Pelvic congestion syndrome (PCS) is a common cause of pelvic pain that persists for 6 months or longer. Roughly 30-40% of women with long-lasting pelvic pain have pelvic congestion syndrome.1 PCS occurs due to the presence of dilated (swollen) and twisted veins called varicose veins in the pelvis (lower part of the torso). These enlarged veins are similar to those commonly seen on the legs. Sometimes, hormonal factors and other medical conditions can contribute to the development of enlarged veins in the pelvis and resultant pelvic pain.
If you suffer from pelvic pain, pelvic congestion syndrome can potentially be the culprit. Read on to learn more about the risk factors and symptoms of pelvic congestion syndrome.
Symptoms of Pelvic Congestion Syndrome
Most patients with pelvic congestion syndrome have non-cyclical chronic pelvic pain, i.e., the pain is present throughout the menstrual cycle and it persists for 6 months or more.
PCS pain is often described as dull and aching, but it can also be sharp and throbbing. The pain is generally worse at the end of the day after sitting or standing for prolonged periods and is relieved by lying down. Oftentimes, pain due to pelvic congestion is worse before the onset of menses and during or after intercourse.2
Patients with pelvic congestion syndrome may also experience generalized lethargy (tiredness), dysmenorrhea (painful periods), urinary urgency and frequency, discomfort in the rectum, lower back pain, and swelling and discomfort in the vulva.2 Some patients with PCS may have visibly swollen veins on the buttocks, inner thighs, and lower extremities. Many patients with pelvic congestion syndrome have hemorrhoids.
Pelvic pain associated with pelvic congestion syndrome often develops during or after pregnancy and becomes worse with each subsequent pregnancy.
If your symptoms sound similar to the ones described above, talk to your doctor about pelvic congestion syndrome as a possible cause.
Risk Factors for Pelvic Congestion Syndrome
A well-known risk factor for pelvic congestion syndrome is multiple pregnancies. During pregnancy, the capacity of the pelvic veins can increase up to 60-times, leading to stretching and weakening of the veins and damage to the venous valves (venous valves prevent backflow of blood in the veins).3 As a result, the veins become dilated (enlarged) and there is a retrograde (reverse) flow of blood. The accumulation of blood in the pelvic veins leads to varicosities (enlarged veins) and pelvic pain. These changes can persist after the completion of the pregnancy. More than 85% of women with pelvic congestion syndrome have given birth before.1 Each subsequent pregnancy causes further damage to the veins, which is why the condition is common in women who have given birth multiple times.
There are other less common causes of pelvic congestion syndrome and pelvic pain. In some patients, primary venous insufficiency leads to the accumulation of blood in the veins. This occurs when there is a congenital absence or incompetence of the venous valves, meaning the valves are defective from birth. Rarely, external compression of the pelvic veins can obstruct the outflow of blood, for example, in patients with tumors, nutcracker phenomenon, or May-Thurner syndrome, leading to pelvic pain. The female hormone estrogen causes dilatation (widening) of the pelvic veins and may be associated with pelvic congestion syndrome.4
If you suffer from persistent pelvic pain and some of the other symptoms listed above, and especially if you have a history of multiple childbirths, you may have pelvic congestion syndrome. PCS is a treatable condition with safe and effective treatment options. Your doctor can complete a clinical evaluation and order imaging studies to make a diagnosis and advise appropriate treatment for pelvic congestion syndrome.
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- Brown CL, Rizer M, Alexander R, Sharpe EE 3rd, Rochon PJ. Pelvic Congestion Syndrome: Systematic Review of Treatment Success. Semin Intervent Radiol. 2018;35(1):35-40. doi:10.1055/s-0038-1636519. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886772/
- Ignacio EA, Dua R, Sarin S, et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25(4):361-368. doi:10.1055/s-0028-1102998. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/
- Durham JD, Machan L. Pelvic congestion syndrome. Semin Intervent Radiol. 2013;30(4):372-380. doi:10.1055/s-0033-1359731. Available online. Accessed on October 11, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835435
- Saadat Cheema O, Singh P. Pelvic Congestion Syndrome. [Updated 2020 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560790/