Pelvic Congestion Syndrome

Pelvic Congestion Syndrome (PCS), also known as pelvic venous insufficiency, is a chronic condition characterized by persistent pelvic pain resulting from abnormal blood flow in the pelvic veins. The pain typically lasts for more than six months and is not related to menstruation or pregnancy.

PCS occurs when the veins in the pelvis, particularly those surrounding the ovaries become enlarged and incompetent, allowing blood to flow backward (a condition known as venous reflux). This backward flow causes the veins to stretch and become engorged, leading to pain and pressure in the pelvic region. While the exact cause remains uncertain, hormonal factors, especially estrogen and vascular changes during pregnancy are believed to contribute to the development of PCS.

Common symptoms of Pelvic Congestion Syndrome

Pelvic pain associated with PCS often presents as a dull, aching, or heavy sensation that may worsen over time. Some individuals experience sharp or stabbing discomfort. Pain is most frequently felt on the left side but can affect both sides. Symptoms commonly intensify:

Towards the end of the day

Before or during menstruation

During or after sexual intercourse (dyspareunia)

After prolonged standing or sitting (often relieved by lying down)

Additional symptoms may include:

  • Visible varicose veins in the pelvis, vulva, buttocks, or upper thighs
  • Gastrointestinal disturbances such as alternating constipation and diarrhea
  • Urinary symptoms, including urgency or pain while urinating
  • Stress urinary incontinence (leakage during coughing, laughing, etc.)

Causes

In healthy pelvic veins, one-way valves help blood flow back toward the heart. In PCS, these valves become dysfunctional or the veins become excessively dilated, allowing blood to pool in the pelvis. This venous hypertension can lead to the stretching of vein walls and irritation of nearby nerves, causing chronic pain.

Potential contributing factors include:

  • Pregnancy-related vascular changes: During pregnancy, blood volume increases significantly. The expansion of pelvic veins to accommodate this increased flow may cause long-term weakening or damage to the vessel walls.
  • Hormonal influences: The condition is more common in individuals of reproductive age and rare after menopause, suggesting a link between estrogen levels and vein dilation.

PCS is likely the result of a combination of anatomical and hormonal influences.

Diagnosis

Diagnosing PCS can be complex, as many individuals without symptoms may still have dilated pelvic veins. The diagnosis is usually made after other causes of chronic pelvic pain have been ruled out.

Evaluation typically involves:

  • Medical history and physical examination, including a pelvic exam to identify tenderness or engorged veins

Imaging studies, such as:

  • Ultrasound (with Doppler): A first-line, non-invasive test that can reveal dilated pelvic veins and assess for venous reflux
  • CT or MRI scans: Provide detailed views of pelvic anatomy and help rule out other causes of pain
  • Pelvic venography (gold standard): Involves injecting contrast dye via a catheter to visualize venous flow and confirm the presence of reflux and vein dilation
  • Laparoscopy: Sometimes used to exclude other conditions such as endometriosis or ovarian cysts, though it is less effective in detecting venous abnormalities

Treatment Options

PCS management often begins with conservative, non-surgical treatments. If these are ineffective, image-guided or surgical procedures may be considered.

Medications that lower estrogen levels can reduce symptoms by decreasing vein dilation. When symptoms persist despite medical therapy, the following procedures may be recommended:

Ovarian Vein Embolization (OVE): A catheter-based procedure where small coils, foam, or medical glue are used to seal off incompetent veins, stopping reflux and reducing venous pressure.

Iliac Vein Stenting: For patients with pelvic vein compression (e.g., May-Thurner syndrome), a stent can be placed in the narrowed iliac vein to restore normal outflow and relieve pressure.

Surgical removal of pelvic organs (hysterectomy with bilateral salpingo-oophorectomy) is rarely indicated and typically reserved for individuals who have completed childbearing and do not respond to less invasive treatments.

Why Choose Minimally Invasive Therapies Over Other Treatments?

When treating pelvic congestion syndrome, combining iliac vein stenting with ovarian vein embolization can offer a comprehensive solution especially when both vein blockage and abnormal reflux are present.

Iliac Vein Stenting Benefits:

  • Restores normal blood flow by opening narrowed or compressed pelvic veins.
  • Reduces pelvic pressure and swelling, which often cause chronic pain or heaviness.
  • Improves circulation from the legs and pelvis, relieving symptoms like bloating, aching, or leg fatigue.
  • Minimally invasive, typically performed through a small catheter with no large incision.
  • Quick recovery, with most patients returning to normal activities within a few days.

Ovarian Vein Embolization Benefits:

  • Closes off faulty veins that are leaking blood backward (venous reflux).
  • Relieves pelvic pain, especially that which worsens after standing, during periods, or after intercourse.
  • Targets the root cause of PCS, not just the symptoms.
  • Low-risk and outpatient, usually done under local anesthesia with light sedation.

How Does Pelvic Congestion Syndrome Treatment Work At Rivea?

How Iliac Vein Stenting Works

  • A small, flexible tube (catheter) is inserted into a vein, usually in the groin.
  • Using live imaging, the doctor guides the catheter to the compressed or narrowed iliac vein.
  • A tiny metal mesh tube (stent) is placed inside the vein to hold it open.
  • This restores proper blood flow and reduces pressure in the pelvic veins.

How Ovarian Vein Embolization Works

  • A catheter is guided into the enlarged or leaking ovarian vein.
  • Small coils or a special medical solution is released to block the faulty vein.
  • This stops abnormal backward blood flow (reflux), relieving pressure and congestion.
  • Blood is naturally rerouted through healthy veins.

Why Choose Rivea?

At RIVEA, pelvic congestion syndrome (PCS) is treated with both interventional radiology (IR) and vascular surgery approaches, depending on each patient’s specific condition.

Our IR team is led by Dr. Arjun Reddy, a specialist in minimally invasive, image-guided treatments like embolization.

The vascular surgery team is headed by Dr. Karthik Mikkineni, an American Board-Certified Vascular Surgeon, offering advanced surgical and endovascular solutions when needed.

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Our Team

  • Dr. Arjun Reddy, expert in vascular and interventional radiology at RIVEA

    Dr. Arjun Reddy

    MBBS, MD, FVIR

    Dr. Arjun Reddy is a highly accomplished Interventional Radiologist with extensive international training and a track record of pioneering minimally invasive, image-guided procedures in India.

    View Profile Book an Appointment
  • Dr. Kartik Reddy – Interventional Radiologist at RIVEA Vascular Institute

    Dr. Karthik Mikkineni

    MD, FACS, FSVS, RPVI

    Dr. Karthik Mikkineni is an internationally recognized vascular and endovascular surgeon, known for his pioneering work in complex aortic interventions, limb salvage, and carotid disease management.

    View Profile Book an Appointment

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