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If you suffer from chronic pelvic pain, you’re not alone. It’s estimated that 10–15% of gynecological visits in the U.S. are scheduled to address this type of pain, and that it affects close to 40% of women.[1] Pelvic congestion syndrome (PCS) is the name given to chronic pain that results from varicose veins in the pelvic region, similar to pain that can result from varicose veins in the legs. Unlike varicose veins in the legs, the veins that contribute to PCS are not visible from the outside (although women who have this condition may also have visible varicose veins elsewhere in the body).
What are the symptoms of PCS?
The pelvic pain associated with PCS is typically described as dull, aching, and persistent. It is often worse during and after intercourse, during menstruation, and after sitting or standing for long periods. Many women notice that the pain subsides when they lie down.
How Is PCS diagnosed?
If you have pelvic pain that lasts at least six months and is not related to your menstrual cycle, then PCS is one of several possible causes. When a women complains of chronic pelvic pain, her doctor will typically run several tests, including a pelvic exam, Pap smear, blood and urine tests, and possible imaging exams such as MRI, CT, or ultrasound.[2] While the varicose veins that cause PCS may be visible on these exams, venography better enables doctors to specifically diagnose PCS.[3]
Venography is an X-ray exam that uses contrast dye to examine blood flow through the veins. If you undergo a venogram, you’ll need to remain very still during this procedure so the radiologist can get clear images of your veins. The procedure takes 30–90 minutes.
What Causes PCS?
Like other types of varicose veins, PCS results when valves that help to return blood to the heart become weakened. This allows blood to pool in the vein, which can cause vein enlargement, pressure, and pain. Women who have had multiple pregnancies appear to have a predisposition for developing PCS, which is thought to be a result of increased vein capacity, weight gain, and other physical changes associated with pregnancy.[4]
What Treatments Are Available?
Depending on the severity of your symptoms, your doctor may recommend medication or surgery. Vein embolization is a minimally invasive surgical procedure that has been shown to significantly decrease pain in women suffering from PCS.[5] It involves closing off the affected veins so they can no longer pool with blood.
Embolization is performed in a hospital setting using intravenous sedation. For this reason, you’ll need to arrange for someone to drive you home following the procedure. Be sure to follow your doctor’s instructions for fasting and avoiding certain medications prior to the procedure. As with any imaging exam, you should always inform your doctor and technologist if there is a chance that you may be pregnant.
Find more information about embolization through Iowa Radiology here. If you have further questions about the procedure, feel free to contact us directly. We strive to provide patients the information they need to make wise choices about their health care. Click any of the images below to learn more about women’s imaging procedures at Iowa Radiology.
[1] Ignacio, Elizabeth et al. "Pelvic Congestion Syndrome: Diagnosis and Treatment." Seminars in Interventional Radiology. 2008 Dec; 25(4): 361–368. Accessed 17 Nov 2017.
[2] Singh, Manish K. "Chronic Pelvic Pain in Women Workup." Medscape.com. WebMD LLC, 13 Jan 2015. Accessed 17 Nov 2017.
[3] Perry, Paul C. "Current Concepts of Pelvic Congestion and Chronic Pelvic Pain." Journal of the Society of Laparoendoscopic Surgeons. 2001 Apr-Jun; 5(2): 105–110. Accessed 17 Nov 2017.
[4] Ignacio, Elizabeth et al. "Pelvic Congestion Syndrome: Diagnosis and Treatment." Seminars in Interventional Radiology. 2008 Dec; 25(4): 361–368. Accessed 17 Nov 2017.
[5] Ibid.
