Pelvic Congestion Syndrome
Pelvic congestion syndrome (PCS) is a chronic condition caused by varicose veins in the pelvis. These veins develop around your ovaries in a process similar to the varicose veins that occur in the legs. These varicose veins occur due to dysfunctions of the valves that keep blood flow towards the heart. When weakened, this allows for backflow pooling of the blood in the pelvis. This pooling stretches the veins, resulting in thick, enlarged veins that can cause pain and heaviness.
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Many women suffer from chronic and sometimes debilitating pelvic pain. In fact, nearly ten to fifteen percent of referrals to gynecologists are because a woman is seeking answers to her long-term pelvic pain. For some women, PCS may be the root of their discomfort, however, some cases go undiagnosed because doctors are not familiar with the condition or do not consider it when they are trying to diagnose the cause of their pelvis pain.
Symptoms of Pelvic Congestion
Pelvis Congestion Syndrome can affect up to 15% of women who are of childbearing age, although many are unaware of the condition because they are asymptomatic. PCS usually develops during and after pregnancy, due to the increased pressure on the pelvis and hormonal changes that occur this period. As such, many women may not show symptoms until after pregnancy and then develop pelvis pain following pregnancy.
Heaviness and pelvic pain is the most common and noticeable symptom of pelvic congestion syndrome. The symptoms tend to worsen as the day goes on specially if you sit or stand for a long period of time. Pain may be most noticeable in your lower back, and can be a dull ache, or a sharp, throbbing sensation. This type of pain is most often relieved by lying down.
Other symptoms of PCS include:
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Abnormal vaginal bleeding
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Clear or watery vaginal discharge
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Abdominal bloating
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Headaches
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Fatigue
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Increased pain after intercourse or physical activity, or before or during your period
How Is PCS Treated?
If you are suffering from heaviness and chronic pelvic pain, and a pelvic examination does not show any abnormalities, your doctor may want to exclude pelvic congestion syndrome as the source of your pelvic pain. This can be diagnosed by ultrasound, CT, or MRI.
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Treating PCS or pelvic congestion syndrome may involve one or more of the following procedures:
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Ovarian Vein Embolization (OVE)– a catheter is placed directly into the engorged veins, and tiny coils or plugs are injected to block the blood flow in the vein. After the abnormal varicose veins close off, the blood reroutes itself into a healthy vein.
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Sclerotherapy – Similar to embolization, sclerotherapy involves a catheter placed in the pelvic vein. Sclerosant (a solution damages the vein walls causing them to scar down) is injected, damaging the venous walls and causing it to scar down. Once the abnormal veins scarred down, the blood reroutes itself to healthier veins.
Coils (metal plugs) used to "embolize"
the pelvis veins
Engorged pelvic veins causing PCS
What To Excpect From The Treatment?
OVE is an outpatient procedure, performed through a small skin incision (less than ¼ inch long). Using Xray guidance and a small catheter, your doctor will close off the veins so they can no longer enlarge with blood.
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Recovery
Plan to be in the recovery area for a 1-2 hours, after which you will be released. Patients can experience cramping for several days after the procedure which is typically most severe during the first 24 hours after the procedure, and improve significantly over the next several days. You will be prescribed oral pain medicine.
Most women recover completely within 1-2 weeks after the procedure, and are able to return to normal activities.
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What to expect?
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90%-95% of women report near complete or partial relief
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Overall it less expensive and less invasive than major surgery i.e. Hysterectomy