What is pelvic congestion syndrome?
Pelvic congestion syndrome is a progressive disorder characterized by persistent chronic pelvic pain for a period longer than 6 months having unknown pelvic pathology.
Pelvic congestion syndrome is very common in the Age – 20-50. However, it is not diagnosed in its early stage and only 60% of the affected experience the symptoms.
It affects women more as compared to men, due to the complexity of female pelvis. It has a number of vital organs like reproductive organs, bowel and bladder. And just like every other organ, these organs too need a rich blood supply to carry out their vital functions.
As we know, the arteries supply our organs with oxygenated blood from heart and veins are responsible to carry out the blood back to our heart. Just like the varicose veins in legs, when valves present in the veins responsible for blood flow in pelvic region get disrupted and the blood follows wrong way, as a result, cause varicose veins in the pelvis. When the blood collected in these veins pressures the vital structures or organs in the pelvis area, it causes discomfort and pain.
The affected veins could have a blockage or the valves that regulate the blood flow within the vein become disrupted. Because of that, gravity floods the pelvic veins with blood under pressure. The collected blood potentially causes pain from prolonged standing, during menstrual period,etc. This situation is termed as Pelvic Congestion Syndrome.
Pelvic congestion syndrome gives rise to different ailments occurring at different sites.
- Varicose veins in pelvis involves vagina, it can cause pain while having sexual intercourse and periods.
- when involving anus it results into hemorrhoids, if they pressure rise the bladder or bowel, it can lead to pain and discomfort in that area during micturition or stool passage and irritable bowel syndrome.
Causes of Pelvic Congestion Syndrome in women
- Pregnancy
- Genetically transmitted
- Compression of common iliac vein (My Turner syndrome)
- Compression of left renal vein between superior mesenteric artery and aorta (Nut Cracker Syndrome)
Symptoms of Pelvic Congestion Syndrome
- Chronic pelvic pain that is pain for more than 6 months that accentuates before menses, a condition called dysmenorrhea.
- Dyspareunia i.e. pain while having sexual intercourse and postcoital aching that means pain after having sexual intercourse.
- Dysuria that means painful urination or micturition
- Stress incontinence worsens that results into involuntary leak of urine while sneezing, coughing, or laughing.
- Discomfort on prolonged standing and sitting
- Pain in the back
- Leg varicose veins
Signs and Symptoms of Pelvic Congestion Syndrome in men
- Chronic pelvic pain
- Pain in lower abdomen, back and hips
- Scrotal varices
- Hemorrhoids
- Irritable bowel syndrome
- Dysuria and stress incontinence
- Erectile dysfunction
How to diagnose Pelvic Congestion Syndrome ?
- Abdomial and Pelvic Duplex Ultrasound Scan (internally)
- Transvaginal Duplex is also another effective diagnostic tool
- CT scan and MRI can also be done but since they only show the size of the veins, the condition can be better known by performing internal duplex ultrasound.
Treatment of Pelvic Congestion Syndrome
A complete evaluation of the entire venous system is done to choose the adequate treatment methodology.
In case of spider veins or swelling venous uclers:
- Sclerotherapy
- Laser treatment
In most advanced disease
- In case of venous reflux in superficial veins of the affected part, the refluxing vein is closed through modalities while rerouting the blood through a healthy vein.
- Venous hypertension is treated with a stunt in the affected vein.
- Ovarian vein reflux is treated by embolising the reflux vein shut