What is Pelvic Congestion Syndrome (PCS)? Symptoms, Causes, Diagnosis and Treatment Methods

Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is a condition characterized by the dilation and loss of function of veins, which is seen especially in women of reproductive age and often leads to unexplained pelvic pain. Simply put, as a result of the veins in the pelvic region not being able to drain blood effectively, the vessels dilate, pressure increases, and this causes pain. Just like varicose veins in the legs, this involves venous insufficiency developing in the internal region, specifically around the uterus and ovaries.

What is Pelvic Congestion Syndrome?

Pelvic congestion syndrome (PCS) is a vascular disease that occurs due to the dilation of veins located in the pelvic region and the pooling of blood within these vessels, often causing chronic pelvic pain. It is possible to define this condition in its simplest form as the equivalent of varicose veins seen in the legs, but occurring around the uterus, ovaries, and surrounding internal organs. Under normal conditions, the valves within the veins ensure the one-way flow of blood toward the heart. However, in PCS, these valves lose their function; blood struggles to flow upward against gravity and accumulates within the vessel. This accumulation causes the vessel to dilate, exert pressure on surrounding tissues, and leads to the onset of pain.

What Are the Symptoms of Pelvic Congestion Syndrome?

The most fundamental symptom of pelvic congestion syndrome is a dull, aching pain felt in the pelvic region that gradually increases throughout the day. This pain is usually concentrated in the lower hip area, the groin, sometimes in the lower back, or around the vagina. The intensity of the pain increases significantly when standing for long periods, spending long times sitting, or during the premenstrual period. While the pain is sometimes just a feeling of pressure, in some patients, it can become a throbbing and widespread sensation of discomfort.

Feeling pain during or after sexual intercourse, known as dyspareunia, is a very common finding in pelvic congestion syndrome, and this condition can seriously affect women's quality of life. Additionally, some patients may experience a feeling of pressure on the bladder or rectum (the final part of the large intestine); this can be confused with complaints such as frequent urination, burning during urination, or constipation. Since the symptoms of PCS often resemble those of different gynecological or gastrointestinal diseases, the diagnostic process can take time for this reason.

What Causes Pelvic Congestion Syndrome?

The most fundamental cause of pelvic congestion syndrome is the dilation of veins in the pelvic region and the inability of the blood within these vessels to be transported back to the heart in a healthy manner. Causes of pelvic congestion syndrome include pelvic venous insufficiency, hormonal influences, and vascular dilations that develop after childbirth. The valves in the veins normally prevent the backflow of blood. However, when these valves lose their function, blood pools downward and the vessel walls begin to dilate over time. These dilated and slackened vessels cause pain by pressing on surrounding tissues. The incidence of PCS is higher in women who have given birth multiple times because the increased uterine volume and hormone levels during pregnancy can cause permanent changes in the vessels.

Progesterone hormone, in particular, prepares the ground for this dilation by relaxing the vessel walls. Furthermore, genetic predisposition plays an important role; women with a family history of varicose veins or venous insufficiency have a higher risk of developing pelvic congestion syndrome. Additionally, the likelihood of developing PCS increases in individuals who stand for long periods due to their profession, those who suffer from chronic constipation, or those with hormonal disorders. In other words, this syndrome does not arise due to a single cause, but through the combination of hormonal and mechanical effects along with deterioration in the vascular structure. Both pelvic congestion and Nutcracker syndrome are circulatory disorders caused by venous compression and can lead to pelvic pain.

How is Pelvic Congestion Syndrome Diagnosed?

The diagnosis of pelvic congestion syndrome is often not easily made because the symptoms resemble many other pelvic conditions. For this reason, the diagnostic process is based on a method of exclusion carried out with patience. In the first step, a detailed history of the patient is taken; the type, location, and duration of the pain, and the situations in which it intensifies are carefully evaluated. Subsequently, a gynecological examination is performed, but this examination often does not provide specific findings. If the physician suspects the condition, imaging methods are utilized. Color Doppler ultrasound is used to evaluate the diameter and blood flow of the vessels around the uterus and ovaries. However, this method may not provide sufficient information in some patients.

For a more detailed examination, pelvic MRI (magnetic resonance imaging) or computed tomography (CT) venography can be performed. With these techniques, dilated vessels and their locations can be seen more clearly. The most definitive diagnosis is usually made with pelvic venography. In this interventional procedure, access is gained through the groin area, contrast material is injected into the vein, and the structure of the vessels is imaged in detail. This procedure is important both for making a diagnosis and for planning for a potential future embolization procedure. The more meticulously the diagnostic process is conducted, the more successful the treatment will be.

