Could aching in my pelvis be from veins? Pelvic Congestion Syndrome (PCS) and treatments simplified

What is Pelvic Congestion Syndrome (PCS)?

Pelvic congestion syndrome is a common reason for ongoing pelvic pain in women. This pain is usually described as a constant or on-and-off ache in the lower belly or pelvic area. Symptoms oftan worsen during mentrual cycle but oftan can be felt throughout the month. It is oftan underdiagnosed but can oftan be effectively treated when properly diagnosed.

What causes PCS?

There are different theories as to what causes PCS, but it's usually see along with large dialated  veins in your pelvis, around the uterus and ovaries seen on ultrasound, CT scan or an MRI. Normally, veins carry blood away from organs. In PCS, these veins, especially the ones around your ovaries and uterus, can become widened (like varicose veins in the legs) and the valves inside them might not work properly. This can cause blood to flow backward and pool in the pelvis, stretching those veinswhich can lead to pressure and pain.

Some things that might contribute to PCS include:

• Genetics: It might run in families.
• Anatomy: The way your veins are formed.
• Hormones: Changes in hormone levels, especially estrogen, bring more blood to the region and can make pain worse.
• Pregnancy: Pregnancy can increase the size of pelvic veins, and these changes might sometimes persist after giving birth.
• Pressure on veins: Sometimes, other structures in your body can press on the pelvic veins and cause problems.

What are the symptoms of PCS?

The main symptom is a dull ache or feeling of heaviness in your pelvis which can be on or off but lasts for months. Other symptoms can include:

• Pain that gets worse when you stand for long periods, walk, or lift things.
• Pain that feels worse before or during your period.
• Pain that gets worse with each pregnancy.
• Pain during or after sex which oftan can last until the nest day.
• Pain that is often worse at the end of the day.
• Tenderness when your doctor examines your pelvis.
• Sometimes, visible varicose veins on the vulva (outer genital area) or upper thighs.

How is PCS diagnosed?

Your doctor will talk to you about your symptoms . They might also order some tests, such as:

• Ultrasound: This is often the first test. It uses sound waves to create pictures of your pelvic organs and blood vessels. It can help see if your pelvic veins are widened and if blood is flowing backward.
• CT or MRI scan: These imaging tests can provide more detailed pictures of your pelvic area, but are not always needed.
• Venography: This is considered the most accurate test but is usually done if other tests are unclear. It involves injecting dye into the pelvic veins through a needle puncture and taking X-rays to see how the blood flows.

How is PCS treated?

Treatment for PCS aims to relieve your pain and can include:

• Medications:
  • Pain relievers: Over-the-counter or prescription pain medications can help manage the pain.
  • Hormone treatments: Medications that affect your hormone levels, like birth control pills, progestins, or GnRH agonists, can sometimes help reduce pain.
  • Phlebotonics: These medications may help improve vein health.
• Physical therapy and counseling: Exercises and therapy can help strengthen pelvic muscles and cope with chronic pain.
• Procedural treatments:
  • Pelvic vein embolization: This is a minimally invasive procedure where a doctor inserts a thin tube into a vein and guides it to the widened pelvic veins using X-Ray guidance. They then use small coils or other materials to block off these veins, which can reduce blood pooling and pain. This is often the most effective treatment.
  • Surgery (less common): In some cases, surgery to tie off or remove the affected veins or even a hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) might be considered, especially if you have completed childbearing. However, these usually not needed and are considered more invasive due to the high success rate of embolization.

What is the outlook for women with PCS?

With appropriate treatment, data has shown that  women with PCS can experience significant, durable pain relief. Pelvic vein embolization has shown good long-term results for many women. Symptoms may also improve after menopause due to changes in hormone levels.

The Importance of Your Healthcare Team:

It is important to seek treatment from a vascular doctor who has experience specifically treating this condition and is able to make the correct diagnosis and treatment plan for best results. 

To Learn more about Pelvic Congestion SYndrome and the latest treatmemts, call our office today. You can also book an appointment with Dr. Golowa, a specialist in treating Pelvic Congestion Syndrome through our website.