Pelvic congestion syndrome

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Pelvic congestion syndrome — this condition is caused by what is commonly called «varicose dilatation of the veins of the pelvis».

Due to differences in the anatomy of the pelvis, it usually affects women more often than men. As with varicose veins in the legs, if the valves in the pelvic veins fail, the blood that should return from the pelvis back to the heart remains in the dilated varicose veins of the pelvis. This stops the normal circulation of blood in the pelvic organs, and also leads to the fact that these large varicose veins put pressure on the pelvic organs – bladder, intestines, vagina, and pelvic floor.

The main symptoms of PCS:

• Pain (dull, sharp, throbbing) in the pelvis and / or in the area of ​​intervals increases at the end of the day (after sitting or standing for a long time) and decreases in the supine position
• Varicose veins on the genitals (labia, testicles), large veins of the groin and / or perineum, hemorrhoids
• Swelling of the vulva, not pounding
• Discomfort and pain that gets worse during or after intercourse
•    lumbar pain, in the legs and pathological  vaginal bleeding

The symptoms of PCS are usually caused by blood pressure on these structures.
ТIt is not known exactly what proportion of women suffer from congestion in the pelvis. However, many studies estimate that up to a third of outpatient gynecological patients do not have gynecological pathology. Usually, gynecologists ignore PCS and a surprising number of gynecologists talk about "large varicose veins in the pelvis", for example, after ultrasound or laparoscopy. It becomes obvious that many women suffering from symptoms of plethora do not undergo appropriate examinations (transvaginal duplex ultrasound scanning), but spend time on MRI, CT and even laparoscopy under general anesthesia to find out that there is nothing wrong with them!

What to do if you suspect PCS:

• Оgo to a phlebologist and undergo ultrasound duplex scanning of the veins of the lower extremities and veins of the small pelvis
• Contact a gynecologist with an examination and vaginal ultrasound if necessary or a urologist
• Undergo additional instrumental examination methods (MSCT, MRI, angiography – if prescribed by a doctor)

Is it necessary to do surgery for PCS?

• Indications for the treatment of PCS are very limited and only an expert consultation of a phlebolgist and a gynecologist can competently choose the best treatment method.
• In 90% of cases, all types of PCS are treated with non-surgical methods, namely sclerotherapy, echo-sclerotherapy, endovenous embolization, laser treatment, etc.

Unfortunately, false indications for the surgical treatment of PCS are often presented. Therefore, we always recommend that patients undergo a consultation at 2-3 specialized vascular centers in order to obtain a more objective and alternative point of view.

We are trying to improve our understanding of venous disease, in particular pelvic vein problems. More and more patients should receive the correct diagnosis and treatment, and a highly qualified consultation of a phlebolgist and a gynecologist will, of course, help in this.

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Author: Machuskyi Serhii MD ©