Pelvic Congestion Syndrome Q&A with Dr. Carl Black

Dr. Carl Black answers questions on pelvic venous disorders, commonly known as pelvic congestion syndrome.

Pelvic congestion syndrome, also called pelvic venous congestion, falls under a broader range of pelvic venous disorders which are a known, but often unrecognized cause of chronic pelvic pain. Varicose pelvic veins develop when the valves in veins are not working correctly, or occasionally when critical deeper veins are obstructed, causing blood to pool and distend pelvic veins. Healthy veins return blood to the heart through one-way valves, allowing blood to travel toward the heart. Congested veins have weakened valves, allowing blood to flow backward and distend pelvic veins. Occasionally, increased pressure inside pelvic veins may be the result of an obstruction in the major veins draining the pelvis.

Typical symptoms of pelvic congestion include:
• Dull achiness and/or heaviness in the pelvis, often made worse by prolonged standing
• Bloating sensation
• Pain in the lower back
• Visible varicose veins on the buttocks, vulva, and upper thighs
• Painful menstrual cycle with referred pain in the legs
• Increase urination frequency
• Pain during and after intercourse

Unfortunately, pelvic venous congestion often goes unrecognized and untreated. Symptoms, physical exam and ultrasound findings have a high combined predictive value in diagnosing pelvic venous disorders. The ability of duplex ultrasound (DUS) to image realtime makes it an important tool in the evaluation of possible pelvic venous congestion. Because there are many other potential causes of chronic pelvic pain, medical professionals may conduct multiple exams and tests including:
• Pelvic exam
• Pelvic duplex ultrasound
• CT or MRI scan
• Laparoscopy

Once a patient is diagnosed with pelvic venous congestion, it can often be successfully treated with a minimally invasive procedure called embolization. Pelvic venous embolization requires little or no downtime and is performed in an outpatient setting. Occasionally, a compressed iliac vein may contribute to venous congestion and a stent may be indicated to help restore normal flow.

The embolization procedure consists of inserting a thin, flexible, plastic catheter (or tube) into the jugular vein in the neck. Liquid contrast agent is then injected into the veins of the pelvis and special x-rays are obtained. These images allow the doctor to visualize the refluxing pelvic varicosities and seal them off using sclerosant and coils placed inside the abnormal veins. The catheter is then removed and a small dressing is then applied. After treatment, patients can often return to normal activity immediately. Non-coil embolization is also available.

Embolization requires little or no downtime, is performed as an outpatient, and is minimally invasive but highly effective. After treatment, patients are typically able to return to most routine activities the same day.