Pelvic congestion syndrome (also known as pelvic vein incompetence) is a chronic medical condition in women caused by varicose (dilated) veins in the lower abdomen and pelvis, usually as a result of incompetent veins higher up the system. It is most often related to the left ovary vein and its connection to the left kidney, though other problems can affect the venous system and give rise to the syndrome.
The condition causes chronic pain, often manifesting as a constant dull ache, which can be aggravated by standing. In some patients, it can also be related to painful intercourse and painful periods. Women with pelvic congestion syndrome can have a larger uterus and a thicker endometrium. Around half of women with this syndrome manifest cystic changes to the ovaries and many report other symptoms; for example, back pain, vaginal discharge, abdominal bloating, mood swings or depression and fatigue.
Pelvic congestion syndrome is more common in women after multiple pregnancies when the venous valves have been affected rendering the relevant veins incompetent giving ‘backflow’ into the pelvis. Up to 15% of all women have varicose veins in the pelvic area but most do not suffer symptoms.
Diagnosis of true pelvic congestion syndrome can be difficult and most often is made once other possible causes for the symptoms have been ruled out. Imaging is very helpful to assist in diagnosis – dilated pelvic veins might be seen on ultrasound or MRI studies. If so, a CT scan is usually done to understand all the veins involved and be able to plan possible treatment.
Treatment for Pelvic Congestion Syndrome:
Embolisation can be used as a minimally invasive treatment for pelvic congestion syndrome. It is usually sensible to ensure you have seen a Gynaecologist to ensure the diagnosis and have an opportunity to discuss surgical treatments too.
If embolisation is right for you, it is performed as a day case procedure under local anaesthetic and x-ray guidance. A tiny needle puncture is made into a vein in the groin and angiography is performed by injecting dye to show the veins involved and provide a ‘road map’. The problematic veins are blocked off by placing metallic coils under x-ray guidance. This should encourage blood flow through more healthy veins and decompress the varicose veins in the pelvis thereby treating the symptoms.
The whole procedure only takes about 30-60 minutes followed by an hour or two of bed rest. Due to the minimally invasive nature of the treatment, patients can get back to normal activities the next day and should notice a prompt improvement in symptoms. Patients with more extensive or complex venous problems may need more than one treatment to deal with the underlying issue.