5 Facts About Pelvic Congestion Syndrome

As a woman, if you are experiencing chronic pelvic pain, there is a possibility that you might be dealing with pelvic congestion syndrome, also referred to as PCS. Pelvic congestion syndrome is a health condition that brings pain or heaviness in the pelvic region and abdomen. It occurs when there is improper blood flow in the deep veins or iliac vein. 

Patients with pelvic venous disease caused by May-Thurner compression or other pelvic venous obstructive disease often present with left lower quadrant and/or groin pain and left lower leg swelling. When compression occurs in the iliac vein, the blood pool and causes pain as the day progresses and it is peaked at the end of the day when the patient stands or sits for an extended period of time. This pain is relieved when the patient lies down in most cases.

According to vascular specialists, an estimated 15 percent of adult women will experience varicose veins (bulging veins). But it is worth noting not every individual dealing with varicose veins will suffer from pelvic congestion syndrome. The vascular research at the Lakhanpal Vein Foundation has shown that 55% percent of patients with pelvic congestion show signs of visible varicose veins. 

Women with the condition don’t know if the disease can be treated. Pelvic Congestion Syndrome is often an underdiagnosed disorder and other factors must be considered before determining a vascular condition. When the patient is evaluated, other gynecological conditions are considered first this may include endometriosis, uterine abnormalities (eg, leiomyomata, adenomyosis, arteriovenous malformations), pelvic inflammatory disease, and adhesions. 

In this article, you will learn five things about pelvic congestion syndrome that you didn’t know. 

Women Mostly Suffer from It

Based on research, chronic pelvic pain will affect approximately 14 – 30% of ladies. The risk of chronic pelvic pain of a vascular origin is increased with each subsequent pregnancy, and women pregnant with multiple pregnancies like twins or triplets. 

During pregnancy, blood vessels expand to accommodate increased blood flow. This expansion can cause the valves of the veins responsible for keeping blood flowing in the right direction to malfunction. When these valves malfunction, blood begins to pool and back up into the veins. When blood backs up into the veins, the affected vein becomes varicose, or swollen and painful.

PCS is usually not considered as the primary reason for chronic pelvic pain. Other considerations must be evaluated by the Ob/GYN and a separate pelvic ultrasound must be performed by a vascular specialist. It is best to visit your gynecologist before diagnosing this condition. Several gynecologists may overlook the vascular problem. You may be requested to take several tests while experts attempt to determine the best way to treat you. 

Men can also suffer from chronic pelvic pain. Men can have improper blood flow in the deep veins caused by compression of the iliac vein.  The quality of symptoms they experience can be different but they still feel heaviness or pain in the pelvic/abdomen region. 

The most common expression of this condition by patients is that they "feel as if a bowling ball is between their groin area." This is partly due to the improper blood flow in the abdomen and/or pelvic region and this pain increases throughout the day.

Quality of Pelvic Pain using the PQRST Pain Assessment Method

Quality of pain is a description of the characteristics of the pain, preferably in the words used by the patients to describe the pain. It is helpful in determining the type of pain to guide the most appropriate treatment option. The CVM has a questionnaire template that has been perfected in the last decade to determine if the pain is of a vascular origin. The vascular doctor will go through this method along with a noninvasive transabdominal ultrasound, similar to a pregnancy ultrasound. 

P = Provocation/Palliation

What were you doing when the pain started? What caused it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities?

What relieves it? Medications, massage, heat/cold, changing position, being active, resting?

What aggravates it? Movement, bending, lying down, walking, standing?

Q = Quality/Quantity

What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting, or stretching.

R = Region/Radiation

Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around? Did it start elsewhere and is now localized to one spot?

S = Severity Scale

How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?

T = Timing

When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly? Is it sudden or gradual? What were you doing when you first experienced it? When do you usually experience it: daytime? night? early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during or after meals? Does it occur seasonally?

In about 55% of pelvic congestion patients, there are visible varicose veins in the pelvic and abdomen region. That is why it is recommended to speak to a doctor once you experience pain in the pelvis and see visible varicose veins in the legs or vulva region. 

Chronic pelvic pain is diagnosed after pain has been present for at least 6 months. Patients with PCS from gonadal vein reflux often report lower pelvic pain, dyspareunia, postcoital pain, and/or bladder irritability or urgency. This pain is exacerbated by prolonged standing and can radiate to the posteromedial thigh or buttocks. Patients with pelvic venous disease caused by May-Thurner compression or other pelvic venous obstructive disease often present with left lower quadrant and/or groin pain and left lower extremity swelling.

Visit a gynecologist before considering pelvic pain of a vascular disorder

The patient should visit a gynecologist before considering the pelvic pain of a vascular condition. The gynecologist can rule out any other reason including endometriosis, fibroids, and other issues. CVM collaborates with many other physicians to identify and rule out these other causes of pelvic pain. Many gynecologists refer the patient to our practice after ruling out other issues. 

The picture above shows the many causes of chronic pelvic pain. Pelvic Congestion Syndrome is in the top three most common causes of chronic pelvic pain in women. 

Patient Experiences Pain While or After Sexual Intercourse

Pain may be felt because of pressure or heaviness in the pelvic region. According to vascular doctors, ladies who have Pelvic Congestion Syndrome may experience painful menstruating cycles, pain during sex and after successive pregnancies. The pain can be felt even while walking, posture, or engaging in other labor-intensive activities. This is due to the increased blood flow in that region during these activities.

There is a Chance of Suffering from Varicose Veins in the Vulva

Yes. It may happen, but most people will find the experience uncomfortable. The varicose veins can be seen in a female’s genitalia and can occur after pregnancy. Several women who suffer from varicose veins will be informed that they can’t get suitable treatment. What they should do is wear special medical-grade compression stockings. It is best to ask your medical provider for the correct medical grade that is right for you.

Vulvar varicosities are dilated veins found in the labia majora and minora and are more common in pregnant women as opposed to the non-pregnant population. While as many as one in ten pregnant women experiences these troublesome veins, spontaneous improvement in the appearance of vulvar varicosities is typically seen within six to eight weeks post-partum. However, in some women, these dilated veins may never resolve and only worsen with time and further pregnancies. When persistent and symptomatic, they may present with the following:

• Pelvic discomfort during walking.
• A sense of swelling.
• Vulvar pressure.
• Pelvic pain.
• Itchy skin.
• Painful Intercourse (dyspareunia)

If you are experiencing pelvic congestion syndrome, you should first visit your gynecologist and the next option should be to visit The Center for Vascular Medicine for a noninvasive pelvic ultrasound. The Center for Vascular Medicine is the leading medical practice on the East Coast to determine the cause of chronic pelvic pain in both men and women.

The video below is by Rick Kennedy the CEO of The Center for Vascular Medicine explaining Chronic Pelvic Pain of a Vascular Origin.