Pelvic Congestion Syndrome - Causes, Symptoms, and Treatment

Introduction:

Pelvic congestion syndrome is a condition characterized by chronic pelvic pain. The condition arises mostly due to problems in the veins of the pelvic area, which is the lower part of the belly. It is one of the pelvic venous conditions that is often misdiagnosed. When veins in the lower abdomen region do not function properly, blood starts to build up inside the veins resulting in the enlargement of the pelvic veins. This leads to pain and many other discomforts of pelvic congestion syndrome.

What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome is chronic pain in the pelvic or abdominal region that is constant or intermittent lasting for three to six months, related to the blood flow problems of the pelvic veins. It is also known as pelvic venous insufficiency. The pain associated with pelvic congestion syndrome involves faulty veins of the pelvis and ovaries. The pain may occur throughout the menstrual cycle and is not related to pregnancy. Even though it is commonly seen in women of childbearing age, women who have given birth to more than one child are more affected.

What Are the Causes of Pelvic Congestion Syndrome?

The definitive cause of pelvic congestion syndrome is unknown. Problems in the blood flow of the pelvic and ovarian veins are believed to play a major role in causing pelvic congestion syndrome. In normal anatomy, blood flows from the pelvic veins towards the heart through the veins in the ovaries. The valves in the veins prevent the blood from flowing backward.

In pelvic congestion syndrome, the dilated veins cause the valves to malfunction, leading to the reflux of blood through the veins, making them twisted and overly filled. The pooling of blood in the pelvic veins causes severe pain. The two possible reasons for vein enlargement in pelvic congestion syndrome are as follows:

• Pregnancy: During pregnancy, blood vessels enlarge to support the increased blood flow required for the developing baby. Sometimes these changes can lead to long-term damage to the blood vessels leading to permanent enlargement of the veins.

• Hormones: Hormones like estrogen can make the veins enlarged. This is the reason why pelvic congestion syndrome is not common in women after menopause, as estrogen levels decrease after menopause.

What Are the Symptoms of Pelvic Congestion Syndrome?

The symptoms of pelvic congestion syndrome are as follows:

• Heavy or achy pelvic pain lasting for six months or more.

• Pain is commonly seen on the left side of the body but can also occur on both sides of the body.

• Pelvic pain that gets severe towards the end of the day.

• Pelvic pain that increases while sitting or standing and relieved while lying down.

• Pelvic pain that becomes worse during and after intercourse.

• Pelvic pain that becomes severe before and during menstrual periods.

• Enlarged veins in the vulva, buttocks, vagina, and thighs.

• Pain while urinating.

• Sudden urge to urinate or urinate accidentally while coughing or laughing.

• Frequent bouts of constipation and diarrhea.

How to Diagnose Pelvic Congestion Syndrome?

The diagnosis of pelvic congestion syndrome is not easy as pelvic pain is a common symptom associated with conditions of the reproductive system, urinary system, gastrointestinal system, muscles or bones, and mental health. The methods to diagnose pelvic congestion syndrome are as follows:

• Medical History: A detailed medical history of the patient to know about the symptoms by the doctor.

• Physical Examination: Physical examination, which may include a pelvic exam and examination to check for tenderness in the uterus, cervix, and ovaries is carried out.

• Ultrasound: This is done to check for vein dilation and to detect other abnormalities that can cause pain. The Doppler ultrasound detects the backward flow of the blood.

• Magnetic Resonance Imaging (MRI) And Computed Tomography (CT) Scan: These imaging techniques are used to detect dilated or twisted veins of the ovaries and pelvis. They are also used to detect irregular growths of the pelvis to rule out conditions like endometriosis.

• Laparoscopy: This is done to find out vein dilation and to rule out other possible causes of pelvic pain.

• Pelvic Venography: Pelvic venography is an invasive gold standard diagnostic method for pelvic congestion syndrome. This procedure involves catheter insertion into the neck vein or groin vein with the help of an X-ray. A dye is inserted into the veins that makes them clearly visible on the X-ray. Pelvic venography is used to observe the twisting and dilation of veins, blood pooling, and blood flow.

What Are the Treatment Options for Pelvic Congestion Syndrome?

There is no specific treatment to cure pelvic congestion syndrome. However, there are treatment options that can reduce the symptoms of the disease. They are as follows:

• Hormonal Medications:

  • Gonadotropin-releasing hormone drugs block ovarian function and relieve pain.

  • Progestin hormone drugs relieve pain.

  • Medications like Medroxyprogesterone acetate, GnRH agonists, Etonogestrel implant, and Goserelin can suppress estrogen production and reduce pain.

• Laparoscopy: It is used to tie off the veins to prevent the backflow of blood.

• Embolization or Sclerotherapy: This procedure is carried out to close the damaged veins. This procedure involves blocking the blood vessels that cause backward blood flow, thereby preventing blood pooling. A catheter is inserted into the faulty pelvic or ovarian vein, followed by the release of chemicals through the catheter to irritate or inflame the veins. Glue, small metal coils, or foam is inserted into the veins to prevent the backflow of blood.

• Bilateral Salpingo-Oophorectomy: This is a surgical procedure that is rarely indicated in pelvic congestion syndrome cases. This procedure involves the removal of pelvic organs (ovaries, uterus, and fallopian tubes) and is mainly done in women who do not want to give birth or women who have finished giving birth to children.

Conclusion:

Even though pelvic congestion syndrome does not have a definitive treatment; the available interventions provide excellent pain relief. The main problem associated with pelvic congestion syndrome is the difficulty in diagnosing the condition, as pelvic pain is a common symptom of many other diseases. Hence multiple tests and collaborative work of certain specialists might be needed to diagnose pelvic congestion syndrome. Hence, seeking medical care at the earliest helps in diagnosing the condition and the relief of symptoms. With the right treatment, the patient can live normally without compromising the quality of life.