Poor vein function can often lead to several health problems. Conditions such as varicose veins occur when veins expand and hold excessive capacities of blood. It usually occurs in the lower part of your legs. Though both men and women may suffer from such conditions, women are more likely to have it. But, when the same condition occurs in your pelvic area, the condition is called as pelvic congestion syndrome (PCS).

One-way valves present in veins play a critical role in regulating the circulation of your blood. These valves never let blood to flow in the reverse direction. But, when these valves in veins do not work well, blood gets blocked at the veins – i.e., instead of reaching your heart. As a result of this excessive blood supply, your veins tend to dilate. As gravitational pull makes pushing blood upward more difficult, this condition is commonly observed in the limbs; especially in the lower part of your legs.

The most-likely triggers for this condition are menopause, pregnancy, excessive bodyweight as well as your family’s medical history. It is also likely to affect if you are aged above 50 years.

Pelvic congestion syndrome

This medical condition is categorized as a chronic ailment. This is similar to varicose veins (described above); the only difference is this condition occurs at the lower abdomen, adjacent to the pelvic floor. Women are more vulnerable to it. Among women, those who have already delivered a baby have a higher level of risk. Of all pains in the pelvic area – especially, those experienced by women – pelvic congestion syndrome is likely to account for more than 25% of them.

Veins in the pelvic area get larger due to repair of valves that regulate flow. As a result, veins in pelvic area function poorly which further lengthens and twists your veins in the region. Women with such malfunctioning veins may report a persistent pain. This pain is mostly dull but may flare up at times. During times of such flare-up, the pain only gets worse and can turn into an unbearable condition.

Signs of pelvic congestion syndrome

The pains women experience due to this condition are never the same. It is likely to fluctuate. However, presence of a dull type of pain is seen as a chronic occurrence. The common instances wherein worsening of pain is observed are (1) during the days immediately prior to women’s menstrual cycle, (2) soon after a sexual act; at times, even before a sexual intercourse, (3) during the advanced stage or last trimester of your pregnancy and (4) while women remain in a standing posture for a long time. Some women have also reported worsening of their pains late in the evening.

Pain is only one of the signs of this pelvic syndrome. Hence, apart from pains in the pelvic area, a few conditions may also show up. The extent of pain experienced is dependent on a few other conditions to show up; these are – (a) varicose veins in legs, buttocks or in areas closer to your sexual organ, (b) mood swings – including depression and schizophrenia, (c) excessive discharge of blood during your menstrual cycles, (d) painful menstrual cycle (also called as dysmenorrhea), (e) unexplained weariness or backache, (f) frequent urges to urinate or a marked increase in the quantum of urine, (g) inflammation of your vulva or vagina, (h) painful bowel movements, etc. Pain can also show up as pains in your joints – especially, in your hip; at times you may also notice softening of your abdomen.The pain you may experience depends to a greater extent on the incidence of one or more of these aforesaid symptoms.

Risk factors which may lead to pelvic congestion

Women who have previously given birth carry a lot of risks. These risks factors are found to get more pronounced each time such women become pregnant. Medical sciences have studied the reasons behind this; common reasons include –

– Pregnancy is a period when a woman’s hormones work at the fullest. For instance, estrogen – a female sex hormone – is made in abundant levels i.e., pregnant women’s body starts making additional amounts of this hormone. But the other side of this spike also means estrogen can weaken the walls and linings of women’s blood vessels

– Medical studies have assessed the other changes that can occur in a woman’s body during pregnancy. The most common change is an increase in body weight. Such weight gain occurs because your body is getting prepared to bear a new baby. As your weight and fluids build up, veins are not fully prepared to deal with such increased quantum of liquids. As valves that control blood circulation through veins are more likely to get overwhelmed, one-way valve mechanism may come under severe stress. This is the starting point of valve malfunction. Soon, your valve may let blood to pass through the opposite direction. A varicose vein condition shows up owing to your body’s inability to handle all these developments.

In general, pregnancy is the time when your pelvis undergoes a few changes; these changes are your body’s response to make you ready for childbirth. These changes – often structural in nature, which can impact your pelvic region – can at times change the blood circulation settings of your body. Such altered settings can impact your blood vessels, their linings as well as functioning of valves.

