Pelvic Congestion Syndrome

It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. This pain may be due to hard-to-detect varicose veins in the pelvis.  Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, faulty veins cause blood to flow backwards and pool in the vein causing pressure and bulging veins.  Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.

Prevalence

  • Women with pelvic congestion syndrome are typically less than 45 years old and in their child bearing years.
  • Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
  • Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
  • Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15 percent have PCS along with another pelvic pathology.

Risk Factors

  • Two or more pregnancies and hormonal increases
  • Fullness of leg veins
  • Polycystic ovaries
  • Hormonal dysfunction

Symptoms

The chronic pain that is associated with pelvic congestion syndrome is usually dull and aching.  The pain is commonly felt in the lower abdomen and lower back.  It typically worsens with standing or exercise and is more severe at the end of the day.

Other symptoms may include irritable bladder, abnormal menstrual bleeding, pain during intercourse, vaginal discharge, or varicose veins on the external genitalia, buttocks or lower extremities.

Diagnosis

Pelvic varicosities may be seen on pelvic ultrasound (usually with a transvaginal probe) and/or laparoscopy.  Magnetic Resonance Imaging (MRI) may be used to provide additional information.  Pelvic venography is  thought to be the most accurate method for diagnosis.  The exam is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, interventional radiologists examine patients on an incline, because the veins decrease in size when a woman is lying flat.

Treatment Options

Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure,  tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) are inserted to close the vein. After treatment, patients can return to normal activities immediately.

Effectiveness of Embolization

In addition to being less expensive to surgery and much less invasive, embolization offers a safe, effective, minimally invasive treatment option that restores patients to normal. The procedure is very commonly successful in blocking the abnormal blood flow. It is successfully performed in 95-100 percent of cases. A large percentage of women have improvement in their symptoms, between 85-95 percent of women are improved after the procedure. Although women are usually improved, the veins are never normal and in some cases other pelvic veins are also affected which may require further treatment.

Treatment Locations:

The Interventional Radiologists at Association of Alexandria Radiologists, PC provide minimally invasive treatment of pelvic congestion syndrome at the following locations:

Inova Alexandria Hospital
Department of Interventional Radiology
4320 Seminary Road
Alexandria, VA 22304
Appointment Scheduling: 703.504.7950
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Inova Mount Vernon Hospital
Department of Interventional Radiology
2501 Parker’s Lane
Alexandria, VA 22306
Appointment Scheduling: 703.664.7175
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Initial consultations also offered at the following location:

Advanced Interventional Vein and Vascular Center
4001 Prince William Parkway, Suite 302
Woodbridge, VA  22193
Appointment Scheduling: (703) 824-3228
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