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Pelvic Congestion Syndrome (PCS)

Pelvic congestion syndrome (PCS) is a group of disease conditions leading to persistent and chronic pelvic pain in females. This pain is postulated to be mainly due to the engorgement of pelvic blood vessels and the resulting pressure which builds up in the pelvic cavity. Unfortunately, this syndrome is of common occurrence in half of the female population during their reproductive and childbearing age. PCS's main symptom is severe pain which can help in the early detection and treatment since concerned patients consult their physician to relieve their pelvic pain as soon as possible.

Normal Venous Flow:

In normal conditions, veins tend to take blood from the body and direct it towards the heart. The blood flowing towards the heart is kept from coming back due to gravity and the help of valves in the vein. These valves prevent the backflow of venous blood to the organs.

Varicose Veins:

Due to several disease conditions, the venous valves may not function well which will lead to backflow of blood and hence pooling in the respective organ. This collection of blood causes engorgement and enlargement of veins which further deteriorates the venous valves and walls. These bulging veins are called varicose veins which play a contributing part in pelvic congestion syndrome.

Pelvic Veins involved in progressing Pelvic congestion syndrome:

Almost any vein in the pelvic region can get congested and result in a disease condition. Commonly involved pelvic varicose veins in pelvic congestion syndrome include the following:

- Internal iliac vein

- Left renal vein

- Left ovarian vein

Risk Factors for Pelvic Congestion Syndrome

A certain number of factors can put females at greater risk of developing the disease in their reproductive timeline. They are mentioned below:

• Family history

• Multiple Pregnancies

• Hormonal Imbalances

• Deep Venous Thrombosis (DVT) in the legs

• History of Polycystic Ovaries

Pelvic congestion syndrome can interfere with one's ability to reproduce. If the above risk factors for PCS persist, one must consult a physician before the disease develops or further progresses.

Symptoms of Pelvic Congestion Syndrome

A long list of symptoms may lead to the diagnosis of pelvic congestion syndrome and it may vary greatly from person to person. A few of the main symptoms of progressive pelvic congestion syndrome are briefly mentioned below.

1. Chronic Pelvic Pain:

Patients will complain of severe pain in their lower back or belly for 6 months or more. This pain may interfere with their daily life causing discomfort and distress. The pain is more pronounced while working, during sexual intercourse, or throughout days of menstruation. Resting in a supine position relieves the pain, whereas sitting or walking worsens the pelvic pain due to pelvic congestion syndrome.

2. Bulging veins on the lower body:

As the disease progresses, veins in the lower limbs will also get affected as pressure builds up in the pelvis. This finding can be observed in patients' inner thighs or vulva that show marked visibility and even bulging of veins on it.

3. Irritable Bowel Syndrome:

The 'syndrome' in pelvic congestion syndrome calls for many health complications that may arise in association due to proximity. Patients frequently complain of urinary incontinence or irritable bowel syndrome. It presents with dull abdominal pain, diarrhoea, or frequent episodes of constipation.

Diagnosis of Pelvic Congestion Syndrome

OB/GYN healthcare professionals can diagnose pelvic congestion syndrome on the basis of symptoms alone. Due to variations in the severity of symptoms from one person to another, a confirmatory diagnosis made with recent advancements can result in a better prognosis.

1. Pelvic Ultrasound

A pelvic ultrasound will help in ruling out certain health conditions while directing toward a specific group of diseases as pelvic pain alone can never confirm the diagnosis of pelvic congestion syndrome.

2. Computed Tomography

Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) help in further investigation of the disease process by presenting a detailed picture diagnostic of the pelvic area. The presence of enlarged veins can be appreciated from these imaging techniques.

3. Pelvic Venography

Pelvic venography is the gold standard investigation in diagnosing PCS. A small catheter is inserted through the patient's groin into the ovarian vein that is led by x-ray imaging on the screen for the vascular specialist. Iodine-based dye is infused into the ovarian vein which will demonstrate the location and severity of engorged or congested veins in pelvic congestion syndrome.

Treatment of Pelvic Congestion Syndrome

Treatment options for pelvic congestion syndrome aim to eradicate the disease in the long run. If the disease is affecting other organs in the proximity then the treatment plan will aim to cure it while considering the rest of the cavity as well. Health experts have both medical and surgical approaches for their patients and its decision can be based on the severity and progression of this disease process.

1. Medical Approach

   Medicinal treatment options are always the first priority since invasive procedures might come with unwanted consequences. Non-steroidal anti-inflammatory drugs, painkillers, progestins, phlebotonics, and GnRH agonists are mainstays for the treatment of pelvic congestion syndrome. Other drugs may also be prescribed by the health expert that will aid in symptomatic treatment.

2. Surgical Approach

   Previously, oophorectomy and hysterectomy were performed to cure this disorder but the results were not successful to cure pelvic congestion. Many patients resist such surgeries since PCS occurs during the reproductive age. Although, a more advanced and recent procedure is now performed for patients of any age with high success rates is discussed below.

   • Gonadal Vein Embolization:

     Gonadal Vein Embolization or Ovarian Vein Embolization is a minor surgical procedure. This procedure is performed right after pelvic venography confirms pelvic congestion syndrome is present. The inserted catheter that was used to locate the engorged veins will now help the health expert to inject certain chemicals that will irritate and hence regress the engorged veins. This will block the backward blood flow of venous blood into the ovaries and hence the pressure in the pelvic cavity is relieved. Most patients recover within a week from PCS with this procedure and can carry on with their daily activities.

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