Pelvic Congestion Syndrome - Dr. Eileen Morrisroe

Pelvic congestion syndrome is a condition that causes chronic pelvic pain. It is thought to be caused by problems with the veins in the pelvic area; predominantly large ovarian veins.

Veins are the blood vessels that carry blood back to the heart. In some women, veins in the pelvis may stop working (or “reflux”). This can cause blood to build up inside the veins, and pool in the pelvic area. When this happens, the veins can enlarge and change shape, similar to what can happen with leg varicose veins. This may lead to pain or the symptoms of pelvic congestion.

Pelvic congestion syndrome happens mostly in women of childbearing age; symptoms are often worse with menstruation. Symptoms may become significantly worse with pregnancy, and tend to worsen with multiple births.

The main symptom of pelvic congestion syndrome is pelvic pain (that lasts at least six months). This pain often first starts, or significantly worsens, during or after a pregnancy. The pain may be heavy, aching, or sharp; often worse at the end of the day. Patients with pelvic congestion syndrome may also experience some or all of the following:

Dull, aching or “dragging” pain in the pelvis or lower back, particularly on standing and worse around the time of your menstrual period
Dyspareunia (discomfort during or after sexual intercourse)
Vaginal or vulvar varicose veins (bulging veins around the front passage)
Varicose veins at the top of the inner thighs or the back of the thighs
Irritable bladder (that sometimes leads to stress incontinence)
Irritable bowel (recurrent abdominal pain / erratic bowel habits)

Pelvic pain is common and there are many different causes, such as pain from your reproductive system, urinary system, gastrointestinal system, muscles or bones. There are also some mental health conditions, such as depression, which can be linked to chronic pelvic pain. Pelvic congestion is diagnosed in part using history, and a focused discussion of symptoms with your vascular surgeon. But imaging confirmation is also required, this can usually be achieved with a fasting pelvic duplex. In some cases, CT or MRI scan may be required, but this should only be considered after a vascular ultrasound is undertaken.

Along with history, a pelvic venous ultrasound by a trained vascular sonographer is usually enough to diagnose ovarian vein incompetence (the most common underlying cause of pelvic congestion syndrome). At your appointment, Dr Morrisroe will discuss whether further imaging is needed in your case, or whether intervention may be an option.

How is pelvic congestion syndrome treated?

Hormonal treatments
Procedures / surgery to seal off damaged veins (sclerotherapy, embolization)

Ovarian vein embolization:

In this procedure, a catheter (tube) is placed directly into the abnormal ovarian vein (and pelvic veins). Sclerosing agents (chemicals that cause inflammation) are injected into the pelvic varicose veins, and small metal coils or plugs are placed to block flow into the ovarian vein.

This “coiling” prevents backwards flow in the abnormal vein, which reduces the pressure from the enlarged pelvic veins. The procedure is typically performed as a day procedure, in a hospital, and patients can return to normal activity within a few days. After ovarian vein embolization, 75-85 percent of patients will report improvement of their symptoms.

*Further information:

https://www.bsir.org/patients/pelvic-venous-congestion-syndrome/

https://www.nycsurgical.net/for-women/pelvic-congestion-and-embolization/

https://www.hopkinsmedicine.org/interventional-radiology/conditions/pelvic/

*Disclaimer: Dr Morrisroe is not affiliated with the external websites above, nor does she endorse their content.