Venous Disease

Pelvic Congestion Syndrome

Pelvic congestion syndrome is also known as pelvic venous insufficiency. It is one of the causes of chronic pelvic pain in women. The characteristic feature of pelvic pain associated with PCS is worsening of the pain on sitting or standing and a sense of relief on lying down. The patient may also experience pain during urination or during/after sexual activity.

The incidence of this disease is more common in women between the age of 20 to 45 years and those with multiple pregnancies. The hormonal changes and weight gain along with anatomic changes in the pelvic structure during pregnancy weakens the walls of the ovarian veins causing them to enlarge. Oestrogen is also known to weaken the walls of the ovarian veins. The dilation of these veins causes the valves to dysfunction leading to backward flow of blood that pools within the pelvis. This further leads to pelvic varicose veins and causes symptoms of heaviness and pain in the pelvic region.

Diagnosis

PCS is usually missed during diagnosis of chronic pelvic pain as women are usually made to lie down for a pelvis exam. This relieves the pressure over the ovarian veins and hence not detected during the test.

Pelvic venography is the most accurate method for diagnosis of PCS. In this, X-rays are used to visualise the varicose veins, after a contrast dye is injected into the veins of the pelvic region. The patient is made to lie on a tilting X-ray table during the test. Pelvic ultrasound and transvaginal ultrasound may also be performed to exclude other causes of chronic pelvic pain.

Treatment

Ovarian vein embolisation is a minimally invasive non-surgical procedure that is performed to treat PCS. It has a high success rate and is a relatively safe procedure.

 It involves the closure of the faulty ovarian vein by directly injecting sclerosing agent into it through a catheter. The catheter is directed into the vein under X-ray guidance. All the abnormal ovarian veins are embolised. This blocks the flow of blood in these ovarian veins and subsequently, pooling of blood in the pelvic veins is prevented. It is usually performed as an outpatient procedure and the patient can go home on the same day, after a few hours of observation. The patient can resume normal activities within a few days after the procedure.