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Pelvic Congestion Syndrome

by JoAnn V. Pinkerton, MD

Pelvic congestion syndrome is long-lasting (chronic) pain in the lowest part of the torso (pelvis) caused by accumulation of blood in veins of the pelvis, which have widened (dilated) and become convoluted.

Pelvic congestion syndrome seems to be a common cause of chronic pelvic pain (pain lasting more than 6 months). Pain occurs because blood accumulates in veins of the pelvis, which have dilated and become convoluted (called varicose veins). The resulting pain is sometimes debilitating. Estrogen may contribute to the development of these veins. Up to 15% of women of childbearing age have varicose veins in their pelvis, but not all of them have symptoms. Sometimes pain that occurs before or during menstrual periods results from pelvic congestion syndrome.

Symptoms

Typically, the pain is a dull ache, but it may be sharp or throbbing. It is worse at the end of the day (after women have been sitting or standing a long time) and is relieved by lying down. The pain is also worse during or after sexual intercourse. It is often accompanied by low back pain, aches in the legs, and abnormal vaginal bleeding. Some women occasionally have a clear or watery discharge from the vagina. Other symptoms may include fatigue, mood swings, headaches, and abdominal bloating.

Diagnosis

Doctors may suspect pelvic congestion syndrome when women have pelvic pain but a pelvic examination does not detect inflammation or another abnormality.

Ultrasonography can help doctors confirm the diagnosis. Sometimes, particularly if doctors are considering other possible causes of pelvic pain, laparoscopy is done. In this procedure, doctors make a small incision just below the navel and insert a viewing tube to directly view the structures of the pelvis.

Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) usually relieve the pain. If NSAIDs are ineffective, doctors may try to block blood flow to the varicose veins and thus prevent blood from accumulating there. Two procedures are available:

  • Embolization of a vein: After using an anesthetic to numb a small area of the thigh, doctors make a small incision there. Then, they insert a thin, flexible tube (catheter) through the incision into a vein and thread it to the varicose veins. They insert tiny coils, sponges, or gluelike liquids through the catheter into the veins to block them.

  • Sclerotherapy: Similarly, doctors insert a catheter and inject a solution through it and into the varicose veins. The solution blocks the veins.

When blood can no longer flow to the varicose veins in the pelvis, pain usually lessens.