Pelvic Congestive Syndrome

Chronic pelvic pain is a common condition.  Reports indicate that 1/3 of women will experience chronic pelvic pain during their lifetime. While there are many causes of chronic pelvic pain, pelvic congestion syndrome (PCS) is becoming increasingly recognized as a cause of chronic pelvic pain. PCS is associated with pelvic varicosities, or abnormally dilated veins, which are often present in women with unexplained pelvic pain.

While nobody knows for sure why some women develop pelvic varicosities there are several possibilities including anatomic factors, hormones, pregnancy and genetics. Hormones, particularly estrogen compounds, are also known to contribute to the dilation of veins. The pelvic veins typically enlarged in those with PCS tend to be near the uterus and ovaries and are exposed to high concentrations of estrogen compounds produced by the ovaries.. It is the enlargement, stretching, reflux and resultant congestion within these pelvic veins that are postulated to be the cause of chronic pelvic pain in women with PCS.

Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.  The diagnosis of Pelvic Congestion Syndrome (PCS) is difficult because chronic pelvic pain can have multiple causes and most symptoms of PCS are shared with other common pelvic disorders including Endometriosis, Uterine fibroids and Uterine prolapse.

Diagnosis

Some women may undergo laparoscopic (surgical) evaluation to evaluate chronic pelvic pain but the diagnosis of PCS can be missed in more than 80% of patients during laparoscopy. To diagnose PCS, common diagnostic imaging techniques are best, including ultasound, CT, MRI and Venography. At RAS MRI is frequently used to diagnose pelvic congestion syndrome.

Treatment

There are a number of treatment options for Pelvic Congestion Syndrome (PCS) including both non- surgical, minimally invasive embolization and surgical approaches.

Embolization is a minimally invasive procedure performed by RAS Interventional Radiologists using imaging for guidance. During the outpatient procedure, physician inserts a thin catheter, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. Contrast is injected directly into pelvic veins to perform a venogram and confirm the presence of abnormal pelvic veins. Sclerosants and metal coils are injected directly into the culprit veins and cause them to become permanently blocked. After treatment, patients can typically return to normal activities in 1-2 days. There may be some mild pain, nausea and a low grade fever after treatment.

In addition to being less expensive to surgery embolization offers a safe, effective, minimally invasive treatment option that can significantly improve the symptoms of women suffering from PCS. The procedure is successfully performed in 95-100 percent of cases.