Pelvic congestion syndrome (PCS) is a chronic condition that occurs in women when varicose veins form below the abdomen within the pelvic region. Varicose veins are veins that become swollen, twisted, and lengthened as a result of poor vein function.
The syndrome often causes a constant dull pain in the pelvic area that is said to worsen at different times and in varying situations. It’s more likely to develop in women who have previously given birth.
Experts believe it can be the source of pain in up to 30 percent of women who have chronic pelvic pain.
What are the symptoms?
Women with PCS generally report that the dull pain is chronic but that it worsens in certain situations, including:
- after standing up for a long time
- in the days leading up to menstruation
- in the evenings
- during and after sexual intercourse
- in the late stages of pregnancy
Besides the pain, women may experience other PCS symptoms as well as different combinations of these symptoms. The severity can also vary quite widely between individuals. These symptoms can include:
- dysmenorrhea (painful menstruation)
- abnormal bleeding during menstruation
- 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
Causes and risk factors
Pregnancy is currently thought to be the most common cause of PCS. There are many reasons why pregnancy might bring this condition on:
- Pregnancy can cause structural alterations in a woman’s pelvis. These changes can affect some blood vessels, and that increases a woman’s risk of developing varicosities.
- Another risk factor is that a woman’s body usually gains fluid and weight to support her baby. Sometimes the veins can’t cope with the volume of fluid. They then become engorged to the extent that the valves are damaged and blood can then flow back through them, which causes them to become varicose.
- Another reason pregnancy is thought to cause PCS is because the rise in estrogen weakens the blood vessel walls.
Therefore, women who have had a previous pregnancy are more likely to develop PCS, and the risk is thought to increase the more pregnancies a woman has.
How is it diagnosed?
PCS can be quite difficult to diagnose, and doctors often need to carry out multiple diagnostic procedures to eliminate other possible causes for your symptoms. These procedures can include:
- laparoscopy (a surgical procedure that uses small cameras to look inside the pelvis)
- CT scan
- MRI scan
The ultrasound is often preferred as the first step in diagnosing PCS as it’s possible to detect the varicosities as well as assess the blood flow.
Treatment for PCS is usually aimed at reducing and alleviating symptoms. Unfortunately, there is no definite cure for the condition, and it can be challenging to treat.
Medications available to help relieve your symptoms can include:
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- chronic pain medications (such as gabapentin plus amitriptyline)
Currently, the most successful treatment is a minimally invasive surgical procedure called pelvic vein embolization (PVE). This procedure blocks off certain varicose veins that are believed to be the source of pain.
Many studies have shown significant improvement of symptoms in women who have had PVE. As with any procedure, there are risks, and not all women may be appropriate for this treatment option.
Pelvic congestion syndrome in pregnancy
The symptoms of PCS often get worse in the late stages of pregnancy as the baby gets bigger and heavier. Additional pressure is put on the varicose veins in the pelvis, which often leads to an intensifying of the pain caused by the condition.
PCS isn’t a condition that affects your life expectancy, but it does have the potential to significantly affect your quality of life. Symptoms such as chronic pain, pain during sexual intercourse, and dysmenorrhea can lead to a decrease in physical activity, loss of function, and depression.
A diagnosis does not necessarily mean you will be affected to this extent — PCS varies greatly in terms of severity.
Keep in mind that there are treatments available to minimize your symptoms and help you to cope with this condition. Talk to your doctor about your options.
It’s also important to talk to your doctor about counseling, if needed, to help you cope with the significant chronic pain that can go along with having PCS.