An introduction to pelvic congestion syndrome

In his latest online article, Dr Omar Abu-Bakr gives us his insights into pelvic congestion syndrome. He talks about what it is, if it’s a chronic condition or if it will go away and if it is overlooked when considering pelvic pain.

What is pelvic congestion syndrome?

Pelvic venous congestion syndrome, also known as pelvic congestion syndrome, can be better explained as varicose veins that develop in the pelvic area. These veins are similar to the varicose veins we often see in the legs, but they affect the veins in the pelvic region and the pelvic floor. To understand this more easily, it's important to know that all veins below the heart have valves. These valves help blood move against gravity and flow upwards to the heart. When these valves don't work properly and blood flows back down, it's called venous insufficiency. In the legs, we call it "varicose veins," while in the pelvis, it's referred to as "pelvic venous congestion syndrome."

In men, this syndrome might show up as varicose veins in the genital area. In women, it could appear as varicose veins in the vulvar area, or it might not be visible on the surface at all. Having varicose veins can lead to symptoms and even cause varicose veins on the legs, because it can contribute to the development of leg vein issues. Importantly, about one in every five women and one in every thirty men with varicose veins in their legs also have pelvic venous congestion syndrome. This highlights that the pelvic aspect of the syndrome isn't rare, but rather quite common. Additionally, it's influenced by genetics, meaning it can run in families. While pregnancy can make symptoms worse, it's worth noting that the syndrome isn't solely caused by pregnancy – this is clear because men can also have it. So, while women are more likely to have it, especially due to the effects of pregnancy, the fact that it occurs in men too shows that it's connected to genetics.

Is it a chronic condition or can it go away?

It won't go away on its own, like varicose veins or any vein-related problem. It's about how the veins work, causing symptoms due to blood flowing in the wrong direction and affecting leg tissues. This happens with varicose veins or conditions like pelvic congestion syndrome. The blood hits the pelvic floor, affecting organs, especially the genital ones.

This is what brings about these symptoms. Trying things like taking medicine, using treatments, or doing exercises won't help much. These won't really work because the vein's problem isn't fixed by them. To properly deal with it, the only way is to get rid of these veins. This means closing the veins using a simple procedure, and it's done with local anaesthesia while the patient is awake.

Before procedures on legs or the pelvis, we suggest patients share some jokes to stay relaxed. After the procedure, especially for women, we advise them to do something simple like going shopping. Getting them to walk is important, as it really lowers the risk of issues like deep vein thrombosis, heart attacks, or strokes. The risk drops from one in seventy-two to one in one thousand or even one in ten thousand. I usually tell female patients to go shopping to encourage walking, though this might vary with husbands.

As for high heels and pregnancy, it's important to clear up that they don’t directly cause vein problems. High heels don't lead to vein issues. Regarding pregnancy, it's a natural process for humans. It's not a problem itself; it's something our bodies are built for. But if there's a vein issue already, pregnancy can make it worse. It won't create a problem out of nowhere. In short, if the issue isn't there before, pregnancy won't make it appear.

Is pelvic congestion syndrome an overlooked condition when considering pelvic pain?

Roughly one out of every five women and one out of every thirty men with varicose veins on their legs also have issues in the pelvic area. Do I need to have varicose veins on my legs to have pelvic congestion syndrome? No, that's not a must. It's not directly tied together. However, varicose veins can act as a signal, a sign for those who have them.

Among five women, one might have this condition. But keep in mind, even if I'm dealing with back pain or discomfort in the pelvic area, it's quite common to hear stories of doctors not being sure about the cause. This can lead them to suggest big surgeries like hysterectomies or other medical procedures. But really, the answer could be simpler – just get an ultrasound scan of the pelvic floor and the pelvic veins. This can tell us if pelvic congestion syndrome is the root cause. Sadly, stories like these are quite common in our work. Sometimes, the solution can be as basic as getting an ultrasound. So, if I have these symptoms but no gynaecological problems are causing them, and if my back pain isn't due to an issue with my back, and there's no obvious reason for these symptoms, it's worth looking into the veins. In medicine, we can have both things happening together. You could have pelvic congestion syndrome alongside gynaecological problems. So even if I deal with a gynaecological problem and the symptoms don't go away, it's worth exploring if it's connected to pelvic congestion syndrome.

Dr Omar Abu-Bakr is a highly esteemed consultant venous surgeon and phlebologist with over 15 years of experience. You can schedule an appointment with Dr Abu-Bakr on his Top Doctors profile.