Pelvic Congestion Syndrome

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Pelvic Congestion Syndrome

What is pelvic congestion syndrome?

Pelvic congestion syndrome is a condition that causes chronic pelvic pain.  It is due to the congestion (or abnormal enlargement) of the veins in the pelvis (the lower abdomen).

Veins are the blood vessels which take blood back to the heart.  In some women, the veins in the pelvis are not working properly and they enlarge and become tortuous like varicose veins.  This can lead to chronic pain and fullness in the pelvis as well as other symptoms.

It happens mostly in women of childbearing age and is more common in women who have given birth multiple times.

What causes pelvic congestion syndrome?

Medical providers are trying to understand what causes pelvic congestion syndrome.  Enlarged veins in the pelvis seem to play a major role.  However, enlarged veins may be present without symptoms.   Pregnancy results in enlargement of pelvic veins, and sometimes they do not return to normal size after delivery.

Hormones may play a role.  One of the effects of estrogen is to cause veins to dilate.  This may be why the condition is not as common after menopause.

Who is at risk for pelvic congestion syndrome?

Women who have given birth to more than one child are at increased risk.  You may also be at increased risk if other members of your family have pelvic congestion syndrome.

What are the symptom of pelvic congestion syndrome?

The main symptom is pelvic pain that lasts for at least 6 months.  The pain often first starts during or after pregnancy.  It is usually described as a heavy, or achy feeling.  The pain may be sharp.  It is usually on one side or the other (left side more common) but may be on both sides.  At times is may be worse at the end of the day, or after long periods of standing.  Other symptoms may include pain while going to the bathroom, or pain with intercourse.  Sometimes pain is worse before or after your period.  Some women will also have enlarged veins in the buttocks, external genitalia (vulva region), or inner thighs.

How is pelvic congestion syndrome diagnosed?

Pelvic congestion syndrome is not easy to diagnose.  Pelvic pain is common, and there are many possible causes related to the uterus and ovaries, urinary bladder, and bowel issues.  Mental health issues such as depression are also known to be linked to pelvic pain.  Your healthcare provider will need to consider many possible causes.

Your healthcare provider or OB/GYN may diagnose the condition.  You will need a thorough history and physical, and many tests may be required.

Imaging findings of pelvic congestion syndrome may be detected on ultrasound of the pelvis, CT or MRI of the abdomen or pelvic, or during a special X-ray exam called a venogram.

How is pelvic congestion syndrome treated?

Initial treatment options may include medications such progestin hormones which may relieve pain.  Gonadotropin-releasing hormone drugs can block ovarian function and may relieve pain.  Surgery can also be performed to remove the abnormally enlarged veins.  Sometimes this is done when the ovaries or uterus are removed.

A minimally invasive treatment option includes performing a venogram and embolizing (which means blocking off) the abnormal veins.

What is embolization for pelvic congestion syndrome?

This is an outpatient procedure, in which an Interventional Radiologist inserts a small tube (a catheter) into the veins, and using X-ray, guides it to the abnormal veins.  The abnormal veins are then embolized (shut down from the inside).  No incisions or stitches are required.  Patients are mildly sedated for this procedure and discharged home the same day.  Patients typically return to work and light activities the next day, and to full activity in a week.

How can I seek further evaluation?

If you think you may have pelvic congestion syndrome, contact the RCI Vein and Interventional Clinic for further evaluation by one of our Interventional Radiologists.  You do not need a referral for this evaluation.

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RCI is accredited by the American College of Radiology (ACR).

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RCI Imaging Center
1948 First Avenue NE
Cedar Rapids, IA 52402
Hours: Monday – Friday,
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Phone: 319-364-0121
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Vein & Interventional Clinic
1948 First Avenue NE
Cedar Rapids, IA 52402
Hours: Monday – Friday,
8 a.m. – 5 p.m.
Phone: 319-261-0636
Toll Free: 800-747-0121
Fax: 319-364-5684

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Cedar Rapids, IA 52402
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Radiology Consultants of Iowa
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Cedar Rapids, IA 52406