Pelvic Congestion Syndrome

Women who experience chronic pelvic (lower abdominal) pain are often frustrated because diagnosing the cause of such pain has proven to be elusive. Often, women will see their Ob for this complaint, only to start a cycle of specific imaging tests and often undergoing laparoscopic procedures that offer hope, but rarely provide a solution.

Pelvic Congestion Syndrome (PCS) is a common cause of pain in women of reproductive age, with some estimates suggesting that it can be present in up to 40% of women in this group. Although it is now recognized as a common problem, it is often misdiagnosed, partly because it is not well understood and mostly because the front line practitioners who women seek help from are not aware that at its core, PCS is a vascular problem, and as such do not tend to refer to an appropriate practitioner. Studies have shown that slightly over one-third of patients are referred for evaluation. Commonly, women are just given a diagnosis of endometriosis, despite the fact that often this diagnosis is often one of exclusion, and is not based on the actual identification of endometriosis. 

Pain in the pelvis (the lower abdomen) that persists for 3-6 months, occurs throughout the menstrual cycle, not associated with pregnancy is defined as chronic pelvic pain. It can be intermittent or constant and might be associated with a sensation of fullness and changes in bowel or bladder function, as well as heavy periods. Often, women may also experience lower extremity symptoms of achiness, heaviness or swelling. They might also note varicose veins that are not in the legs, but rather can involve the vulva, the buttocks or the area around the vagina, also known as the perineum. 

PCS is essentially the result of inadequate vein function. Although most practitioners believe that the cause is not understood, at Bloomfield Vein and Vascular, we believe that the problem stems from inadequate vein function in the iliac veins, which are responsible for draining not only the lower extremities but also the reproductive organs. If the major outflow veins do not work properly, vein flow is affected and the back up of blood in the veins that surround the ovaries and the uterus, lead to the symptoms that women find debilitating. 

Although some practitioners believe that medical management can be effective in treating PCS, often this approach is just the equivalent of putting a band aid on the problem. Contraceptives, hormonal manipulation, either by drugs or implants, and NSAIDs, have been previously used, and although some of these therapies offer resolution of pain, they really do not address the underlying root cause of the problem. These therapies are ineffective in the long term, lead to further delays in definitive treatment and increase the dependency on medications that frequently have side effects. 

Although the ovarian veins (the veins that drain the ovaries) are often affected, these veins are secondary to the underlying problem of iliac vein dysfunction. Practitioners that only focus on treating these veins, are not actually treating the underlying problem that led to the ovarian veins being involved, and symptoms either persist or worsen after such isolated treatments.

At Bloomfield Vein & Vascular, we approach PCS differently. We ensure that we educate you about your condition, and guide you throughout all of the phases of treatment. To diagnose this problem, we listen to you and then if indicated, we perform a specific ultrasound to ensure that we can evaluate venous function within the iliac veins.  If treatment is indicated, we focus on dealing with the root cause of the problem and treating any veins that have been affected by the iliac vein dysfunction. By doing this, we ensure that we address all aspects of this complex condition and increase the likelihood of success. 

Dealing with PCS requires a team that is dedicated to the overall wellbeing of a woman. This is a multifaceted condition and without the right understanding, mistakes can be made and complications can arise. Because it is a vascular problem, having a Board Certified Vascular Surgeon to guide your treatment, can provide hope for a condition that women often struggle with.

The team at Bloomfield Vein & Vascular has significant experience and has the expertise to treat PCS. Let us evaluate you, answer your questions about this condition and offer you the appropriate treatment that can help you regain your life, free of the debilitating pain of PCS. 

Diego A Hernandez, MD Board Certified Vascular Surgeon, with over 20 years of experience and owner of Bloomfield Vein & Vascular, a practice in Bloomfield Hills, Michigan, that focuses on the minimally invasive treatment of vein and arterial problems.

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