The pelvis contains a lot of different systems of the body. There are various organs: the bladder, the colon and the uterus or prostate and there are various joints, muscles, ligaments, nerves and blood vessels. Impairments to any of those areas can lead to pelvic pain.
In general chronic pelvic pain is not well understood and is often misdiagnosed; this is especially true if the cause is due to venous dysfunction.
Veins help bring blood flow from the extremities to the heart. If these vessels are not able to do their job properly, blood can start to pool and the vessels can dilate and become enlarged. When this happens in the extremities or the labia it is called a varicose vein. This type of venous dysfunction in the pelvis is called: Pelvic Congestion Syndrome (PCS).
PCS is a poorly understood condition. Yet, research shows that it can impact up to 30 percent in patients presenting with chronic pelvic pain in whom no other obvious pathology can be found. At this point in time, there is no criteria to diagnose the condition, but it is often based upon a person’s symptoms, medical history, along with exclusion of other conditions. A patient may be referred to a vascular specialist that would perform tests to determine if venous dilation is occurring.
Symptoms of Pelvic Congestion Syndrome
Patients with Pelvic Congestion Syndrome may present with the following symptoms:
- Pelvic Pain that increased with prolonged standing or walking
- Pelvic Pain that is a dull ache or heaviness
- Pain during and/or after intercourse
- Pain that is relieved with laying down
- Dysmenorrhea (painful periods)
- Varicose veins of the genitals, buttocks and/or thighs
- Urinary Urgency
The cause of PCS is not well understood but there seems to be an increased risk for PCS in patients who have multiple pregnancies. This may be due to the fact that during pregnancy there is an increase in blood flow and this may lead to changes in the vessels that become permanent. Hormones may also play a role in this condition, as estrogen and other hormones contribute to the dilation of the blood vessels. As of right now, no cases have been documented in menopausal women.
Many of the symptoms associated with PCS can be due to a variety of other medical conditions, so it is important to work with a healthcare provider to determine the cause of someone’s pelvic pain. As mentioned, a healthcare provider may order diagnostic imaging to assess the function of the pelvic vessels.
If Pelvic Congestion Syndrome is diagnosed there are a variety of treatment options. It may include medications or a procedure to block blood flow to the vein which would prevent any blood from pooling in the vessel.
While more research is needed to better understand Pelvic Congestion Syndrome, it should always be included as a possible cause for chronic pelvic pain.
Dr. Rachel Gelman is a pelvic floor physical therapist. She is the owner and founder of Pelvic Wellness & Physical Therapy in San Francisco which specializes in treating patients with pelvic floor dysfunction including pelvic pain, bowel, bladder and sexual dysfunction. She is an adjunct instructor at Samuel Merritt University where she teaches the pelvic health curriculum in the Doctor of Physical Therapy program.