Pelvic Congestion Syndrome and Pelvic Pain

Pelvic congestion syndrome (PCS) is a common cause of chronic pelvic pain in women of reproductive age.

Think about a traffic jam in the veins of the pelvis! The blood is stagnant and is not able to drain properly creating dilation on the veins of the pelvis. This leads to feeling of fullness, pain, swelling along with other symptoms.

Usually, Pain that is intermittent or constant lasting for 3-6 months, present in the pelvic or abdominal region, occurring throughout the menstrual cycle, and without any association with pregnancy is chronic pelvic pain.

Pelvic congestion syndrome (PCS) is one of the pelvic venous syndromes that is frequently misdiagnosed. It is a common cause of chronic pelvic pain in women of reproductive age.

Pelvic venous insufficiency is due to the incompetency of the internal iliac vein, the ovarian vein, or both. It is often the underlying cause of pelvic congestion syndrome. Nearly 10% of women suffer from ovarian varices. Of this 10%, about 60% have pelvic congestion syndrome.(1)

The pelvic pain caused by PCS is non-cyclical and lasts more than 6 months in duration. Pain is worsened by sitting, standing, at the end of the day, upon sexual arousal, during or after intercourse. Other symptoms include generalized fatigue, depression, abdominal or pelvic tenderness, lumbosacral neuropathy, rectal pain, and urge to urinate.

Symptoms:

• Chronic pelvic pain/pressure for more than 6 months

• Unusual degree of discomfort with menstrual cycles

• Pelvic pain during and/or after sexual intercourse

• Feeling of fullness in the pelvic region, vaginal region, labia and/or perineal region

• Swelling in the vagina, labia and/or perineal region

• Varicose veins present in the upper thigh, vagina, labia, suprapubic and/or perineal region

• Frequency of urination

• Stress Incontinence

The gold standard for diagnosis is venography. But a medical professional who is trained and experienced in treating and diagnosing can tell by symptoms and manual palpation.

We at Pelvic Elements treat patients with Pelvic Congestion with variety of different treatment techniques along with compression therapy. We do a comprehensive evaluation of not just pelvic floor but also, abdomen, back hip, legs, and movement to determine if there is swelling, congestion, compression of pelvic nerves including pudendal nerve involvement, varicosities, or referred pain from other associated orthopedic issues found during the orthopedic exam.

Pelvic Congesion Syndrome is under diagnosed and misdiagnosed and patients are left for years with either wrong treatment or no treatment. It is just broadly assumed that it only happens in people are have kids or are pregnant. Men can also have PCS and it can be mistaken as prostatitis. We see it in people with conditions such as IC or Endometriosis and other chronic conditions.

References:

1. Saadat Cheema O, Singh P. Pelvic Congestion Syndrome. [Updated 2022 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560790/

2. Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, et al. (2019) A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLOS ONE 14(4): e0213834. https://doi.org/10.1371/journal.pone.0213834