Pelvic congestion syndrome: Symptoms and treatment

Written by: Dr Omar Abu-Bakr
Edited by: Kate Forristal

In his second article of a two-part series on pelvic congestion syndrome, Dr Omar Abu-Bakr talks about what aggravates pelvic congestion syndrome and its symptoms, how its treated and how individuals can manage their symptoms at home.

What aggravates pelvic congestion syndrome? What are the main symptoms?

The signs, particularly focusing on the symptoms, might point to pelvic venous congestion syndrome. However, these same signs could also exist as separate health issues. In cases of pelvic venous congestion syndrome, I’ve come across situations involving irritable bowel syndrome. It's important to note that irritable bowel syndrome might be a distinct condition on its own, but it could also be a symptom of pelvic venous congestion syndrome. Another example is an irritable bladder, where patients feel discomfort and a strong urge to urinate. All of these scenarios could exist as separate health problems.


In the context of pelvic venous congestion syndrome, patients could experience specific symptoms such as discomfort in the lower abdomen, heavy menstrual periods, and unfortunately, pain during sexual intercourse. This painful sensation is considered a medical issue and can significantly affect a person's life. Interestingly, many female patients have been mistakenly referred to psychiatrists due to assumptions about psychological issues. However, the reality is that these individuals truly experience pain and struggle to lead normal lives, especially in their relationships. This emphasises the need for appropriate treatment. Haemorrhoids present a similar situation; they could develop as an independent issue, but they could also be connected to pelvic venous congestion syndrome.


As a result, when faced with a patient who has haemorrhoids or similar conditions, a thorough evaluation becomes important. This involves not just looking at the condition itself but also exploring any other symptoms that might be present. Checking the pelvic floor and using a doppler ultrasound scan becomes crucial. This scan helps to see the veins, especially if varicose veins are found in the legs but stem from the upper thigh in the genital area, or if they run from the inner thigh into the genital region. This pattern is a significant sign of a higher risk related to pelvic congestion, indicating the presence of a connected pelvic aspect that needs to be examined and treated.


It's worth noting that many women have grown used to these symptoms, often unaware of potential pelvic problems. In such cases, scanning the lower limbs can uncover the pelvic connection, revealing that the symptoms are linked. Once this connection is identified, an internal pelvic scan can be done for women, revealing the issue. Discovering this link can lead to a transformative effect, freeing individuals from enduring pain and discomfort in the lower abdomen, genital area, and during intimate moments. When it comes to diagnostics, if there are suspicions, complex surgeries aren't necessarily the answer. Instead, a simple ultrasound, including an internal scan, can be very helpful. This approach allows us to assess pelvic veins and their function, which confirms or rules out the presence of congestive syndrome. This method is more effective than resource-intensive techniques like MRI or CT scans, which provide information about vein size but don't capture functionality. Ultimately, what matters most is how well the veins are working, regardless of their size. Dysfunction, even in small veins, indicates a real syndrome with ongoing symptoms that require effective treatment.



How is pelvic congestion syndrome treated?

The treatment, as previously mentioned, is carried out using local anaesthesia with X-ray guidance. We start from the jugular area and insert a catheter with a small amount of local anaesthesia. It might seem a bit intimidating, especially around the neck, but it's actually a simple procedure. This technique has been used for a long time in heart-related conditions, like when we put stents to open up arteries. It's similar in this case, but instead of opening an artery, we're closing a vein. Patients don't need to worry; it's a routine procedure done in most hospitals.


During the process, we insert a metallic coil made of platinum into the veins, guided by X-ray images. This coil creates inflammation in the veins, causing them to stop working. This approach is different from what's done in leg veins. In the pelvis, the anatomy is different. There are other structures like nerves, arteries, and poles. So, using a laser near these structures isn't safe. Instead, we put a coil into the vein, focusing only on that vein. This doesn't affect nearby organs or tissues. This coil essentially stops the vein's function, and it stays there – there's no need to remove it. This is similar to how heart stents are left in place after being inserted.


After the procedure, patients can go back to their regular activities right away. Whether it's going shopping or doing other things, they can carry on without any problems. The process is simple and lets patients get back to their normal lives quickly.



How can people with pelvic congestion syndrome relieve their symptoms at home?

Unfortunately, at home, it's unlikely that we can do much about the symptoms in the legs. The anatomy is different in various parts of the body; though it's the same human body, the anatomy varies. While elevating the legs might somewhat alleviate the symptoms, the pelvis isn't something you can elevate. So, the sole way to treat and alleviate the symptoms is to address the root cause. Just as in the case of varicose veins or pelvic congestion syndrome, treating the cause makes all the symptoms vanish. When you address the core issue, everything else goes away. The treatment for this is quite straightforward. Trying any measures at home for pelvic congestion syndrome is unlikely to provide much relief. Taking action is necessary. If you're facing problems, experiencing symptoms, and can observe bulging veins like varicose veins in the upper thigh or genital region, it's crucial to promptly consult a specialist. The goal is to determine if the condition requires treatment, as with any ailment, the sooner, the better in terms of treatment.


Dr Omar Abu-Bakr is a highly esteemed consultant venous surgeon and phlebologist with over 15 years of experience. You can schedule an appointment with Dr Abu-Bakr on his Top Doctors profile.

By Dr Omar Abu-Bakr

Dr Omar Abu-Bakr is a leading consultant venous surgeon and phlebologist in London, Guildford and Bristol who holds a special interest in treating varicose veins. His areas of expertise include varicose veins surgery, thrombophlebitis, leg ulcers, perforating veins and thread veins. He is a specialist in general ultrasonography. His slogan 'the art of treating varicose veins' is with good reason as his patients have a 3% recurrent rate following his treatment of varicose veins.

With over 13 years’ worth of experience, Dr Abu-Bakr is the first ever surgeon to describe the Multi-Pass technique, which treats huge varicose veins using the Endovenous Radial Laser 1470 nm and without the need for open surgery. The technique was described in the second international meeting of the College of Phlebology in London in March 2018. Proudly, Dr Abu-Bakr won second prize for the best scientific paper.

Dr Abu-Bakr is also the first surgeon in the UK and second worldwide who treats varicose veins with the new high-intensity focused ultrasound known as SONOVEIN S, which is the only method in the world that does not require incisions. He is the second surgeon in the UK to treat varicose veins using the Endovenous Microwave Ablation (EMWA).

In 2020, Dr Abu-Bakr and his team at The Whiteley Clinic were awarded the Best Varicose Veins Treatment (UK) by Global Health & Pharma magazine. He is also an honorary senior lecturer at The College of Phlebology, UK. 

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