Author: Dr. Allyson Shrikhande
What is Pelvic Congestion Syndrome?
The NIH describes pelvic congestion syndrome (PCS) this way: “a common cause of chronic pelvic pain in women of reproductive age. Pain that is intermittent or constant lasting 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.”
What are the symptoms of Pelvic Congestion Syndrome?
The symptoms of PCS can vary in presentation, given the complexity of the venous networks in the pelvis. Any symptom of Chronic Pelvic Pain (CPP) is possible. Classically, the pain is chronic and dull. The pelvic pain is worse with long periods of standing, walking, or sitting, and factors increasing abdominal pressure such as lifting or pregnancy. The pain is classically relieved with lying down. Pain also increases during and after intercourse. The classic intercourse pain in PCS patients is a post-intercourse soreness. Patients with PVI often present with atypical varicose veins of the upper inner and back thigh of the lower limb, and vulvovaginal, glutaeal, and suprapubic perineal varices.
What causes Pelvic Congestion Syndrome?
The primary underlying cause of PCS is pelvic venous insufficiency (PVI). PVI is indicated by dilation and dysfunction of the ovarian or internal iliac veins with characteristic slow flow and reflux. The underlying etiology of pelvic congestion syndrome is not completely understood, however, it may result from a combination of factors including:
- Genetic predisposition
- Hormonal factors
- Damage to the wall of a vein
- Valve dysfunction in a vein
- Reverse blood flow
- High blood pressure and dilatation
- Anatomical abnormalities
With a genetic predisposition, there might be congenital wall abnormalities in the veins causing their dilatation, which leads to dysfunction of valves. However, Pelvic Venous Insufficiency is not the only factor leading to the PCS diagnosis. Studies show that ovarian varices are symptomatic in up to 59% of patients and dilated pelvic veins are a frequent symptomless phenomenon in women.
A vicious cycle is created, as the prolonged venous dilatation in PCS causes inflammation that further damages walls of the vessel causing the growth of reflux and pressure gradient between veins.
What conditions are common with PCS?
Patients with pelvic congestion syndrome are in premenopausal age and typically have had multiple pregnancies.
Hormonal disorders such as endometriosis and polycystic ovary syndrome (PCOS) are associated with Pelvic Congestion Syndrome. This is because hormonal factors play an important role in the development of PCS. The correlation between pelvic congestion syndrome and ovarian activity can be explained by the physiological effects of female sex hormones. Estrogen causes increased nitric oxide secretion. This results in increased dilatation and weakening of veins, which causes greater stress on the valves. Progesterone, by its activity, also weakens venous valves in the pelvic veins.
Having multiple pregnancies is a risk factor for developing PCS because during pregnancy, an increased volume of circulation is put on the ovarian and pelvic veins. The increased requirement for venous return as an outcome of the pregnancy and altered hormonal environment leads to chronic venous insufficiency.
Other conditions associated with PCS are varices of the lower limbs, phlebitis, prolapsed uterus, or previous pelvic surgery.
How is Pelvic Congestion Syndrome treated?
At Pelvic Rehabilitation Medicine, we treat the symptoms of PCS through the PRM Protocol™, a proprietary, office-based treatment which directly targets the inflamed nerves and spastic muscles of the pelvic floor. Learn more about our treatment here.
Can Pelvic Congestion Syndrome go away on its own?
The symptoms of PCS usually completely resolve after menopause.
If you are experiencing the symptoms of chronic pelvic pain or pelvic nerve inflammation and spastic muscles, schedule an appointment with a pelvic pain specialist today.
