Many women experience pelvic pain during their lives. Often, this is a predictable aspect of menstruation. However, persistent pelvic pain that’s not related to the menstrual cycle can have a wide range of causes, including conditions related to the bowels, urinary tract, and reproductive organs. To investigate the cause of chronic pelvic pain, doctors commonly conduct a physical exam and recommend lab and/or imaging tests. One common cause is a condition known as pelvic congestion syndrome (PCS) or ovarian vein reflux.
What is PCS?
Pelvic congestion syndrome develops from the formation of varicose veins in the pelvic region. An estimated 10–30% of patients with the condition report chronic pelvic pain. Pain from PCS often becomes worse after long periods of standing, during and after intercourse, and just prior to menstruation. PCS is sometimes accompanied by
- Increased menstrual pain
- Abnormal menstrual bleeding
- Visible varicose veins on the legs, buttocks, or vulva
- Back or hip pain
- Urinary and bowel symptoms
What causes PCS?
When the valves in the veins that help return blood to the heart against gravity become weakened, they may no longer close properly, allowing blood to pool in the vein. This creates varicose veins and can cause persistent pain. Pregnancy is thought to be the most common cause of this phenomenon. Pregnancy causes structural changes to the pelvis, weight and fluid gain, and increased estrogen, all of which can contribute to the weakening of pelvic veins. The more pregnancies a women experiences, the greater the likelihood of developing PCS.
How is PCS diagnosed and treated?
Ultrasound is often the first imaging exam used to investigate possible pelvic congestion syndrome. This can allow the radiologist to identify varicose veins and examine blood flow in the region. Pelvic venography or MRI may also be used for diagnosis.
Treatment may include pain medication to control symptoms. To treat the source of the pain, however, vein embolization is often recommended as a minimally invasive yet effective option. During this procedure, an interventional radiologist, using X-ray guidance, inserts a catheter through the femoral vein and into the veins that are causing the problem, closing them off to prevent them from pooling with blood and thereby relieving the pain. Vein embolization requires only a tiny surgical incision, and success rates upward of 85% have been reported worldwide. IV sedation typically is used during the procedure, which is performed in a hospital setting. Most patients are discharged within 24 hours after the procedure is completed.
If your doctor has identified PCS as the source of your chronic pelvic pain and recommends vein embolization, Iowa Radiology’s interventional radiologists can perform this procedure at Unity Point Methodist Medical Center. Feel free to contact our clinics with any questions you may have.
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