What are the Symptoms of Pelvic Congestion Syndrome?

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May 5, 2021 The Vein Institute

Pelvic congestion syndrome (PCS) is chronic pain affecting women. It can be incredibly debilitating and may even lead to disability. PCS pain is frequently confused for menstrual pain, so it’s important to know the symptoms of pelvic congestion syndrome, as well as the causes and available treatment options. 

What is pelvic congestion syndrome?

PCS affects the pelvis region (lower torso) and is associated with the pooling of blood in the veins of the pelvis, which have become dilated, swollen and distorted. 

Approximately one-third of all women will suffer from chronic pelvic pain at some point in their lives. Chronic pain is defined as lasting six months or longer. In most cases, the pain is not related to a woman’s menstrual cycle but it can get worse during her period.

The pain can intensify when sitting or standing, particularly at the end of the day. It can start with a dull ache at first, developing into a sharp, throbbing pain that’s only relieved by lying down. 

Some patients may also experience pain when urinating (dysuria) or after engaging in sexual activity (dyspareunia).

Pelvic Congestion Syndrome Causes

PCS is a complex medical condition that’s thought to be caused by vaginal varicose veins as well as varicose veins in the pelvis, thighs and buttocks. Normal ovarian veins propel blood from the pelvis up toward the heart, and functioning vein valves prevent blood from flowing backwards.

When the ovarian vein valves become faulty, they dilate without closing properly. This results in a backward flow of blood (reflux), and the pooling of blood in the pelvic region. This is what leads to pelvic varicose veins and the associated chronic pain.

It should be noted that PCS tends to occur during or after pregnancy, and can become progressively worse after each child. Most women affected by PCS are between the ages of 20 and 45, with multiple previous pregnancies.

One possible explanation for the pregnancy connection is that hormonal fluctuations combined with weight gain and changes in the pelvic structure during pregnancy cause increased pressure in the pelvic region. Under the influence of estrogen, the ovarian walls weaken, becoming dilated and bent out of shape.


What puts you at risk of pelvic congestion syndrome?

  • Being a woman under 45 in her childbearing years
  • Multiple pregnancies ( 2 or more)
  • Hormonal dysfunction or excess
  • Retroverted uterus (also called “tipped”)
  • PCOS (polycystic ovaries)
  • Fullness of the leg veins
  • Vaginal varicose veins, ovarian varicose veins and pelvic varicose veins

What are the Symptoms of Pelvic Congestion Syndrome?

The symptoms of pelvic congestion syndrome can sometimes be confused with menstrual pain however one key thing to note is that symptoms of PCS generally do not develop until a woman becomes pregnant, the symptoms often then continue after the pregnancy, and the pain can be continuous – lasting for up to six months. 

  • Dull ache or pain in the pelvis or lower back: this condition may intensify when standing or sitting, particularly around the time of menstruation. The pain of PCS usually goes away after sleeping at night.
  • Irritable bowel: recurring abdominal pain, with alternating periods of diarrhea and constipation
  • Irritable bladder: with possible incidence of incontinence
  • Dyspareunia: pain or discomfort during sexual activity
  • Pelvic varicose veins: bulging veins around the vulva, vagina or thighs
  • Some women occasionally experience clear or watery vaginal discharge with pelvic pain. PCS may also cause mood swings, fatigue, headaches and abdominal bloating.

How to diagnose pelvic congestion syndrome

PCS should be diagnosed by a professional veins specialist or Phlebologist. The diagnosis normally starts with a thorough review of your medical history and physical exam. Next, your specialists will use ultrasound technology to see directly into the body to detect reflux and identify dilated pelvic veins or vaginal varicose veins. 

Diagram showing a normal vein vs a varicose vein.

Treatment Options for pelvic congestion syndrome

If you suffer from PCS, there are a number of non-surgical treatments that can permanently address the varicose veins and help you alleviate pelvic pain and discomfort:

  • Sclerotherapy – injecting a sclerosing solution directly into the affected vein to irritate the lining of the blood vessel, causing it to collapse.
  • Endovenous Laser Ablation (EVLT) – inserting a catheter that emits laser energy to close off the abnormal veins and minimise their appearance.
  • Radiofrequency Ablation (RFA) – inserting a catheter that emits radiofrequency energy to close off the blood flow and minimise the vein.

If you are thinking about any of the above treatment options, here is: What to Expect. 

Seek expert advice

The doctors at The Vein Institute specialise in varicose vein treatment. We offer patients a comprehensive treatment program to treat varicose veins, with non-surgical laser treatment techniques. The benefits of laser treatment to patients are:

  • Walk-in walk-out treatment
  • 98% success rate
  • Extremely effective
  • Can be performed at a clinic (no hospitalisation)
  • No general anaesthetic
  • Medicare rebates apply
  • No downtime or time away from work

To book a consultation and discuss our treatment program, call  1300 535 017 or make an enquiry via the Contact Us page.

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