Pelvic Congestion Syndrome is chronic pelvic pain due to insufficient or “varicose” veins in the pelvis.  Estimates are that 1/3rd of all women will have chronic pelvic pain in their lifetime.

There are many causes of pelvic pain.  Like varicose veins in the legs, in both cases, the valves in the veins that help return blood to the heart against gravity are not functioning properly allowing blood to flow backwards – this causing dilation of the vein and turbulent blood flow which releases inflammatory factors and triggers pain from adjacent nerves.

The syndrome can be difficult (can take many years) and it is usually arrived at by eliminating other diseases. Typically, the pain is worse with standing, and during the time of your period.  It can also cause sexual intercourse to be painful.

Most women are in their 40’s and a significant percent have pelvic congestion as the sole cause of their pain.  Women with pelvic congestion usually have had multiple pregnancies, varicose veins in their legs, buttocks, or labia, painful intercourse, hormonal dysfunction, and sometimes polycystic ovaries.

Diagnosis

Most women will have ultrasounds, MRI’s, or CAT scans showing abnormal veins.  Some patients will even have these veins seen during other surgeries.

The diagnosis is confirmed with a test known as a “venogram” where X-ray “dye” is injected into the veins and images are taken.  The condition, if present, can be treated at the same time (if desired).

Treatment

Percutaneous (“through the skin”)

Most patients are treated with one or two sessions of embolization (plugging the veins with various chemicals and/or metal coils).  This can be done through a tiny incision in the groin and the use of small catheters.  Recovery is minimal and the procedure is done as an outpatient.

Surgical

Other options are surgical ligation of the veins where the veins are tied closed.  This is done in the hospital in the operating room with larger incisions.  Hysterectomy may also be done.

Efficacy

Pelvic congestion is often diagnosed after many years making complete success difficult.  However, significant improvement can still be made.  The percutaneous treatment is less expensive and invasive than surgery.  It is also safer, and effective.  The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95-100 percent of cases. A large percentage of women have improvement in their symptoms, between 85-95 percent of women have some improvement after the procedure. Although women are usually improved, the veins are never normal and in some cases other pelvic veins are also affected which may require further treatment.