductive system.
- The pain can be a problem with the urinary system, like the bladder.
- It can be the result of gastrointestinal system problems, such as the large intestine.
- The pain can also be muscular or skeletal.
Because of the variety of causes of pelvic pain, a healthcare provider will want to know the patient’s medical history and the current symptoms. The doctor will also want to do a physical exam which will likely include a pelvic exam.
After a physical examination, a Pap test to rule out cervical cancer, routine laboratory bloodwork, and a cross-sectional imaging study (CT scan or MRI) is obtained to be certain that there is not a pelvic tumor.
Some of the tests that may be performed include:
- Urine tests to check the urinary system.
- Blood tests to check for pregnancy, STDs, anemia, and other conditions.
- Pelvic ultrasound to look for growths in the pelvis.
- Doppler ultrasound to check blood flow in the pelvic blood vessels.
- Pelvic venography, a minimally invasive procedure to insert a catheter (tube) in a vein. X-rays help guide the catheter into the ovarian vein where a dye is injected to help obtain images of the vein.
- Routine gynecologic pelvic exam.
- Laparoscopic exam to examine the pelvic organs with a thin, lighted tube inserted through an incision in the belly.
- Hysteroscopic exam to examine the cervix and inside of the uterus with a thin, lighted tube inserted into the vagina.
How is Pelvic Congestion Treated?
There are several treatment options for pelvic congestion syndrome. Early treatment includes pain medication using nonsteroidal anti-inflammatory drugs and alternative therapies such as acupuncture and physical therapy. In addition, a doctor may recommend certain prescription drugs to suppress ovarian function (stop the ovaries from making estrogen). Prescription hormonal medications can be used to reduce blood flow and congestion of the varicose veins.
If drug therapy is ineffective, minimally invasive treatments may be an option, such as nonsurgical embolization (intentional plugging) of the varicose veins. The varicose veins are permanently sealed off from the inside. Patients typically return to work and light activities the following day, and to full activities in a week.
If the minimally invasive procedures fail to bring pain relief, surgery is an option. Depending on the patient, the doctor may only remove the damaged veins, or the doctor may surgically remove the uterus and ovaries.
In some cases, the symptoms may ease once the patient enters menopause.
Novus Spine & Pain Center
The Novus Spine & Pain Center vein clinic is in Lakeland, Florida, and specializes in treating pelvic congestion. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Pelvic Congestion Resources
How Can You Tell Pelvic Congestion Syndrome is Causing Chronic Pelvic Pain? (WebMD)
Pelvic Congestion Syndrome: Diagnosis and Treatment (PubMed)
Pelvic congestion syndrome (Wikipedia)
Pelvic Pain (Pelvic Congestion Syndrome) (Johns Hopkins)
Pelvic Congestion Syndrome (Cedars-Sinai)
Pelvic Congestion Syndrome (Stanford Healthcare)
Medical Definition of Pelvic congestion syndrome (MedicineNet)
Pelvic Congestion Syndrome (Stony Brook Medicine)