Net impact of this congestion syndrome – especially at the advanced stages of your pregnancy – can have a telling effect on your baby. The baby may get heavier and bigger due this pelvic syndrome. Carrying an overweight baby only adds to the pains. The resultant pains are often more severe. This is because an overweight baby can apply additional pressure onto your veins in the pelvis. As a direct consequence, your already-damaged veins and valves end up facing additional discomforts in the form of acute pains.

Diagnosis of pelvic congestion syndrome

It is not an easy thing to confirm the incidence of this congestion syndrome. Your treating doctors may have to conduct numerous diagnostic tests and procedures. Most tests are done to rule out the possibility of other conditions associated with pelvic pain or congestion in your pelvic region. Most commonly done diagnostic tests to confirm pelvic congestion syndrome are laparoscopy, scan (done with an ultrasound machine), X-ray (specifically, a venogram), CT scan or MRI scan.

Of these tests, the ultrasound scan is the foremost tool to diagnose the incidence of pelvic congestion syndrome. The scan helps identify vein varicosities and also can help detect malfunctions, if any – in your blood circulation system. Venogram is an X-ray procedure done by injecting a dye to serve as a contrast. The dye is often made of iodine. This procedure lets the treating medical team to view your present medical condition as well as understand the size or shape of your veins. Of the various types of venogram, descending procedure is done to understand the functioning of your valves.

Laparoscopy is a minimally-invasive surgical procedure to check the proper functioning of your abdomen and organs in the pelvic region. It is generally considered as a very low risk procedure due to its minimal invasiveness. It can be done with very minor incisions made to your body. The procedure involves inserting a thin, long tube (known as a catheter) which has a focused light and a camera of very high resolution. This long tube is made to enter into your body through a minor incision made onto your abdominal lining or walls. The tube – as it enters deeper inside your abdomen – transmits images which are viewed from a laparoscopic console.

MRI scan is done with radio waves and strategically placed magnetic fields. This combination helps produce pictures of organs deep inside your body. On the other hand, CT scans provide images of body parts and their functioning through specially powered and positioned X-ray source points. Scans are in general done in evenings or in the later part of the day. These are the times when the signs of pelvic pains are likely to be more pronounced.

How to treat pelvic congestion syndrome?

There is unfortunately no complete cure for this medical condition. Also, the treatment process is quite complex in nature. Approaches pursued to treat this pelvic syndrome focus on decreasing your pain and other related signs. Drugs aim to reduce the pains as well as decrease inflammation of veins. As a fairly recent development, a procedure known as embolisation of pelvic veins is widely used to treat this condition. This procedure however cannot be done on all women. But, women whose condition has been found to be well-suited to perform this procedure have reported greater relief from pains associated with pelvic congestion syndrome.

Medications

Your treating doctor will prepare a suitable treatment plan after fully assessing your pelvic condition. The doctor will commence a plan only after successfully ruling out all other possibilities. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common medications prescribed to treat pelvic pain. These are however administered for a shorter span of time.

Ibuprofen

This medication is administered for the management of pain. It helps alleviate pains including arthritis, pains in your pelvic region, toothaches, headache, period pains, ear pain, etc. This drug belongs to a genre of medicines called Non-steroidal anti-inflammatory drugs (NSAIDs). Its key function is to control agents that trigger inflammation and pains (such as prostaglandins, cyclooxygenase, etc.) to reduce discomforts.

Likely side effects of this drug include drowsiness, nausea, indigestion, etc. You are advised not to perform activities which may need a high level of mental concentration, such as driving and operating heavy equipment or machines. If your family’s medical history includes cardiac ailments, kidney problems, internal bleeding issues like perforation or ulcers, you are advised to talk to your doctor before starting a course. This drug may interact with a few co-administered medications and alcohol. If you are already consuming beta blocking drugs, diuretics (water pills) or heparin, you need to talk about it to your pharmacist or the treating medical team.

Medroxyprogesterone

This drug reduces risks associated with cancers in the uterine region. This is often administered to women to stop excessive bleeding, especially among women who have not reached menopause.

