This is a chronic condition which occurs in women when varicose veins form within the pelvic region. The pelvis is located in the lower part of your abdomen, below the belly button. Varicose veins are veins that become swollen, twisted and lengthened as a result of poor vein function.
Veins are vessels which carry blood back to the heart, if these stop working this can lead to blood building up within the veins. When this happens, the veins can enlarge and change shape, this can occur within the legs and also the pelvis especially after being pregnant. This blood pooling may lead to pain and other symptoms of pelvic congestion syndrome.
This mainly affects women of child bearing age and is more common in women who have given birth to more than one child.
Causes of Pelvic Congestion Syndrome
Research is still ongoing by healthcare professionals as to the cause of pelvic congestion syndrome. Enlarged, swollen veins which aren’t working properly seem to play a major role, however some women can have enlarged pelvic veins without displaying symptoms. Pregnancy can increase the likelihood of pelvic congestion syndrome due to enlarging veins during pregnancy which support the increase in blood flow. This, however, can result in permanent enlargement of pelvic veins and lead to symptoms.
Hormones can also play a role in pelvic congestion syndrome; oestrogen is a vaso-dilator (makes veins wider). This could explain why pelvic congestion syndrome is not common after menopause when oestrogen levels drop dramatically. Other symptoms may also play a part in dilating veins, causing symptoms.
Who Is at Risk?
You are at higher risk if other members of your family have suffered with pelvic congestion syndrome or if you have given birth to more than one child.
Symptoms of Pelvic Congestion Syndrome
The main symptom of pelvic congestion syndrome is pelvic pain which lasts more than 6 months. The pain often starts during pregnancy and persists for at least 6 months after giving birth. The pain can be best described as heavy or aching feeling in the pelvic area or the pain can be sharp. The pain tends to be more on the left side, though you may feel it on both sides, and gets worse as the day goes on.
Such activities might make the pain worse;
· Sex (during and after)
· Standing for a long time
· Changing your posture
Some less common symptoms may include:
· Pain before or during periods
· Feeling a sudden need to urinate
· Enlarged, twisted veins on the buttocks, external genitals or thighs
Diagnosing Pelvic Congestion Syndrome
Pelvic pain is common and there are many different causes so diagnosing pelvic congestion syndrome can be difficult. Pelvic pain can result from problems with your ovaries and/or the uterus, your bladder, your digestive system and by muscle or bones. Mental health conditions can also be associated with pelvic pain and your healthcare provider will need to consider many possible causes before diagnosing the condition.
Your healthcare provider or OBGYN doctor will ask you about your medical history and the symptoms you’ve been experiencing, you will have a physical exam which will include a pelvic scan.
*Below are ultrasound images of dilated, elongated pelvic veins seen during a routine transvaginal (or 'internal') scan for Pelvic Congestive Syndrome'
Treatment of Pelvic Congestion Syndrome
Your healthcare provider can tailor your treatment according to your symptoms, possible treatments include:
· Gonadotropin-releasing hormone drugs which block ovarian function and may relieve pain
· Progestin hormone drugs which may relieve pain
· Procedures to shut off damaged veins (sclerotherapy, embolization)
· Surgery to remove damaged veins
· Surgery to remove uterus and ovaries
At the clinic we offer surgical procedures to shut off damaged veins within the pelvic regions by inserting a coil into the enlarged veins and also surgery to removed damaged veins.
Summary of Pelvic Congestion Syndrome
Pelvic congestion syndrome is a medical condition that causes chronic pain in the pelvis and is thought to be caused by enlarged veins which aren’t working properly within the pelvic area.
· Women of childbearing age who have had more than one pregnancy are at highest risk of developing pelvic congestion syndrome.
· Pelvic pain is the main symptom and may worsen when standing, walking, during or after sex. It may also start during your pregnancy.
· You may need several other tests to rule out other causes of pelvic pain.
· Hormone treatments such as oestrogen may help symptoms
· Procedures that block the damaged veins (embolization) may treat the underlying cause of pelvic congestion syndrome.
What to expect from your initial Consultation
During your initial consultation the vascular scientist will perform a bespoke Doppler ultrasound scan to map out any issues with the veins in your legs. You will then have a personalised consultation with a vascular surgeon who will go through the scanning report and if necessary, refer you to our affiliate private ultrasound colleagues at Wythenshawe Hospital who will perform an internal Doppler ultrasound scan by an accredited vascular scientist.
An internal ultrasound scan is performed by a female accredited vascular scientist who will insert a long slim ultrasound probe to investigate the blood vessels within the pelvic region. You will be required to blow into a syringe to stimulate blood flow and recordings of how well the main pelvic veins are working will be taken. If the pelvic veins are not working well this could indicate pelvic congestion syndrome and a referral to vascular surgeon who performs pelvic vein surgery will be arranged.