Pelvic Congestion Syndrome

Pelvic congestion syndrome is a condition that is caused by what are basically ‘pelvic varicose veins’. Due to differences in anatomy of the pelvis, it usually affects females more than males. As with varicose veins in the legs, if the valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside dilated varicose veins within the pelvis. This both stops the normal blood circulation to the pelvic organs and also causes these large varicose veins to push on the pelvic organs – the bladder, bowel, vagina and also the pelvic floor.

The symptoms of pelvic congestion syndrome predominantly come from the weight of the blood pushing on these structures.

• ‘Pelvic’ – means that it relates to a condition of the pelvis
• ‘Congestion’ – meaning too much blood in the veins and hence the venous circulation is “congested”
• ‘Syndrome’ – means a collection of different symptoms and signs

Who gets symptoms from Pelvic Congestion Syndrome?

Pelvic congestion syndrome affects women in their childbearing years. It is uncommon for girls to get pelvic congestion syndrome before puberty, as the pelvic organs and blood supply have not increased due to the effect of female hormones. Similarly, it is uncommon to get pelvic congestion syndrome after the menopause, as when the female sex hormones reduce sufficiently, the blood supply to the pelvis also reduces. However it is possible to get pelvic congestion syndrome postmenopausally if the veins have been very dilated.

What are the symptoms of Pelvic Congestion Syndrome?

The symptoms of pelvic congestion syndrome are mainly those caused by the pressure of the venous blood in the dilated pelvic varicose veins pressing on the pelvic organs. As such they can include:

• aching or dragging feeling in the pelvis, particularly on standing. This is due to the weight of blood in the pelvic varicose veins weighing heavily on the pelvic floor which is made of muscle. It is usually worse around the time of the period
• irritable bladder sometimes giving stress incontinence, due to the weight of the pelvic varicose veins on the bladder
• irritable bowel due to the weight of the pelvic varicose veins on the rectum
• discomfort on sexual intercourse medically referred to as ‘deep dyspareunia’

How do I know if I have pelvic congestion syndrome?

Unfortunately many of the symptoms of pelvic congestion syndrome are variable and also can occur with other conditions. Usually patients have already seen their doctors and gynaecologists and have been told that there is nothing wrong with them.

One easy test to diagnose varicose veins of the pelvis is by a transvaginal duplex ultrasound.  MRI or CT can also identify these abnormal veins.

What is Ovarian Vein Embolization?

Unlike the veins of the leg, which are surrounded by subcutaneous fat, the pelvic veins have got very sensitive organs and vital structures around them. As such, we cannot use the heat producing method such as laser, which might end up burning the ovaries, uterus, vagina, bowel, bladder or indeed the ureters, nerves or arteries. Therefore to be able to treat these veins successfully, we need to be able to close them without using heat.

Open surgery or laparoscopic surgery is not particularly useful to treat pelvic veins. Firstly, the pain and complications from open surgery is not needed. Secondly, it is exceptionally difficult to get to the very small veins involved deep in the pelvis by using open surgery or laparoscopy.

By using x-ray guided venography, we are able to place very thin catheters directly into the veins that need treatment. Once the catheter is in place, a combination of foam sclerotherapy and insertion of a specialist inert metal coil can be placed into the vein, closing it and stopping the pelvic vein reflux.

Although some patients are concerned about having coils placed into their pelvic veins, the actual metal involved is less than the clips used in many surgical procedures such as laparoscopic hernia repair or laparoscopic gallbladder removal and far far less than the metal used in a hip replacement or other joint replacement procedure.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.