Pelvic Congestion Syndrome

What is Pelvic Congestion Syndrome?

The Pelvic Congestion Syndrome is the condition where there is a chronic or a long-lasting pain in the lowest part or area of the torso which is the pelvis or the pelvic bone.

This is usually due to the accumulation or obstruction of the blood circulation in the veins of the pelvis. It is usually noted to have a wider vein and have become tortuous. The veins are dilated which causes the blood overflow and adding too much pressure on the pelvic area. ^[2][3][4]

Anatomy of Pelvis

The pelvic area is located in the torso part of the body. It is comprised by the different organs and systems. The body system that are usually found in this area are the Urinary system, Lower Digestive system and the Reproductive system.

The pelvis is the bone found supporting the lower part of the body. It also caters and protects the organs from the different body systems. It the bone carries the half of an individual’s body weight. It is also connects the limbs and bones on the most lower part of the body.

The pelvis is also surrounded by muscles, arteries and veins that connects and makes the lower part of the body well supported and provided with proper circulation and supply of blood.

What are the causes for having Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome can be caused by various contributing factors and alterations on the anatomy and physiology  such as: ^[2][4][5]

• Abnormality on the veins such as dilatation (widening) or obstruction (constriction)
  • Retroaortic Left Renal Veins
  • Retroaortic Right Renal Veins
• 
• Multiparous where the women had two ⁽²⁾ or more pregnancies.
• Increase or abnormal levels of hormones.
• Deep vein thrombosis or the fullness of the leg veins.
• Polycystic ovaries.
• Hormonal imbalances and dysfunction.
• Compression and pressure of the Left Renal Veins.

Who is at risk for developing?

Women and men who have an abnormality on the anatomical structure and physiological function of the pelvic area can be candidates for acquiring a  Pelvic Congestion Syndrome (PCS). ^[1][2]

• Having more than two pregnancies
• Hormonal imbalances and sudden increasing levels
• Deep vein thrombosis or the fullness of leg veins
• Polycystic ovaries

Signs & symptoms

The patients with Pelvic Congestion Syndrome may manifest the following signs and symptoms: ^[2][3]

• Chronic or long-lasting pain noted at the pelvic area.
• Sharp to throbbing pain on the torso area.
• Low back pain.
• Abnormal vaginal bleeding.
• Fatigue or getting tired easily.
• Body malaise.
• Painful sexual intercourse.
• Irritable bladder
• Varicose veins on vulva, buttocks or thigh.

Complications

Pelvic Congestion Syndrome can really be painful and can cause too much stress not only to the individual but also to the other parts of the pelvic area.

• Abnormal levels of the hormones.
• Possible fractures
• Vein congestions
• Affected circulation
• Dislocation of other parts of the bones and the pelvic bone
• Severe pain on the pelvic area

Diagnosis

Pelvic Congestion Syndrome can be easily detected by the different diagnostic exams to avoid complications and easy management of the said medical condition. The patient needs to undergo series of tests for early detection and early prevention and management. The following diagnostic examinations are to be done or prescribed by the medical practitioners. ^[4][5]

• Ultrasonography – An image is provided to assess the pelvic bone area to see if there is a possible occurrence of fracture and where the congestion is likely to be located.
  • Pelvic ultrasound: One of the most accurate is where the patient is in a standing position and the ultrasound is placed on the pelvic area where the scanning is done and to see if where is the exact anatomical part has been damaged or have an impending congestion.
  • Transvaginal ultrasound: ultrasound is placed via the vaginal area to see the exact location or to confirm the congestion in the pelvic area of the patient. The position of the individual is likely to be placed in a standing position for easy access and exclusion of the medical problems.
• Magnetic Resonance Imaging (MRI) – The increase in the congested area is being manifested in the images provided in the MRI machine. It is likely to show the diameter of the pelvic area and the ovaries that are affected.
• CT scan – The procedure shows images which provides a contrasted and dilated pelvic and ovarian veins. The positioning of the patient during this procedure must be given extra caution for the supine position during scanning may underestimate the size of venous dilatation which can affect the overall result of the said examination.

• MR Venography – Same with the MRI, the venography shows the location of the congested part in the pelvic area.

Treatment

If the patient is confirmed and was diagnosed, he/she needs to take extra careful in managing the said condition. An individual who suffers from Pelvic Congestion Syndrome can take the following treatments and apply the management. ^[2][3]

Medications

• Psychotherapy drugs – The patient is aided with anti-anxiety when the patient is suffering from severe pain that can also aggravate the condition.
• Hormonal medications
  • Progestins
  • Danazol
  • Gonadotropins receptor agonists (GnRH) with hormone replacement therapy (HRT)
  • Medroxyprogesterone acetate (MPA)
  • Goserelin acetate
• Phlebotonics – This medication prevents the occurrences vein congestion. This is also a blood thinning medicatoin.
• Nonsteroidal antiinflammatory drugs (NSAIDS)
• Dihydroergotamine

Surgical Procedures

• Vein Embolization: This procedure is done by having a small incision on the pelvic area. A thin, flexible catheter will be inserted and will pass through the incision into a vein and thread it to the varicose veins.
• Sclerotherapy: Like the vein embolization the medical practitioner or surgeon will have to insert a catheter and inject a solution through it and into the varicose veins. The solution blocks the veins.
• Laparoscopic – This procedure is done to ligate the ovarian area and the fallopian tubes to avoid any possible complications and alterations of the level of the hormones in the body.

References:

1. https://www.msdmanuals.com/home/women’s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/pelvic-congestion-syndrome
2. http://www.sirweb.org/patients/chronic-pelvic-pain/
3. https://www.msdmanuals.com/home/women’s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/pelvic-congestion-syndrome
4. http://www.hopkinsmedicine.org/interventional-radiology/conditions/pelvic/
5. http://radiopaedia.org/articles/pelvic-congestion-syndrome-2