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What is pelvic congestion syndrome?

Pelvic congestion syndrome is also known as pelvic venous insufficiency. There are enlarged, tortuous, blood-filled veins around the ovaries and in the pelvis; as a result, blood accumulates in the groin area, causing pain.

Who is affected by pelvic congestion syndrome?

If you are between the ages of 20-45 and have had one or more pregnancies, your likelihood of having pelvic congestion syndrome is higher. A family history of varicose veins and polycystic ovary syndrome are also other risk factors. Pelvic congestion syndrome is rare after menopause.

What is the frequency of pelvic congestion syndrome?

Gynecological examinations account for 40% of chronic pelvic pain cases, and in 30% of these cases, the cause of the pain is pelvic congestion syndrome.

What are the symptoms of pelvic congestion syndrome?

  1. The pain is typically dull and felt in the lower abdomen or groin, with a sensation of heaviness, although it can occasionally be sharp. It is usually localized to the left side, but can also occur on the right or bilaterally. The pain often develops during or shortly after pregnancy and tends to worsen with subsequent pregnancies. It tends to be more pronounced in the evenings, just before and during menstruation, during sexual intercourse, or after prolonged sitting. However, lying down can alleviate the symptoms.

  2. Varicose veins may also be present in the groin, hips, thighs, vulva, and vagina.

  3. Other symptoms may include:

  4. Irritable bowel syndrome (with episodes of diarrhea and constipation)

  5. Urinary incontinence, especially when sneezing, laughing, or performing other actions that put pressure on the bladder

  6. A burning sensation while urinating.

Why does pelvic congestion syndrome occur?

The exact cause of pelvic congestion syndrome is not fully understood. However, the blood flow in the ovarian vein plays a significant role. Normally, blood flow in the ovarian vein is directed towards the heart, but when the valves in the vein become dysfunctional, blood flows backward. In pelvic congestion syndrome, veins dilate, causing the valves to become even more ineffective. This results in blood accumulating in the pelvic area, leading to pain. Additionally, the enlarged veins may press on neighboring nerves, contributing to the pain.

Why do the vessels deteriorate in pelvic congestion syndrome?

  1. During pregnancy, veins expand by up to 50% of their normal size, and this dilation can lead to irreversible changes in the vein walls.

  2. Estrogen:

  3. After menopause, pelvic congestion syndrome is rarely observed, which suggests that estrogen plays a role in the dilation of veins.

  4. While these factors are significant, other contributing factors may also be involved in the development of pelvic congestion syndrome.

How is pelvic congestion syndrome diagnosed?

After your doctor inquires about your symptoms and medical history, a thorough physical examination is performed to check for tenderness in the ovaries, cervix, and uterus in order to identify the source of the pain. Imaging techniques help in ruling out other potential causes and identifying dilated veins, which aids in the diagnosis.

Diagnostic Methods for Pelvic Congestion Syndrome:

  1. Ultrasonography:
    This is the first imaging method to be used. It helps to visualize the enlarged veins and is a non-invasive, effective method for diagnosis.

  2. MRI or CT Scan:
    If the enlarged veins are not visible through ultrasound, MRI or CT scans can help identify them. These methods can also rule out other potential chronic pain causes, such as endometriosis.

  3. Pelvic Venography:
    This is considered the gold standard for diagnosing pelvic congestion syndrome. It is relatively more invasive than other methods and is typically used when other imaging techniques are insufficient. Pelvic venography is also used during the treatment process for patients diagnosed with the condition.

  4. Laparoscopy:
    Laparoscopy is used to rule out other causes of chronic pain, such as conditions unrelated to pelvic congestion syndrome.

These methods together provide a comprehensive approach to diagnosis, helping doctors confirm pelvic congestion syndrome and rule out other possible conditions.

Which patients should be treated?

Enlarged veins alone can also be seen in patients without chronic pelvic pain, so treatment is not necessary for asymptomatic individuals. To determine if pelvic congestion syndrome (PCS) is the cause of chronic pelvic pain, other potential causes must be ruled out.

How is Pelvic Congestion Syndrome Treated?

There is no definitive cure for pelvic congestion syndrome. Treatments aim to reduce and control symptoms.

1. Medication:

Medications may be prescribed to help manage the symptoms, including pain relief and anti-inflammatory drugs.

2. Ovarian Vein Embolization:

This procedure involves blocking the veins responsible for blood reflux, preventing the backward flow of blood. Through a catheter inserted into the ovarian vein, the vein and pelvic veins are visualized, and they are occluded using fine metal coils, glue, or sclerosant agents. This procedure helps alleviate the pain caused by the reflux.

3. Laparoscopy:

Laparoscopic surgery may be used to tie off the veins to prevent the backward flow of blood. It is minimally invasive and can be done with small incisions.

4. Bilateral Salpingo-Oophorectomy:

This is the surgical removal of the fallopian tubes and ovaries. It is usually a last resort treatment for women who have severe, persistent symptoms and where other treatments have not been effective.

These treatments aim to address the symptoms and prevent complications, but it is important to note that each patient's condition and response to treatment may vary.

Can the development of pelvic congestion syndrome be prevented?

Unfortunately, it cannot be prevented.

Is pelvic congestion syndrome life-threatening?

It is not life-threatening; however, depending on the severity of the pain, your activities may become limited, and you may lose enjoyment in life.

What to expect if I have pelvic congestion syndrome?

Although there is no standard treatment for pelvic congestion syndrome, pain is effectively relieved after interventions. In patients who undergo ovarian vein embolization, pain is eliminated in 75% of cases, and only 5% of cases experience recurrence.

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