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Pelvic Congestion Syndrome

What is Pelvic Congestion Syndrome (PCS)?

PCS also known as Pelvic Venous Insufficiency, can be an unrecognized cause of chronic pelvic pain, not related only to menstrual cycle, and present for greater than six months. In 75% of women, no definite cause for their pelvic pain is found. This syndrome, first described in 1857,  is associated with dilation of the pelvic veins, specifically the ovarian veins and sometimes the internal iliac veins or it’s branches. Ligation (blockage) of the veins has been shown to reduce pain.

What causes PCS?  PCS is caused by incompetence of the valves and dilatation of the ovarian veins and other veins draining the pelvis.  Some women (6-15%) naturally have no valves or have incompetent valves. During pregnancy, ovarian blood flow increases up to 60 times, resulting in valve damage. Incompetence allows backwards flow of blood causing varicose veins in the pelvis. The varices put pressure on the structures of the pelvis leading to the symptoms.

Who gets PCS?

  • Usually women between ages 20 and 40
  • More common in women with multiple pregnancies.
  • 90% of women with unexplained chronic pelvic pain have dilated pelvic veins and venous congestion.

What are the symptoms?

  • Chronic (longstanding) abdominal or pelvic pain, sometimes back pain.
  • Usually worse after prolonged standing, after sexual intercourse, during menstruation,  fatigue, after exercising. Symptoms are often relieved by lying down.
  • May be associated with varicose veins in the thigh, legs, buttocks or vaginal area, especially if they come back after treatment.
  • Other symptoms include bladder irritation or urgency, pelvic or abdominal fullness or pressure.

What is Ovarian Vein Embolization?

  • A non-surgical minimally invasive technique preferably done after menses and before ovulation.
  • Performed by your CiCC physician at the Center. No overnight hospital stay is necessary.
  • IV sedation for comfort. No General Anesthesia required.
  • Short recovery time (most patients are back to normal within 1 week. Pain is variable 24-48 hours after the procedure, subsiding over 2-3 days)

A tiny nick is made in the skin in the neck or in the groin. Then a catheter is advanced into the abnormal vein or veins where X-ray contrast is used to show the anatomy of the abnormal vein. The vein is then blocked using either metal coils, plugs, or a special glue, all of which are delivered through this tiny catheter

What will I experience?

  • The doctor will clean and numb the skin.  During the procedure you will receive medication to control pain and make you sleepy.
  • You may feel some pressure (but not pain) as the doctor advances the catheter.
  • You may feel a warmth whenever the doctor injects the x-ray contrast to take a picture of your vessels.