What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome is characterized by presence of pelvic varicose veins, i.e, dilated, elongated, and tortuous veins in the pelvic region.
Intense pain that lasts for more than 6 months results from the dilation of the veins in the uterus, vulva and ovaries, as well as the blood flow moving in the opposite direction – due to the incompetence of the venous valves.
Diagnosis of Pelvic Varicose Veins
In clinical observation there are some signs that demonstrate the presence of this syndrome, namely presence of vulvar and vaginal varicose veins, as well as in the inner thigh and groin, or buttocks.
However, for diagnosis, it is important to exclude other causes, since there are no symptoms exclusive to pelvic congestion syndrome.
Pelvic Doppler ultrasound is a first-line examination that reveals the presence of pelvic varicose veins. It is often necessary to perform a transvaginal Doppler ultrasound, as these varicose veins are difficult to study through the abdomen.
It is almost always necessary to complement this study with other complementary, non-invasive imaging methods, such as angio-resonance or angio-CT.
These exams may involve the injection of contrast media. They allow for the identification of possible areas of stenosis (tightening) in the venous axes, as well as the vessels involved in the reflux process. Ultimately, they help to understand the origin of pelvic varicose veins and estimate their contribution to the clinical picture (complaints and externally observable varicose veins).
Causes
Pelvic congestion syndrome affects above all, but not only, young women who have already had more than 2 pregnancies.
During pregnancy, the pelvic veins are compressed by the expanding gravid uterus, which can lead to impaired venous drainage and consequent reflux.
On the other hand, pregnancy is characterized by increased blood flow to the pelvis, which in itself will eventually contribute to the development of varicose veins in the pelvic region.
There are other causes, such as ovarian vein thrombosis and the absence of venous valves due to congenital maldevelopment, or anatomical compression of the left renal vein, although these are rarer.
Symptoms
Chronic pelvic pain is the most common symptom. It typically worsens with physical exertion, prolonged standing or sitting, menstrual periods, and during or after sexual intercourse.
Patients also often experience:
- Severe and prolonged abdominal pain;
- Worsening urinary incontinence;
- Feeling of heaviness in the stomach;
- Abnormally painful menstrual period, with heavy bleeding;
- Fatigue and lack of energy;
- Feeling of bloating and tension in the abdomen or pelvis.
In some cases, symptoms only become evident during or after pregnancy.
Specialist Doctor
in Pelvic Congestion Syndrome
Prof. Doctor Sergio Sampaio
- Graduated from the Faculty of Medicine of the University of Porto
- PhD from the Faculty of Medicine of the University of Porto
- Specialist in Angiology and Vascular Surgery
- Fellow of the European Board of Vascular Surgery
English (UK)