By Joseph V. Lombardi, MD
Head, Vascular and Endovascular Surgery, Cooper University Health Care
What Is Pelvic Congestion Syndrome (PCS)?
Chronic pelvic pain is a common problem in the United States. Chronic pelvic pain is defined as “non-cyclical” pain lasting greater than six months. It is estimated that more than one-third of all women are affected by this problem. Dozens of conditions can result 
in chronic pelvic pain. In many cases, the root cause is never discovered, despite numerous tests and operations. For some women, however, pelvic pain is caused by a condition known as pelvic congestion syndrome (PCS)—varicose veins in the pelvic region that may go undiagnosed simply because the symptoms may often be overlooked or ignored. A common sign of this syndrome is that the women may feel pelvic pain while standing but not when they are lying down. This alone can sometimes make it difficult to diagnose because women are usually asked to lie down for a pelvic exam, relieving the painful pressure that brought them to the doctor in the first place.
What Causes Pelvic Congestion Syndrome?
PCS occurs when varicose veins develop around the ovaries, similar to varicose veins that occur in the legs. The valves in the veins no longer function normally, blood backs up and the veins become engorged or “congested,” which can be very painful. In men, a similar condition can cause varicose veins to form on the scrotum, which is known as a varicocele. In women, however, these varicose veins are internal. Occasionally, varicose veins appear on the vulva, thighs or buttocks.
Who Is Most Prone to Develop PCS?
- Women between the ages of 20 and 45 in their childbearing years
- Women who have had multiple pregnancies
- Women who have experienced hormonal increases
- women with ormonal dysfunction
- Women who have polycystic ovaries
- Women who have varicose veins in their legs
What Are the Symptoms of Pelvic Congestion Syndrome?
- Pain is the number one complaint
- Just before the onset of the menstrual cycle
- At the end of the day
- After prolonged standing
- During or just after intercourse
- During later stages of pregnancy
- Irritable bladder
- Varicose veins on vulva, buttocks, legs
- Feeling of fullness
- Swollen vulva/vagina
- Abnormal menstrual bleeding
- Tenderness to touch in lower abdomen
- Pain during intercourse
- Painful menstrual periods
- Backache
- Vaginal discharge
- General lethargy
- Feelings of depression
Can Other Conditions Mimic PCS?
In most cases, the diagnosis of pelvic congestion syndrome is not obvious and the diagnosis can only be made after ruling out some other disorders. Other disorders that may have the same symptoms as pelvic congestion syndrome include:
- Endometriosis
- Fibroids
- Uterine prolapse
How Is PCS Diagnosed?
A thorough history and physical examination by your gynecologist is necessary to rule out more common causes of your symptoms. Ultrasound is usually the first test of choice because it is painless, effective and only takes about 30 minutes. It can assess the uterus and other organs in the pelvis. It can also help visualize the blood flow and assess the presence of varicosities in the pelvis. However, CT scan, MRI and/or a venogram could all be utilized as well.
What Are the Treatment Options for Pelvic Congestion Syndrome?
Embolization, a non-surgical, outpatient procedure, is the most effective treatment for PCS. No incisions or stitches are required and there is no sensation inside while this is happening. After treatment, patients typically return to work and light activities the following day, and to full activities a few days later. In addition to being less expensive and less invasive than surgery, embolization offers patients a safe, effective, minimally invasive treatment option. Embolization successfully blocks abnormal blood flow in 95 percent to 100 percent of cases, and 85 percent to 95 percent of women experience improvement in their symptoms shortly after the procedure. Although symptoms are improved, the veins are never normal, and in some cases other pelvic veins may require further treatment.
Learn more about vascular and endovascular surgery at Cooper.