Pelvic congestion syndrome (PCS) occurs in women whose veins in the lower abdomen become enlarged and twisted (varicose), leading to chronic pain. Similar to varicose veins in the legs, with PCS, the veins in the abdomen become dysfunctional. This causes blood to pool in the pelvic region instead of being efficiently returned to the heart. PCS can result in increased pressure within the veins and pain. PCS is associated with pregnancy and can persist after childbirth. 

Many women with PCS may experience a dull and aching pain that can vary in intensity. The pain typically worsens throughout the day, especially after standing for long periods, during or after intercourse, and just before the start of a menstrual period. Key PCS symptoms include 

• Chronic pelvic pain: a persistent, dull, and aching pain that may become sharp 
• Varicose veins: visible on the thighs, buttocks, or vaginal area 
• Post-coital pain: pain after sexual intercourse 
• Fullness or heaviness: feeling of fullness or heaviness within the pelvis 
• Irritable bladder: increased frequency or urgency to urinate 
• Dysmenorrhea: painful menstrual periods 
• Backache: usually lower back pain 

The causes of PCS are not completely understood, but several factors can increase the risk: 

• Pregnancy: Multiple or large pregnancies are a significant risk factor due to the increased strain on the pelvic veins 
• Hormonal dysfunction: Hormonal imbalances may weaken vein walls 
• Family history: A family history of varicose veins may predispose to PCS 

Talk to a Doctor 

For patients experiencing chronic pelvic pain, especially with the symptoms mentioned, it is important to have a discussion with a doctor. The doctor may recommend a comprehensive evaluation with a vascular surgeon.  

Role of Vascular Surgeon 

Vascular surgeons are equipped to assess, diagnose, and treat PCS. They work together with gynecologists to develop treatment plans tailored to patient symptoms and condition severity. 

Diagnosis 

The diagnosis of PCS typically involves:

• Pelvic ultrasound, which scans for signs of varicose veins 
• Venography, an X-ray test, for which contrast dye is injected into the veins to visualize the blood flow and check for dysfunctional valves 
• CT scan or MRI, which provides detailed images of the pelvic veins 

Treatment options range from lifestyle changes to medical and surgical interventions. Lifestyle modifications, such as weight loss and avoiding prolonged standing, may help manage symptoms. Other treatment options include:

• Pain relief medications to manage pain 
• Hormones to decrease blood flow and pressure in the veins 
• Sclerotherapy or embolization procedures to close off the affected veins 
• Surgery, which might entail removal of affected veins or hysterectomy in severe cases

It is important that patients follow-up with their doctors for monitoring and to adjust treatment as necessary.