Varicose veins don’t just affect your legs, they can also develop in your ovarian veins and cause pelvic congestion syndrome. Pelvic congestion syndrome can cause chronic or recurring pelvic pain. Similar to what happens with varicose veins in the legs, the veins in the pelvis are unable to return blood efficiently to the heart, causing blood to pool in the pelvis and cause pelvic venous congestion.
PCS ( Pelvic Congestion Syndrome) is characterized by pelvic pain that worsens when sitting or standing for long periods, but resolves when lying down. The pain may also be worse after urination, menstrual periods, or sexual intercourse. The typical age of women with this condition ranges from 20 to 45 years and in women with multiple pregnancies.
Weight gain and anatomical changes in the pelvic structures during pregnancy can cause enlargement of the ovarian and/or pelvic veins. Hormonal changes associated with pregnancy are also known to weaken the walls of the ovarian and/or pelvic veins. PCS may go undiagnosed in many cases because the person's supine position during a pelvic examination reduces pressure on the ovarian veins and may therefore go unnoticed during the examination.
Patients who suspect they have Pelvic Congestion Syndrome (PCS) should first see a gynecologist to rule out other causes of pelvic pain. From there, the gynecologist will perform an ultrasound to visualize the varicose veins. Pelvic venography is the gold standard for diagnosis. A venogram is a procedure that involves injecting a contrast agent (a type of dye) into the veins of the pelvic organs. This makes the varicose veins visible on an x-ray, so your doctor can see if they are present. Your doctor will also examine you on an incline, since the veins shrink in size when you lie down.
Am I at Risk?
Risk factors for pelvic congestion syndrome include multiple pregnancies and varicose veins elsewhere in the body.
What is the treatment for pelvic congestion syndrome?
The Cardio Thoracic and Vascular surgery team treats pelvic congestion syndrome using minimally invasive ovarian vein embolization ( OVE ) . This is the most common and effective treatment option for pelvic vein congestion. The procedure is performed under local anesthesia. A catheter is inserted through a sheath through the femoral vein in the groin. The catheter is then manipulated and guided into the lumen of the vein to identify the incompetent vein using contrast venography. An embolic agent is then infused into the catheter and additional testing is performed to ensure all abnormal veins are embolized. This blocks blood flow in these veins and prevents blood from pooling in the pelvis. After OVE, blood cannot flow through the treated vein, requiring an alternate route. Your circulation improves, your pain goes away, and eventually, your body absorbs the affected vein.
If you have symptoms of pelvic congestion syndrome, you need to consult a team of healthcare professionals to get a correct and proper diagnosis.
Article written by dr. Muhammad Satyagraha Pradipto, Sp.BTKV (Thoracic, Cardiac and Vascular Surgery Specialist, EMC Alam Sutera Hospital).