Pelvic Congestion Syndrome Symptoms and Treatments

Pelvic congestion syndrome (PCS) is a condition that causes chronic pelvic pain in women. Chronic pelvic pain is considered pain that lasts more than six months. PCS is caused by varicose veins in the pelvis putting pressure on the pelvic organs. According to Stanford Medicine, “PCS accounts for 10-15% of referrals to gynecologists and pain clinics.” While chronic pelvic pain is the most common symptom, there are other pelvic congestion syndrome symptoms you should aware of.

What Are the Symptoms of Pelvic Congestion Syndrome?

Pelvic congestion syndrome may cause different symptoms in different individuals. However, these are the most common pelvic congestion syndrome symptoms:

1. Chronic Pelvic Pain

The most prominent pelvic congestion syndrome symptom is pelvic pain. Different women experience this pain differently. For some people, the pain first starts during or after pregnancy and gets worse with each pregnancy. However, not all women who have symptoms of PCS have been pregnant.

Some people say it is an aching and heavy feeling. Others say the pain is sharp. Or they may experience pain differently over time. Usually, the pain is present on the left side but it may be felt on both sides of the pelvis.

Pelvic pain associated with PCS can get worse throughout the day. Some women have increased pain before or during their menstrual cycles. Other things that may make the pain worse include

Walking
Standing for long periods
Changing posture
Having sex

2. Enlarged External Veins

Pelvic congestion syndrome is caused by varicose veins in the pelvic region. In some cases, these varicose veins are internal and can’t be seen outside of the body. However, some women get enlarged veins that are visible on the buttocks, thighs, or vulva (the external female genitalia).

3. Stress Incontinence

The pressure of the varicose veins in the pelvic region may cause stress urinary incontinence. This is a condition in which urine leaks out of the bladder when sudden pressure is applied to the bladder urethra. Common triggers for stress urinary incontinence include sneezing, exercise, laughing, or coughing.

4. Back & Leg Pain

Another one of the common symptoms of pelvic congestion syndrome is a feeling of fullness in the legs or pain in the lower back. Women with PCS often report that their legs feel heavy or that their pelvic pain extends down into their legs. The varicose veins mentioned before may also appear on the upper parts of the legs. Pain originating in the pelvis may also be felt in the lower back.

5. Other Symptoms

The above symptoms are the most common pelvic congestion syndrome symptoms, but some women experience other symptoms, including:

Abdominal bloating
Fatigue
Headaches
Mood swings
Abnormal vaginal bleeding
Watery vaginal discharge

How Is Pelvic Congestion Syndrome Diagnosed?

Because pelvic congestion syndrome shares symptoms with many other conditions, diagnosing PCS can take time. Your doctor will begin with a thorough medical history and physical exam. From there, several imaging studies may be used to confirm the diagnosis:

Pelvic ultrasound: A transvaginal or transabdominal ultrasound can detect enlarged veins and abnormal blood flow in the pelvis. Doppler ultrasound is particularly useful because it shows the direction and speed of blood flow.
CT scan or MRI: These imaging studies provide detailed pictures of the pelvic anatomy and can reveal dilated veins that suggest PCS.
Venogram: A venogram involves injecting contrast dye into the pelvic veins so they can be seen clearly on X-ray. This is considered one of the most definitive tests for diagnosing PCS.
Laparoscopy: In some cases, a minimally invasive surgical procedure called a laparoscopy may be performed to directly visualize varicose veins in the pelvis.

Because PCS is sometimes misdiagnosed as endometriosis, irritable bowel syndrome, or bladder conditions, it is important to work with a specialist who is familiar with venous disorders.

How Is Pelvic Congestion Syndrome Treated?

Treatment for PCS depends on how severe the symptoms are and how much they affect daily life. The goal of treatment is to reduce pain and improve quality of life.

Conservative Treatments

Mild symptoms of PCS may be treated with over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil and Motrin) or naproxen (Aleve). Prescription pain medications may also be used. Hormonal medications, such as gonadotropin-releasing hormone agonists, may help reduce symptoms by suppressing ovarian function and decreasing blood flow to the pelvic veins. Some women find relief through lifestyle changes such as avoiding prolonged standing, wearing compression garments, and elevating the legs when possible.

Pelvic Vein Embolization

The most successful treatment for pelvic congestion syndrome is a minimally invasive procedure called pelvic vein embolization (PVE). Pelvic vein embolization is a non-surgical treatment that blocks abnormal blood flow to the varicose veins that are causing pain. PVE is done in an outpatient setting and only requires local anesthetic or numbing cream.

During the procedure, a thin catheter is guided into the pelvis to the affected vein. Tiny coils are inserted into the vein and it is sealed off with a material called a sclerosing agent. This material is also used to close varicose veins in other parts of the body. The procedure is safe and effective. According to one study published in the US National Library of Medicine, “almost 80% of patients experienced relief from chronic pelvic pain.”

What to Expect After Pelvic Vein Embolization

Recovery from PVE is generally quick. Most patients go home the same day and can return to normal activities within a few days. Mild pelvic discomfort or cramping is common in the first 24 to 48 hours but usually resolves on its own. Your doctor will schedule follow-up appointments to monitor your progress and confirm that the treated veins have closed successfully. Many women notice a significant reduction in pelvic pain within two to four weeks of the procedure.

References

Riding DM, et al. “Efficacy of embolotherapy for the treatment of pelvic congestion syndrome: A systematic review.” Phlebology, 2024. Link
Kim HS, et al. “Embolotherapy for pelvic congestion syndrome: long-term results.” Journal of Vascular and Interventional Radiology, 2006. Link
Stanford Health Care. “Pelvic Congestion Syndrome.” Link