In essence, it helps restore normal menstrual cycles. It can also help alleviate hot flashes or other symptoms linked to the incidence of menopause in women.
Most likely side effects of taking this drug are formation of gas, nausea and blurring of eyesight. If you have a prior history (or family history) of high blood pressure, liver problems, etc. you need to talk about such disorders with your treating doctor. Also, if you are taking drugs such as antifungal medications or anticonvulsants, your medical team needs to be made aware of your existing treatment plan.

Gabapentin with amitriptyline

Medical studies indicate that women taking a combination of gabapentin and amitriptyline have experienced a reduction of pain levels. The results achieved are far better than those attained by taking amitriptyline as a stand-alone dose.

Gabapentin is a neuropathic pain reliever. The drug works on your nerves in the pelvic region to control spells of pain and convulsions. Its possible side effects are excessive weakness, chills and fever. If you have respiratory troubles or kidney problems, you are advised to talk to the doctor before starting to take this medication. It is known to interact adversely with some antihistamines as well as a few stress-reducing drugs.

Amitriptyline helps fight sadness and depression. It works on a few mood-carriers or neuro-transmitting agents in your brain to ease stress. It is also helpful in treating some pains. This drug belongs to a class of medications called as tricyclic antidepressants. The side effects it can trigger are dehydration and difficulties to pass stools. If you are already experiencing mental health problems such as bipolar conditions or any other mental issues, you need to inform your doctor about them.

If signs of pelvic syndrome do not ease, a radiologist may perform a venography procedure. As mentioned, a contrast (usually, an iodine-based dye) is injected to clearly view the various part of your pelvis.

Embolisation of pelvic vein

This procedure is done with very minimal surgical intervention under the supervision of a qualified interventional radiologist. A catheter is inserted into your neck or groin during the start of this procedure. A very tiny incision – with the help of local anesthesia – is made for this purpose. The catheter is then guided to reach your pelvic and ovarian veins to detect damages, if any. Catheter serves dual purposes here. It is used for diagnosis as well as treatment. Catheter helps in sealing your damaged vein. This is done with the use of medications known as embolic chemicals or agents. The exact positioning of the catheter is essential for the effective sealing as well as for the overall success of this procedure. The procedure is termed as success only if the activity does not cause any fresh injuries or damages to your ovarian or pelvic veins.

Medical science uses different types of embolic substances or agents – the common ones are fluid glues, fluid sclerosing substances as well as coils. The fluid agents (both sclerosing substances as well as glues) seal the veins by making the agents to clot. Coils are made of metals – often an alloy of steel or platinum. These coils are made in different sizes so as to seal veins more effectively. As the incision made is usually very small, no elaborate suturing is done on it. The procedure takes nearly 40 to 80 minutes. Time taken is a matter of complexity and how easily accessible is your damaged vein. This procedure has improved the quality of many women who experienced pelvic congestion syndrome. Improvements are often sensed in less than a fortnight from the time of the procedure.

A few risks – however – cannot be ruled out. Some women may be allergic to the contrast dye used in this procedure. If the catheter accidentally ruptures a vein, it can result in bleeding or bruising your already-damaged vein. At times, the sealing agent may get placed in an incorrect location; this may make your tissues to run short of oxygen needed to keep them healthy. In some extreme cases, risks associated with infections may also emerge. Relapse of pelvic congestion has been observed in some 10% of women. This procedure is sought after due to its minimally invasive nature. Owing to this, your stay in a hospital setting is very short; in most cases, it is done as a day-care procedure. Till date, it remains as an effective approach to seal a damaged vein and to resolve associated pains in your pelvic region.

In general, women experiencing pelvic pains are to be checked for mood swings such as depression. Their personal background and details about their family are needed to rule out allied stresses from domestic discomforts or violence, if any. Psychological stress factors may also show up as bodily discomforts – especially, pain in the abdominal parts.
In such instances, along with medication or surgical intervention, services of a qualified mental health therapist are also added to your treatment plan. Some medical teams go further deep into your lifestyle. Your sleep-cycles and sleeping patterns, regularity of menstrual cycles, medical problems in your lower abdomen or gastrointestinal tract are also studied. A few medical studies have successfully linked the presence of irritable bowel syndrome (IBS) to incidence of pelvic congestion syndrome in women.

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