Pelvic Venous Congestion

What is Pelvic Congestion Syndrome?

Pelvic congestion syndrome is commonly missed and oftentimes results in unnecessary procedures and testing. Nearly 25% of women who visit an OB/GYN for pelvic pain have pelvic congestion syndrome. Pelvic congestion is caused by varicose veins in and around the pelvic organs. This is often secondary to compression of the iliac vein in the abdomen. Signs and symptoms besides varicose veins in the legs include pain during or after intercourse, pain in the legs during menstruation, hip pain, low back pain, irritable bowel symptoms, irritable bladder symptoms, labial veins, hemorrhoids, and vein around the outer thigh, posterior thigh and groin area.

Some patients with Pelvic Congestion Syndrome (PCS) have an underlying correctable problem, but needs to be considered in the evaluation of a vein patient.  Vein disease above the waist is not often considered at most vein centers because it is more complex and requires the attention of highly trained vascular specialists.  At the Princeton Vascular Center, Dr. Brotman is a board-certified vascular surgeon with experience in both simple and complex vein disease.

 

Symptoms Treatments

 

Some with PCS are Treatable

Some patients with Pelvic Congestion Syndrome (PCS) have an underlying correctable problem but needs to be considered in the evaluation of a vein patient.

 

 

Causes & Symptoms

Here are some of the possible causes and symptoms of Pelvic Venous Congestion

Symptoms

Signs and symptoms besides varicose veins in the legs include pain during or after intercourse,

  • Pain in the legs during menstruation,
  • Hip pain, low back pain,
  • Irritable bowel symptoms,
  • Irritable bladder symptoms,
  • Labial veins, hemorrhoids, vein around the outer thigh, posterior thigh and groin area.

How is pelvic congestion syndrome diagnosed?

Pelvic congestion syndrome is not easy to diagnose. Pelvic pain is common and there are many different causes. Pelvic pain can result from problems with the reproductive system, like your ovaries and uterus. It can be caused by the urinary system, like your bladder. It can be caused by the gastrointestinal system, such as your large intestine. And it can be caused by muscles or bones. Mental health conditions, such as depression, are also linked to chronic pelvic pain. Your healthcare provider will need to consider many possible causes before diagnosing the condition.

Your vascular specialist will often work with your GYN to diagnose the condition. He or she will ask about your medical history and your symptoms. You will also have a physical exam.

Common tests performed by the vascular specialist will include:

  • Pelvic ultrasound to look for growths in the pelvis
  • Doppler ultrasound to check the blood flow in the pelvic blood vessels
  • CT scan or MRI for more detailed pictures
  • Diagnostic laparoscopy to rule out other causes of pelvic pain
  • A procedure to take X-rays of the pelvic veins (venography)

How is pelvic congestion syndrome treated?

When pelvic vein reflux is the direct cause, our vascular specialists will discuss both medical and minimally invasive treatment options:

  • NSAIDS: treatment with nonsteroidal anti-inflammatory drugs may help relieve the patient’s pain for the short term. Analgesia is a good first-line option
  • Hormonal treatments
  • Pelvic Ovarian vein embolization: This is a minimally invasive treatment that is safe and can be done as a day-case. You come in for the procedure in the morning and can leave a few hours later the same day. In most cases it is the ovarian vein that is the cause of the varicose veins. However other pelvic veins such as veins called the internal iliac vein, internal pudendal vein, obturator vein and ischial veins may also be responsible and need treating as well.

Seeking Treatment for PCS?

A vеіn dосtоr performs a physical examination and a complete history, taking note of your symptoms and the appearance of your legs. Your physician may ask additional questions to try to understand your priorities.

 

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