Pelvic Congestion Syndrome (PCS)
What is Pelvic Congestion Syndrome?
Chronic pelvic pain is a common condition; more than 30% of women complain about similar pain in their life time. It is known as pelvic congestion syndrome (PCS). It is believed that this condition is associated with varicose veins in the pelvis and groin. The varicose veins develop usually during pregnancy and continue to progress in size afterwards. The syndrome is associated with constant dull pelvic pain, pressure and heaviness.
Why do varicose veins develop in Pelvic Congestion Syndrome?
The exact cause of Pelvic Congestion Syndrome is unknown. The possible causes may be:
- Physiological: In pregnancy there is a significant increase in fluid and weight gain is common. Veins then engorge with blood. Over time, the veins become distended and the condition progresses because the valves get destroyed.
- Estrogen: It is known that estrogens can weaken the vein walls and during pregnancy there is an increase in estrogens.
- Anatomic: Changes in the anatomy of the veins and other structures in the pelvis may make them more susceptible to formation of varicose veins.
How is Pelvic Congestion Syndrome related to varicose veins in the legs?
Pelvic venous congestion syndrome is very similar to the condition of varicose veins in the legs. In both cases, the valves in the veins that help blood flow up toward the heart are either defective or damaged. The function of the valves is to prevent backflow of blood. In Pelvic Congestion Syndrome, the enlarged veins occur near the uterus, fallopian tubes, vulva and even the vagina.
How is the diagnosis of Pelvic Congestion Syndrome made?
PCS is a difficult diagnosis to make. Other conditions must be ruled out first. The diagnosis of Pelvic Congestion Syndrome is made using several tests which include:
- Ultrasound: This is the first test of choice. It can assess the uterus and other organs in the pelvis.
- Venogram: This test was widely used in the past to make a diagnosis of Pelvic Congestion Syndrome, but today has been replaced by CT scan.
- CT Scan: CT scan is frequently used in the diagnosis of Pelvic Congestion Syndrome. It can look at the entire anatomy of the lower pelvis and identify varicosity of the pelvic veins.
- Laparoscopy: When done with a tilt-table, this can be very useful and also can rule out other conditions.
- MRI: MRI is a very useful test in the diagnosis of Pelvic Congestion Syndrome. It does not use radiation.
What treatments are available for Pelvic Congestion Syndrome?
There are a number of treatment options for Pelvic Congestion Syndrome and these include both non surgical and surgical approaches. Interventional radiological techniques are preferred to surgery. Medications can be helpful as well.
What is the role of surgery in treatment of Pelvic Congestion Syndrome?
Today, surgery is not the first choice therapy for Pelvic Congestion Syndrome. Surgery may be done using a minimally invasive approach. Other surgical approaches have involved removal of adhesions in the pelvis, anatomic corrections of a displaced uterus or even hysterectomy.
What is embolization?
In the last several years, there has been a newer interventional radiological method of treating Pelvic Congestion Syndrome called embolization. Embolization is undertaken after the diagnosis is confirmed. It involves directly plugging the abnormal blood vessels, and the varicosities then subside with time. Unlike surgery, there is no large incision and recovery is minimal.
What are the results of embolization for Pelvic Congestion Syndrome?
The results are good and most women feel better after the procedure. However the pain improvement may not be immediate and may take 2-4 weeks. Others may require additional sessions. The success of the therapy depends on the size of varicosities, the symptoms prior to the procedure and accessibility of the veins.
What are the advantages of Embolization versus surgery?
- Minimally invasive: there is no large incision, short duration of the procedure and short recovery. In addition, the procedure is not associated with all the possible complications that can occur after surgery and anesthesia.
- Anesthesia: there is no need for general anesthesia with embolization.
- Symptoms control: More patients appear to have benefit from embolization compared to surgery. In those individuals who benefit, the symptoms are relieved for years.