How is Pelvic Congestion Syndrome Treated?

The treatment of pelvic congestion syndrome is tailored to the individual based on the patient's age, the severity of symptoms, and life plans. In the first stage, medical treatment is usually considered; specifically, the use of hormone-regulating drugs is attempted to reduce the dilation of the vessels. These treatments generally aim to suppress estrogen, as this hormone has a relaxing effect on vessel walls. However, drug therapy may not always provide sufficient results and may only provide temporary relief.

Pelvic congestion syndrome surgery is usually performed via surgical or endovascular interventions aimed at eliminating venous obstructions or closing dilated vessels. Today, the most effective and widely applied method is pelvic vein embolization performed via interventional radiology. In this procedure, dilated and dysfunctional vessels are deactivated by being blocked from the inside. Access is usually gained through the groin or neck vein, the problematic vessel is reached, and the interior of the vessel is closed using small metallic coils or special adhesives. This procedure does not require general anesthesia, and the patient can often be discharged on the same day. Following the embolization procedure, a significant reduction in pain is achieved in the majority of patients, and their quality of life increases rapidly.

Surgical treatment is rarely necessary. Surgical methods may be resorted to, especially in cases where embolization is ineffective or where there are very complex vascular disorders. With these surgical procedures, dilated vessels can be removed or ligated. However, today, minimally invasive interventions are preferred over surgery, and highly successful results are obtained. The success of the treatment depends as much on the accuracy of the diagnosis as it does on the patient being open and cooperative with their physician throughout the process. Since every woman's vascular structure and complaints are different, the treatment process should not be standard but handled with a personalized approach.

Frequently Asked Questions

PCS is most commonly seen in women between the ages of 20 and 45, especially in individuals who have given birth several times. Those who work standing for long periods, those experiencing chronic constipation, or those with hormonal imbalance problems are also in the risk group. Genetic predisposition should be considered in individuals with a family history of varicose vein disease. Pelvic congestion syndrome is very rarely seen in male individuals because this syndrome is usually associated with the dilation of pelvic venous structures in women. If there is pain that is generally felt in the pelvic region, increases at the end of the day, and can radiate to the legs, PCS may be suspected. However, PCS is considered only after other possible causes of pain have been excluded. Pain after sexual intercourse and a feeling of pelvic pressure that worsens during the menstrual period are also important clues. Pain related to PCS can usually radiate to the groin, lower back, and tailbone. Sometimes it can also radiate to the inner thighs or the genital area. This pain is described by some women as a constant feeling of discomfort that almost never goes away during the day. PCS is not a condition that directly prevents fertility, but it can negatively affect the quality of life due to the increased level of pain. As the uterus grows during pregnancy, the pressure on the vessels increases, which can exacerbate symptoms. It is recommended to be treated before becoming pregnant. In most cases, PCS does not resolve on its own. On the contrary, complaints may increase over time. For this reason, it is of great importance to consult a specialist without delay. If left untreated, chronic pelvic pain can become permanent. Color Doppler ultrasound is the first-line test. The diameter of the vessels and blood flow are evaluated. For a more detailed examination, MRI or CT venography can be performed. The definitive diagnosis is usually made with pelvic venography. If PCS is suspected, one should first consult a specialist in Obstetrics and Gynecology (gynecology). During the diagnostic process, interventional radiology or vascular surgery departments may also be involved in the process if necessary. A multidisciplinary approach may be required. After the embolization procedure, a significant reduction in symptoms is achieved in the vast majority of patients, and this effect can be long-lasting. However, the permanence of the treatment depends on the patient's vascular structure and lifestyle. Hormonal fluctuations or new pregnancies can be effective. PCS can recur in some cases. Especially after a new pregnancy or if re-dilation occurs in the pelvic vessels after treatment, symptoms may return. For this reason, regular follow-up is important. In most cases, treatment is possible without the need for surgical intervention. However, in some special cases, for example, in cases where embolization is insufficient or where the vascular structure requires surgical correction, an operation may be considered. This decision is made by taking the patient's individual situation into account.

If you are experiencing persistent pain, a feeling of pressure, or discomfort in the pelvic region for which no cause can be found, consult a specialist without delay. Our experienced physicians at Hisar Hospital Department of Obstetrics and Gynecology offer modern diagnostic and treatment options for pelvic congestion syndrome. Contact us immediately to schedule an appointment or to get more information.