pelvic congestion syndrome

As an area of medicine that’s under-researched, pelvic congestion syndrome is surprisingly common. Around 39% of women will see their doctor for pelvic pain at some point in their lives. It’s difficult to estimate what percent of those women are experiencing PCS, but it’s an important condition to investigate nonetheless.

What is Pelvic Congestion Syndrome?

Problems with the veins in the pelvic area can result in chronic pain felt throughout the pelvis. As vessels that carry blood back to your heart, sometimes they stop functioning at their optimal level. If the veins in your pelvis begin enlarging and become engorged, they may produce ongoing pain. PCS in women often feels debilitating, but there are ways to treat it.

pid symptoms

36-year-old female with PCS. A-Venography showing reflux of right obturator (dashed arrow) and pudendal vein (arrowhead). B-Selective microcatheterization of left obturator vein (black arrow). C-Onyx on left dilated obturator vein (black arrow), and and right dilated obturator vein (dashed arrow). Note the radio-opacity of the embolic mixture without subtraction.
Image source: researchgate.net

What are the PCS Symptoms?

Common PCS symptoms include:

  • Chronic pelvic pain that lasts for at least six months.
  • The pain is usually one-sided, although it can be felt on both sides in some cases.
  • Movements such as changing posture, standing for a long time, and walking can make the pain worse.
  • Some women experience pain following intercourse.
  • Symptoms may feel worse just before menstruation.
  • A sudden urge to urinate is another common complaint.
  • In some cases, enlarged and distorted veins similar to varicose veins appear on the thighs, buttocks, and vulva.

Women who are experiencing the signs of PCS should reach out to their physician for a diagnosis.

Causes of PCS Pain

Diagnosing pelvic congestion syndrome isn’t always easy, and the causes aren’t always obvious. In many cases, clinicians believe their patient is experiencing PID pain, resulting in a misdiagnosis. There’s a chance that having more than one pregnancy will increase your risk. This is because pregnancy increases your blood volume, and the blood vessels in the pelvic area carry a lot of strain.

Hormones such as estrogen also cause your veins to dilate, which means you may be at a higher risk if you’ve used estrogen therapy in the past. Fortunately, this also means your risk of developing pelvic congestion syndrome drops after menopause.

Finally, there may be a genetic component. If a close female relative has been diagnosed with PCS, you’re more likely to receive a diagnosis too.

What PCS Treatment is Available?

At Vascular Health Center, we provide two types of treatment for PCS. The first is hormonal therapy. Each hormonal medication administered will reduce the blood flow to your engorged pelvic veins, which then makes your symptoms less pronounced. Although it has a high success rate, some patients require alternative treatments.

Our second approach involves using a technique called nonsurgical embolization. During your nonsurgical embolization procedure, we’ll insert a small catheter into a vein in your upper arm, shoulder, or thigh. We’ll then use imaging to guide ourselves to the problem vein and plug it using embolization. As a minimally-invasive procedure, it takes place on an outpatient basis in one of our offices. There’s no need for stitches or general anesthetic, so the recovery is fast.

pid treatment

Dr. Nwobi typically treats PCS with a minimally invasive in-office procedure, such as sclerotherapy and embolization.

What Does a Pelvic Congestion Syndrome Diagnosis Involve?

signs of pidDiagnosing pelvic congestion syndrome isn’t easy. Pelvic pain is a common complaint among women, and there are other causes your doctor may consider before they refer you for a PCS diagnosis.

Your doctor may believe you’re experiencing PID symptoms instead. Pelvic inflammatory disease (PID) is a common cause of pelvic pain among women. However, the signs of PID are quite different. For example, you may notice foul-smelling discharge. Some signs overlap, such as bleeding after intercourse. The symptoms of PID in women are more likely to be attributed to PCS after your doctor investigates alternative causes. They can use urine testing, STI swabs, and bladder scans to rule out PID. As PID treatment isn’t effective for PCS, you’re unlikely to go through it before a PCS diagnosis is made.

When your doctor does refer you for a PCS examination, we can use imaging modalities such as ultrasound, CT scans, or MRI to look for engorged veins. You’re more likely to undergo an MRI or ultrasound as they don’t deliver high doses of radiation. We’ll then use the results of these scans alongside the information you provide us with to form a diagnosis. It may help to make a list of your symptoms so that we can note everything down on the day of your appointment. In most cases of PCS, pelvic examinations are normal, so you’re unlikely to need one.

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