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Pelvic Congestion Syndrome (PCS) is a medical condition instigated by internal varicose veins in the lower abdomen and pelvis, which cannot be seen on the surface. It is caused by pelvic vein reflux (back flow), often in the ovarian veins. Most women with pelvic congestion syndrome experience uncomfortable chronic (long-term) pain which is often described as a dragging sensation or chronic ache in the pelvis, worse on standing and sitting and made better by lying down. Pelvic congestion syndrome also causes irritable bowel, irritable bladder, pain on sexual intercourse and can cause varicose veins to arise in the vulva, vagina and around the perineum and anus.
Although the latest research suggests that 13% to 40% of women in the UK who have chronic pelvic pain suffer from PCS, it is not uncommon for these patients to receive misdiagnosis, misdirected therapies, or not seek any help at all.
To provide some clarity on the topic, here are the key facts that everyone should know about pelvic congestion syndrome – including what it is, the warning signs you should look out for, and how the condition can be treated.
What is PCS?
As with most names in medicine, the term Pelvic Congestion Syndrome is really just a description of the problem itself. ‘Pelvic’ highlights that the condition relates to a problem in the pelvic area, ‘Congestion’ links to the fact that there is too much blood in the veins and hence the venous circulation is ‘congested’, and ‘Syndrome’ points to a collection of different symptoms and signs.
Generally, pelvic congestion syndrome is a condition that is caused by troublesome internal, or hidden, varicose veins that lie within the lower abdomen and pelvis. Those suffering with the condition will often experience dull or sharp pains, for a drawn-out length of time.
Due to differences in the anatomy of the pelvis, the condition usually affects women more than it does men. This difference is magnified by the fact that, in men, varicose veins of two of the four pelvic veins can be seen on the outside as varicose veins in the scrotum – medically called varicoceles. These are usually picked up at school medicals and treated. Unfortunately, the same veins are hidden deep within women and so they cannot be identified without proper investigation. The condition is most common in women who have experienced pregnancy, however we have seen many women with pelvic congestion syndrome who have not had previous pregnancies.
What causes Pelvic Congestion Syndrome?
PCS occurs when pelvic veins (those associated with the uterus or ovaries) become enlarged, swollen or dilated. More specifically, if the valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside dilated varicose veins within the pelvis. The dilated veins push on the sensitive structures in the pelvis, as well as lying heavily on the pelvic floor, causing the symptoms of PCS. In addition, the poor circulation of the venous blood increases the risk of inflammation in the pelvic veins (phlebitis).
What are the symptoms of PCS?
Women suffering with PCS typically experience deep pelvic or uterine pain, which is often described as a heavy, or dull ache. This pain often worsens throughout the day, particularly on prolonged standing or exercise.
Women can experience sharp pains when they change their posture, walk, lift heavy objects, or engage in other activities that increase pressure on the abdominal area. Women suffering with PCS are also prone to painful menstruation and can experience discomfort during or following sexual intercourse, and subsequent pregnancies.
In some cases, women with pelvic congestion syndrome will also experience urinary symptoms such as irritable bladder, urinary urgency, urge incontinence and an increased need to urinate during the night.
One of the commonest signs of PCS is vulval or vaginal varicose veins. Many women who develop these, particularly after pregnancy, get told by their midwives or doctors that they cannot be cured and that they just need to wear tight pants. This is totally incorrect as these can now be cured permanently using our new local anaesthetic procedures.
How is PCS treated?
It is becoming more and more evident that, because PCS is not regularly taught as part of Gynaecological training, many gynaecologists do not recognise pelvic congestion syndrome, and so a great many women who are suffering from the symptoms of PCS are not receiving the appropriate tests (transvaginal duplex ultrasound scan) and treatments (Pelvic Vein Embolisation). Instead, they are either getting a misdiagnosis or are being put through expensive and less accurate tests for PCS such as MRI and CT. Many women even have unnecessary laparoscopy, which is performed under general anaesthetic, and then if nothing is found, there are told that there is nothing wrong with them.
At Whiteley Clinics, we treat patients suffering with PCS using a procedure called Pelvic Vein Embolisation. Pelvic Vein Embolisation is an x-ray technique where a needle is put into a vein under a local anaesthetic and ultrasound guidance; then, under x-ray control, a thin tube called a catheter is pushed into the vein we wish to treat. When it is in the correct place, a metal coil, or a special embolising material used as a foam known as STS or Fibrovein, is pushed out into the vein to block off the troublesome blood vessels. By stopping the blood refluxing (falling back down these veins), the pelvic varicose veins shrink away over a few weeks.
Our published research shows that this is an effective treatment and we have recently published our long-term results showing that the procedure is successful in the medium to long-term, and we have also shown it is safe to have a subsequent pregnancy after the embolisation procedure.
|Dr David Beckett is an Interventional Radiologist at the UK’s leading vein clinic, Whiteley Clinics.|