Pelvic Congestion Syndrome (PCS) is essentially varicose veins in the pelvis. It is the cause of chronic pelvic pain in approximately 13-40% of women and are more common in females who have given birth.  It may also be referred to as ‘ovarian vein reflux’.

Varicose veins are simply enlarged or swollen (‘dilated’) sections of veins.  Varicose veins are thought to be caused by the walls of the veins becoming weak in certain sections.  These sections then widen.  If this happens near a valve, then the valve may become leaky and blood may flow backwards, causing blood to collect or pool in the vein.  Pooling of blood in the vein stretches the vein and causes it to become swollen.

You may be more familiar with varicose veins in the legs, commonly seen under the skin as bulging, knotty veins.

…but you can also get varicose veins in the pelvis!  

They tend to affect the veins of the ovaries, hence the term, ‘ovarian vein reflux’.

The symptoms of PCS are due to swelling of these pelvic veins and because blood is flowing in the wrong direction (i.e. backwards). The varicose veins surround the ovary and can also push on nearby structures such as the bladder and rectum. 

This can cause the following symptoms:

 • Pelvic pain or aching around the pelvis and lower abdomen 

Pain is often the most common symptom and is usually on one side but can affect both sides.

Pain is typically worse at the end of the day after sitting or standing for a long time and is relieved by lying down. The pain is also worse during pregnancy, and during or after sexual intercourse.  The veins are also affected by the menstrual cycle/hormones and therefore pain can increase during the time of menstruation.

Other symptoms include:

  • A dragging sensation in the pelvis 
  • Feeling of fullness in the legs 
  • Worsening of urinary stress incontinence
  • Worsening in the symptoms of irritable bowel syndrome 
  • Sometimes, abnormal uterine bleeding

How is PCS diagnosed?

Diagnosis of pelvic congestion syndrome requires that pain be present for more than 6 months.  Detailed questions about your symptoms are key to making a diagnosis.  Examination can also help to support the diagnosis.  If your symptoms are consistent with the diagnosis, then confirmatory testing is usually required.  This most often would involve tests such as venous duplex ultrasound, MRI (MR venography), CT scan (CT venography), and catheter-based injection venography or a combination of these.

Venous Duplex Ultrasound scanning: 

Venous Duplex Ultrasound Scanning uses a technique called Doppler ultrasound to evaluate blood circulation in veins. A device called a transducer passed lightly across the body, directs high frequency sound waves (ultrasound) at superficial and deep veins. The sound waves are reflected back at frequencies that correspond to the speed of blood flow and are converted into sounds and graphic recordings. Duplex scanning combines Doppler ultrasound with real-time ultrasound imaging of the veins. Images are displayed on a viewing monitor and may also be recorded for later examination.

It is this ability of the Duplex Ultrasound scan to see the flow of blood in real time that makes it such an incredibly powerful technique not just for investigation but also in helping to guide management.

For more information on PCS visit the link below:

https://thewhiteleyclinic.co.uk/wp-content/uploads/The-Impact-of-Pelvic-Congestion-Syndrome-Report.pdf

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