Pelvic Congestion Syndrome
Pelvic Congestion Syndrome (PCS) is a condition causing a variety of symptoms which are due to leaking or refluxing veins in the pelvic region.
PCS mostly affects women and common symptoms include aching in the lower abdomen, which can radiate into the loin area and down the legs especially during menstruation. These women will often complain of pain during intercourse. Symptoms are often worse at the end of the day, after prolonged standing or just prior to the start of the menstrual cycle. Pregnancy tends to aggravate symptoms in women who have PCS.
A common source of pelvic reflux are the ovarian veins, particularly on the left side.
Men with testicular varicoceles are sometimes found to have underlying venous reflux in pelvic veins.
PCS can also lead to complex patterns of varicose veins in the legs and are a frequent cause of patients presenting with recurring varicose veins in the legs following previous treatment with surgery or other types of intervention.
The diagnosis of PCS is usually based on the patient’s history and then confirmed by a pelvic ultrasound scan. Unfortunately, pelvic scans are not foolproof when trying to detect the presence of refluxing veins in the pelvis. Some studies indicate that the diagnosis can be missed in up to 50% of cases – “low sensitivity”. However, if the pelvic scan does indicate pelvic reflux is present then the diagnosis is almost always correct – “high specificity”.
The “Gold standard” investigation is a venogram. This is an interventional radiology procedure which involves the insertion of a special catheter (neck, arm, groin) which is fed down inside the vein into the pelvic region so that dye can be injected. With the use of an image intensifier the movement of the dye through the pelvic veins can be tracked dynamically in real time on the screen monitor.
Treatment is aimed at occluding the leaking veins with insertion of coils or sclerosant and this can be undertaken at the same time if the investigation confirms the presence of pelvic reflux.