Pelvic congestion syndrome: symptoms, diagnosis and treatment

Pelvic congestion syndrome is caused by varicose veins in the female lower abdomen, such as the ovaries and uterus, meaning the veins in these areas are swollen and unable to regain their original size and length after pregnancy.

What is pelvic congestion syndrome?

Pelvic congestion syndrome (PCS) can cause fertility problems and difficulties in women who have experienced two or more pregnancies. This condition of the pelvis may also be the cause of the development of venous (vein) insufficiency in lower limbs with varicose veins of the perineal that will cause pain, swelling, heaviness and all other disorders linked to superficial venous insufficiency. This is because there is a direct connection between the uterine venous plexuses and the superficial network of the legs. This is why in many cases varicose veins develop, especially on the inner or posterior side of the thighs or calf.

Symptoms of pelvic congestion syndrome:

Pelvic congestion syndrome symptoms may vary from person to person. They include:

• Discomfort
• Irregular and painful periods
• Haemorrhoids
• Vaginal varicose veins
• Atypical varicose veins in the legs
• Lower back pain
• Chronic pelvic pain and heavy ache
• Post-coital pain

Diagnosis of varicose veins in the pelvis:

Initially an abdominal ultrasound or laparoscopy can be performed in this area to look for varicose dilatations but in order to make an accurate diagnosis an MRI should be carried out. This test will let the specialist see the exact number, size and distribution of the varices in the uterus and ovaries.

Treatment of pelvic congestion syndrome:

There are a number of pelvic congestion syndrome treatments available: 

1. ​Early pelvic congestion syndrome treatment options include anti-inflammatory drugs
2. Alternative therapies such as acupuncture and physical therapy also can treat pelvic congestion syndrome
3. Percutaneous transcatheter pelvic vein embolisation – this non-surgical procedure is done in a radiology room (not an operating room), introducing a catheter (a thin tube) to a vein in the groin, which blocks all veins and varices from inside the uterus and ovaries on both sides. A radiologist injects tiny coils and a hardening solution into the vein to ensure it collapses and permanently closes. With this technique the flow that the blood vessels support is stemmed and the organs are relieved from the pressure that the flow causes.The symptoms disappear and new varices can develop.

Patients report that treatment of varicose veins in the pelvis with venous catheters improves symptoms in 92% of the cases and report a success rate of 80% in pain reduction.