Pelvic congestion syndrome

What is Pelvic Venous Congestion Syndrome, also known as Pelvic Congestion Syndrome?

– Pelvic Venous Congestion Syndrome can cause chronic pelvic pain, and relates to a combination of symptoms and signs associated with high pressure in the venous system in the pelvis.
– Raised venous pressure in the pelvis is generally caused by one of two conditions.
– The first is Ovarian Vein Incompetence. The ovarian vein has valves which should allow flow only in one direction and that direction is from the pelvis up towards the chest. In some women, these veins are malfunctioning, and the direction of flow in the ovarian vein goes the wrong way, from the upper abdomen down into the pelvis causing congestion in the veins of the pelvis.
– The second major cause is Iliac Vein Compression (also known as May -Thurner Syndrome, or Pelvic Venous Obstructive Disease).
– This is where the veins draining the left leg (and sometimes the right) become compressed or squashed in the pelvis.
– These are the iliac veins, and it is usually the left side which can be squashed between an artery and the spine.
– This makes it difficult for blood to drain from the leg through the pelvis back to the upper abdomen and heart.
– The pressure in the venous system in the pelvis rises, resulting in pelvic venous congestion.
– The incidence of chronic pelvic pain in women over their lifetime is somewhere between 15% and 30%. What is not known is how much of this relates to Pelvic Venous Congestion.

What are the symptoms and signs of Pelvic Venous Congestion Syndrome?

– Heavy menstrual flow
– Heaviness or dragging pain in the pelvis
– Heavy feeling in the legs and thighs or hips; back pain
– Pain on intercourse (dyspareunia)
– Pain or discomfort when passing urine
– Pain is often relieved when the patient lies down
– It is also worth noting that women with pelvic congestion (either cause) may show signs of visible varicose veins.
– Rarely, vulva varicosities can dilate veins in the labia majora and minora and often settle post-partum. However sometimes these symptoms do not resolve and worsen with subsequent pregnancies causing pelvic discomfort when walking, itchy skin and painful intercourse.

Pain

Signs of pelvic venous congestion include:

– Chronic swelling of the left leg (sometimes both)
– Varicose veins especially if they return after adequate initial treatment
– Chronic venous insufficiency including pigmentation around the ankle
– Eczema itching or ulcers in the lower leg.
– Remember, pelvic pain can have many underlying causes so it is also important to rule out endometriosis, uterine abnormalities, pelvic inflammatory adhesions and other gyneacological issues with a gynaecologist, should pain persist.
– Once these have been ruled out, it is a good option to see a vascular surgeon.
– The incidence of pelvic venous congestion typically increases with every subsequent child, and also for women who have twins or triplets.
– Dr Huber uses state-of-the-art ultrasound and other imaging protocols to help make a diagnosis.
– Other diagnostic tools include, magnetic resonance, venography and intravascular ultrasound.

What is the treatment for Pelvic Venous Congestion Syndrome?

– Treatment of Pelvic Venous Congestion Syndrome depends on the exact cause.
– If the cause is due to Ovarian Vein Incompetence, then blocking the vein using coils prevents the transmission of pressure and decreases the congestion of the veins in the pelvis.
– If the cause is iliac vein compression, often it needs no treatment, it’s more about whether it impacts your quality of life.

Can men get Pelvic Venous Congestion Syndrome?

– While Pelvic Congestion Syndrome is typically a female issue, occasionally men can suffer from it too.
– 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 a little different but they still feel pain and heaviness in the abdominal/pelvic/groin area.

Should I see a gynaecologist or vascular surgeon for my pelvic pain?

– As pelvic pain can have many underlying causes, it is recommended that before seeing your vascular surgeon you first see a gynaecologist to rule out fibroids, endometriosis, ovarian cyst, bladder or other issues.
– Dr Huber is happy to refer you to a gynaecologist or work with your gynaecologist/urogynaecologist.
– Once your condition is suspected as “vascular” Dr Huber will perform a full vascular work up which includes modern ultrasound and a comprehensive patient history.
Occasionally the condition may be linked to other conditions such as irritable bowel disease, so similarly Dr Huber can help you navigate other specialists to see if required.
– During your consult with Dr Huber it is always a good idea to take a list of your symptoms (as well as medications).
– So consider these questions that Dr Huber may ask you and even keep a diary of symptoms if it helps pinpoint them more accurately.

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