Although the latest research suggests that 13-40% of women in the UK who have chronic pelvic pain suffer from Pelvic Congestion Syndrome (PCS), it is not unusual for these women to receive misdiagnosis, misdirected therapies or to not seek any help at all.
Here to provide some clarity on the topic is interventional radiologist, Dr David Beckett of The Whiteley Clinic, as he explains what PCS actually is and the warning signs you should look out for.
What is Pelvic Congestion Syndrome?
“As with most names in medicine, the term ‘Pelvic Congestion Syndrome’ is really just a description of the problem itself,” explains Dr Beckett.
“The 'pelvic' highlights that the condition relates to a problem in the pelvic area, ‘Congestion’ links to the fact that there is too much blood in the veins and hence the venous circulation is congested, and ‘syndrome’ points to a collection of different symptoms and signs.
“Generally, PCS is a condition that is caused by troublesome internal or ‘hidden’ varicose veins that lie within the lower abdomen and pelvis. Those suffering with the condition will often experience dull or sharp pains, for a drawn-out length of time.
“Due to differences in the anatomy of the pelvis, the condition usually affects women more than it does men. This difference is magnified by the fact that in men, varicose veins of two of the four pelvic veins can be seen on the outside as varicose veins in the scrotum - medically called varicoceles. These are usually picked up at school medicals and treated.
"Unfortunately, the same veins are hidden deep within women and so they cannot be identified without proper investigation. The condition most common in women who have experienced pregnancy, however we have seen many women with PCS who have not had previous pregnancies.”
What causes Pelvic Congestion Syndrome?
Dr Beckett explains: “PCS occurs when pelvic veins (those associated with the uterus or ovaries) become enlarged, swollen or dilated. More specifically - if the valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside dilated varicose veins within the pelvis. The dilated veins push on the sensitive structures in the pelvis, as well as lie heavily on the pelvic floor, causing the symptoms of PCS. In addition, the poor circulation of the venous blood increases the risk of inflammation in the pelvis due to phlebitis.”
What are the symptoms of PCS?
Pelvic or uterine pain that is odten described as a ‘heavy’ or ‘dull’ ache, which worsens throughout the day, especially with prolonged standing or exercise.
Other symptoms include sharp pains when changing posture, walking or lifting heavy objects. Women with PCS are also prone to pain during their period.
In some cases, women with PCS will also experience urinary symptoms such as irritable bladder, urinary urgency, urge incontinence and an increased need to urinate during the night.
“One of the commonest signs of PCS are vulval or vaginal varicose veins. Many women who develop these particularly after pregnancy, get told by their midwives or doctors that they cannot be cured and that they just need to wear tight pants. This is totally incorrect as these can now be cured permanently using our new local anaesthetic procedures.”