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• Pelvic Congestion
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• Pain Management

Pelvic Congestion Syndrome is a common condition believed to be associated with varicose veins in the pelvis (lower abdomen and groin) causing chronic pelvic pain. It is estimated that this condition affects more than one third of all women. Many of these women are told the problem is "all in their head" but recent advancements now show the pain may be due to hard to detect varicose veins in the pelvis.

Classic Symptoms of Pelvic Congestion Syndrome

The classic symptoms related to Pelvic Congestion Syndrome include pelvic pain associated with standing and sitting, which worsens throughout the day. The chronic pain felt is usually dull and aching. Patients often feel less pain in the morning, with relief from pain when lying flat and when legs are elevated.

Symptoms may increase during the following times:

• Following intercourse
• Menstrual periods
• Pregnancy

Other symptoms include:

• Irritable bladder
• Abnormal menstrual bleeding
• Vaginal discharge
• Varicose veins on vulva, buttocks or thigh.

6 Simple Questions to ask yourself if you think you have Pelvic Congestion Syndrome.

Pelvic Congestion Syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don't close properly, this allows blood to flow backwards and pool in the vein causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva.

Pelvic Congestion Syndrome typically affects:

• Women, who are generally less than 45 years old and in their child bearing years.
• Ovarian veins increase in size related to previous pregnancies. Pelvic Congestion Syndrome is unusual in women who have not been pregnant.
• Women who have had two or more pregnancies and hormonal increases.

Other risk factors include:

• Fullness of leg veins
• Polycystic ovaries
• Hormonal dysfunction

Gynecologists do not often diagnose women with Pelvic Congestion Syndrome because women lie down for a pelvic exam, relieving pressure from the ovarian veins, so that the veins no longer bulge with blood as they do while a woman is standing.

Many women with Pelvic Congestion Syndrome spend years trying to get an answer to why they have this chronic pelvic pain. Living with chronic pelvic pain is difficult and affects not only the woman directly, but also her interactions with her family, friends, and her general outlook on life. Because the cause of the pelvic pain is not diagnosed, no therapy is provided even though there is therapy available. However, many women that have Pelvic Congestion Syndrome never experience any of the symptoms.

Procedures to Diagnosis Pelvic Congestion Syndrome

Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, Mountain Medical’s interventional radiologists examine patients on an incline, because the veins decrease in size when a woman is lying flat.

MRI: May be the best non-invasive way of diagnosing Pelvic Congestion Syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.

Pelvic ultrasound: Usually not very helpful in diagnosing Pelvic Congestion Syndrome unless done is an very specific manner with the patient standing while the study is being done. Pelvic ultrasound may be used to exclude other problems that might be causing pelvic pain.

Transvaginal ultrasound: This technique is used to see better inside the pelvic cavity. As with a pelvic ultrasound it is not very good at visualizing the pelvic veins unless the woman is standing. However it may be used to exclude other problems.

Pelvic Congestion Syndrome Treatment Options

Once a diagnosis is made by a Mountain Medical interventional radiologist, if the patient is symptomatic, a pelvic venogram with embolization should be done. Embolization is a minimally invasive procedure performed by our interventional radiologists using imaging for guidance. During the outpatient procedure, our interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, our interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients should expect a low level of pain and to spend a couple of days off their feet.

Additional treatments are available depending on the severity of the woman's symptoms. Analgesics may be prescribed to reduce the pain. Hormones such birth control pills decrease a woman's hormone level causing menstruation to stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.

Ask Yourself These Questions if You Think You Have Pelvic Congestion Syndrome

The following is a list of questions to help you determine if you have Pelvic Congestion Syndrome.

1. Have you been evaluated by a vein center for varicose veins of leg/groin?......................................................Yes/No
2. Do you have pelvic pain?......................................................Yes/No
3. Is your pain worse at the end of the day?..............................Yes/No
4. Does your pelvic pain decrease when you are lying flat on your back?......................................................Yes/No
5. Do you have visible varicosities in the area of the groin or labia?......................................................Yes/No
6. Does your pelvic pain affect your daily quality of life or normal daily activities?......................................................Yes/No

If you answer yes to any of these questions, you may have Pelvic Congestion Syndrome. We advise you to seek an appointment with one of Mountain Medical’s interventional radiologists, who can work alongside your gynecologist to get you the help you need.

Call to schedule an appointment today!