What is Pelvic Congestion Syndrome PCS?

Pelvic congestion syndrome PCS refers to the condition where blood gets accumulated in the dilated veins of the pelvis.

What causes PCS?

PCS occurs when varicose veins develop around the ovaries, similar to varicose veins where blood gets pooled in the veins of the legs. Valves in the veins lose their function, blood back up, veins become engorged, and this is painful. Hence the pain in PCS.

What are the symptoms of PCS?

The most prominent symptom of PCS is the chronic pelvic pain that is felt in the lower abdomen and lower back. PCS pain typically gets worse as the day goes along, especially for women whose routine includes prolonged standing.

The pain can also get worse with
Intercourse
Periods
Pregnancy
Physical activities such as cycling

How common is PCS?

It is estimated that as many as 15 to 20% of the women who complain of chronic pelvic pain have PCS.

How is PCS diagnosed?

Pelvic varicose veins is hallmark of PCS. This can be diagnosed on pelvic ultrasound scan, CT scan and MRI Venogram. Fortunately, all women with congested veins do not have pelvic pain. Only those women with pelvic varicose veins and pelvic pain are given the diagnosis of PCS.

Laparoscopy – This procedure involves making a key-hole size incision near the belly button. A camera is inserted through this small cut that helps examine the pelvic region and confirms diagnosis of large dilated varicose veins in the pelvis. Laparoscopy is not recommended exclusively to confirm PCS. PCS sometimes is an incidental finding during laparoscopy.

How do we treat PCS?

• Although not all women with PCS complain of pelvic discomfort, those with chronic pelvic pain are prescribed oral pain killers for immediate pain relief.
• Lying down improves blood circulation in the pelvic region thus relieving the pressure from the ovarian veins.
• Permanent way to completely cure PCS is to block the blood flow in the dilated veins of the pelvis by embolization, where in an interventional radiologist numbs a small area on the thigh to make a tiny nick on the skin. A catheter is then inserted into the dilated pelvic vein that is to be treated. Through this catheter, a thin metal coil or a solution is inserted into the vein that causes it to clot and permanently close off.
• Laparoscopy: Another option is applying clips on the dilated veins with the help of clips. Lack of blood flow causes these veins to eventually die and get reabsorbed in the body.
• Oral Contraceptives – May help regulate hormone fluctuations and assist in relieving pelvic pain and discomfort.
• Hysterectomy – Is the last resort in case all the above methods have failed. It is a major surgery that involves removing the uterus.