Learn more about pelvic congestion syndrome
If you complain of pelvic floor pain, which is worsened by standing or sitting for long periods, watch the videos of our specialist, Professor Sérgio Sampaio, and learn more about the symptoms and treatments for this syndrome.
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.
Pelvic Congestion Syndrome: Treatment
Indications
There are several treatment options for pelvic congestion syndrome.
In some cases, prescribing anti-inflammatory and/or hormonal drugs improves the clinical picture and helps control pain and other symptoms.
Sometimes, either because symptoms do not improve, or because pelvic varicose veins are involved in externally visible varicose veins that need to be treated, intervention is necessary.
It is usually possible to perform a procedure called VENOUS EMBOLIZATION.
This is a minimally invasive intervention, performed on an outpatient basis.
Procedure
THE venous embolization is a treatment with high levels of safety and efficacy.
The technique involves puncturing a vein, usually in the groin. Using appropriate catheters, the veins are navigated to the desired location. Reflux is then corrected through the injection and/or implantation of various substances or devices.
Other treatment options include ligation, which is the interruption of the veins through open or laparoscopic surgery. These procedures are more invasive and performed under general anesthesia.
Two hours, depending on complexity;
Performed in a hospital environment, under local anesthesia;
Discharged on the same day, returning home after a few hours, resuming daily and professional activities.
Post-treatment
Results
Venous embolization usually has lasting results.
In most cases, one intervention is enough.
After some temporary discomfort, felt in the first few days after embolization, the overwhelming majority of patients (85 – 95%) report a very important symptom relief.
Contraindications
Venous embolization is not recommended for pregnant or breastfeeding women because the procedure involves exposure to radiation.
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)