What is Pelvic Congestion Syndrome? (PCS)

Pelvic Congestion Syndrome (PCS) is a chronic condition that affects the pelvic area. PCS develops when varicose veins form just below the abdomen in the pelvic region. Varicose veins develop from poor vein functioning and result in swollen, twisted, and lengthened veins. PCS typically causes a dull aching pain in the pelvic region that varies in degree of severity. Women between the ages of 20-45 who have been through childbirth are more likely to develop PCS. It is estimated that one third of women will experience chronic pelvic pain in their lifetime.

PCS can be extremely painful, inhibiting your daily life, and lasting up to 6 months or more. Symptoms of PCS may be heightened during your menstrual period, but it is not caused by your period. PCS can be difficult to diagnose.

Symptoms   

PCS has several symptoms that range in severity, often depending on the activity you are doing or whether you are standing for a long period of time. Symptoms may last for several months and sometimes impact your daily activities. Typically, symptoms are experienced on one side. Common symptoms include:

• Dull aching pain in the pelvic region and lower back
• Pain that worsens during your period
• Pain or discomfort during intercourse
• Pain that worsens while standing for long periods of time
• Stressed or irritable bladder that may make it difficult to control urination
• Varicose veins on your upper thighs or buttocks
• Bulging or swollen veins in front of the vagina

Additional symptoms may include:

• Fatigue
• Depression
• Abnormal vaginal discharge
• Abnormal bleeding during menstruation
• Tenderness of the abdomen
• Irritable bowel syndrome (IBS)
• Hip pain

Causes

The most common cause for PCS is pregnancy. There are several reasons why pregnancy may lead to the development of PCS. Reasons include:

• Structural alterations in the pelvis can affect some blood vessels, which increases the risk of developing varicosities
• Weight gain and fluid retention that happens during pregnancy can increase the risk of developing varicose veins
• A rise in estrogen during pregnancy can weaken the blood vessel walls

Risk Factors

There are a few risk factors in addition to pregnancy that may increase the risk of developing PCS. Risk factors include:

• Having more than one pregnancy
• Hormonal changes
• Having a retroverted or “tipped” uterus
• Polycystic ovaries
• Extra weight in the legs

If you are experiencing chronic pelvic pain and meet one of these risk factors, please contact your Baptist Health Gynecologist.

Diagnosis

Diagnosing PCS can be difficult due to overlap in symptoms with other conditions and because PCS can be triggered by several different things. Doctors will utilize multiple diagnostic tools to rule out other conditions before reaching a diagnosis of PCS. Diagnostic tools and tests include:

• Urine test
• Blood tests
• Ultrasound
• MRI or CT scan
• Laparoscopy (small camera inside the body)
• Venogram (x-ray for the veins)

Treatment

PCS can be challenging to treat, and although there is no cure, treatments aim to alleviate symptoms. There are several treatment options for people with PCS and you and your doctor will determine which treatment is best for you. Recommended treatments include:

• Taking NSAIDS (non-steroidal anti-inflammatory drugs) to manage pain
• Taking specific chronic pain medications (gabapentin plus amitriptyline)
• Taking certain hormones to block ovarian function or alleviate the pain
• Pelvic vein embolization (PVE)
• Hysterectomy

The most successful treatment option for PCS is a pelvic vein embolization (PVE), which is a minimally invasive surgical procedure. The procedure blocks off the specific varicose veins that are suspected to be the source of pain. PVE has shown significant improvements in symptoms for those suffering with PCS. Make sure to discuss this treatment option with your doctor, as this treatment is not recommended for everyone with PCS.