What is Pelvic Congestion Syndrome (PCS)?
PCS is essentially varicose veins in the pelvis. It is the cause of chronic pelvic pain in approximately 13-40% of women. Research has shown that 1 in every 7 women, and 1 in 5 women who have had children have varicose veins that come from the pelvis.
What causes PCS?
Varicose veins are most commonly seen in the legs and are caused by valve malfunction (valves in the veins do not work properly and they do not stop blood from flowing backwards). Veins become less elastic, bulky and enlarged. When this happens to the pelvic veins, visible varicose veins emerge in the pelvic region and the pressure often causes severe pain and discomfort. The varicose veins in the pelvis surround the ovary and can also push on the bladder and rectum.
There are three major vessels involved in the venous drainage of the pelvis – the external iliac vein, internal iliac vein and ovarian vein.
What are the Symptoms of PCS?
Pain is the most common symptom. It usually appears on one side but can affect both sides, worsening while standing, lifting, when you are tired, during pregnancy and during or after sexual intercourse. Veins are also affected by the menstrual cycle and hormones and therefore pain my increase during menstruation.
Common symptoms include:
- Pelvic pain or aching around the pelvis and lower abdomen.
- Dragging sensation in the pelvis
- Feeling of fullness in the legs
- Worsening of stress incontinence
- Worsening in the symptoms associated with irritable bowel syndrome
Symptoms usually improve by lying down.
How is PCS diagnosed?
Pelvic congestion syndrome is often an accidental discovery during investigation for chronic pelvic pain or back pain. After other pelvic pathologies and conditions that mimic PCS have been excluded, Pelvic congestion syndrome is evaluated by pelvic ultrasound scans. Ultrasound is used to examine your abdomen and pelvis and in particular your pelvic veins.
During the scan, the sonographer is looking to identify internal varicose veins around the uterus and performs a doppler scan to assess the direction of blood flow in the ovarian veins. Your sonographer will report any findings and you will then have a follow-up with your doctor who will explain treatment options. Occasionally further special imaging focusing on veins are required to evaluate for any causes of anatomy variation and vein obstruction.
Dr Jane Li is an expert in pelvic vein assessment with minimally invasive venography to provide an accurate diagnosis of the disease which may involve the ovarian veins or the iliac veins. The vein anatomy in the pelvis can be complex to map out and requires specialist attention and evaluation. Ovarian vein embolisation are sometime not effective if other pelvic veins are overlooked or missed. Every patient is different and when it comes to pelvic congestion syndrome, we will take the time to perform a thorough examination to give our patient the best outcomes.
What are the treatment options for PCS?
Depending on the symptoms, medical therapy, surgical treatment or embolisation may be indicated.
Medical Treatment
Medical therapy for PCS may include the use of analgesics to control and reduce the pain. Hormones like progesterone or birth control pills can be effective suppressing ovarian activity and thus leading to pain relief.
Surgical Treatment
Surgical treatment options are ovarian vein or sometimes internal iliac vein ligation by open or laparoscopic approach. In PCS surgery, the objective is to interrupt blood flow in the varicosities. Nevertheless, efficacy is unclear and the treatment bears all risks of open surgery. Patients often report persistent pain in the short term due to surgical violation of the pelvis.
Pelvic Vein Embolisation
When PCS is diagnosed, embolisation is usually the indicated treatment. It is minimally invasive, non-surgical treatment used to stop the abnormal flow causing the painful symptoms.
A catheter tube is inserted directly into the abnormal veins. Small metallic coils or sclerosing agents are placed to block the blood flow in the ovarian vein or pelvic vein. The embolised vein will thrombose and shrink, eliminating the symptoms associated with reflux. This procedure has a 75% success rate.
If you have any of the above symptoms, contact us today to undergo a ultrasound scan and consultation.
Frequently Asked Questions
Why do I need Pelvic Vein Embolisation (PVE)?
Embolisation is intended to close off the pathologic veins so that blood can no longer flow backwards. This will help reduce pain and other symptoms by removing pressure of the bulging veins on surrounding pelvic organs and nerves.
Who will be performing Pelvic Embolisation and where will it happen?
The procedure is usually completed in an angiography suite by a qualified doctor such as a vascular surgeon or interventional radiologist.
How long does the PVE procedure take and what happens after treatment?
The procedure will take in general between 60-90 minutes but may take longer depending on how many veins require treating. After the treatment you have to stay in the recovery area whilst nurses complete routine observations on your blood pressure and pulse. When discharged home, you should arrange for someone to collect you.
Will I need to stay in hospital overnight?
Pelvic Vein Embolisation is normally a day procedure and you should not need to stay in hospital overnight.
How long does it take for my symptoms to resolve?
Often a significant improvement in pain is apparent within the first few days post procedure.
Are there any side effects?
It is usual for patients to experience some pelvic cramps following the embolisation for a few days, but this will gradually improve after the first 24 hours and can usually be controlled with pain relief medication. Most patients will be fully recovered after 1 week.
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