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A sneaky condition that causes many unexplained symptoms

Associate Professor of Vascular Surgery, Universitatsklinkikum Munster

Pelvic congestion syndrome (PCS) is a condition that mainly affects women (in men, the corresponding condition is called varicocele) and can significantly affect their quality of life. However, it is often not well known to the general public, even though its effects can be serious. Let’s see what exactly this syndrome is, what are its symptoms, causes and treatment methods.

What is Pelvic Congestion Syndrome?

PVC is a condition in which the veins in the pelvic area (i.e., in the lower abdomen and around the uterus, ovaries, and bladder) become dilated and remain swollen. These dilated veins are called varicose veins and can cause severe pain, especially during menstruation or after prolonged standing or physical exertion.

The pelvic area contains many vital organs, and when blood does not circulate properly, a variety of symptoms can occur. It is important to understand that this condition is chronic and can progress over time if not treated properly.

What are the symptoms of Pelvic Congestion Syndrome?

The main symptom of the syndrome is pain. This pain may be described by women as “heavy,” “annoying,” or “throbbing,” and is usually located in the lower abdomen. It may worsen during menstruation, after prolonged standing, or even after sexual intercourse.

Other symptoms may include:

• Discomfort or pain in the lower back.
• Feeling of swelling or heaviness in the pelvic area.
• Frequent urination or difficulty urinating.
• Pain in the legs due to pressure from dilated veins.

This pain is not constant and may come and go. Often, women with PCOS may complain that this discomfort limits them from doing daily activities or living a normal life.

There are also some opinions that similar to varicocele in men, which affects sperm quality, pelvic congestion syndrome can affect egg quality, with associated infertility due to increased temperature in the ovarian area.

What causes pelvic congestion syndrome (PCS)?

The exact cause of PCS is not fully understood, but scientists believe that it results from the inadequate functioning of the valves in the veins of the pelvic area. These valves normally prevent blood from flowing backward, but when they do not function properly, blood pools, causing the veins to swell.

Pregnancy also plays a significant role in the development of PCS, as during pregnancy, blood flow to the pelvic area increases. This can lead to excessive distension of the veins, which may not fully resolve after childbirth.

Which women are at risk?

PSS occurs mainly in women of reproductive age. In particular, women who have given birth many times or those with a long history of varicose veins in the legs may be more susceptible. However, the condition can also occur in women who have not had children. According to a recent study by our clinic, the prevalence of PSS in patients with venous insufficiency was 10%. In addition, a family predisposition to venous insufficiency and obesity can increase the risk of developing PSS.

How is the diagnosis made?

The diagnosis of PSS is difficult, because the symptoms can be confused with other gynecological or urological conditions. Usually, doctors perform a transvaginal triplex, magnetic resonance imaging (MRI) or venography to determine the presence of dilated veins. The combination of these tests helps to accurately diagnose and rule out other conditions, such as ovarian cysts or endometriosis. In the same study at our clinic, the sensitivity of transvaginal triplex to detect PsA was 99%.

How can it be treated?

Treatment of PsA depends on the severity of the symptoms. In mild cases, lifestyle changes may be recommended, such as weight loss, improved diet, and regular exercise. Wearing compression stockings may also help.

In more severe cases, medication may be needed, while in some cases embolization, a procedure in which a small wire or coil is inserted into a vein to block blood flow to the enlarged veins, is performed.

When should you see a doctor?

If you experience persistent pain in your pelvic area, especially if it is accompanied by other symptoms, such as bloating, difficulty urinating or severe pain after standing, it is important to see a specialist. A vascular surgeon in collaboration with your gynecologist can guide you properly and help you find the right solution. Pelvic congestion syndrome is a common, but overlooked condition that can significantly affect a woman’s life. Correct diagnosis and appropriate treatment are vital to its treatment. If you have any symptom that worries you, do not hesitate to seek help from your doctor. Early diagnosis can make a difference and improve your quality of life.