About Pelvic Congestion

Pelvic Congestion Syndrome: Diagnosis

The symptoms of pelvic congestion syndrome are:

• Deep, dull aching pelvic pain
• Pain worse after upright positions, like standing and sitting
• Pain worse after exercise, like walking, running and weightlifting
• Pain during or after intercourse
• Back and thigh pain
• Varicose veins around the genitals and in the legs

The underlying cause is due to reflux (going the reverse direction) of the ovarian vein which pressurises and overwhelms the pelvic veins leading to enlargement of the pelvic veins, congestion and therefore pain.

Many women with pelvic congestion syndrome only find pelvic pain relief when lying down.

Diagnosis can be made by combining typical symptoms with medical imaging. Pelvic ultrasound quite often detects dilated and congested pelvic varicose veins. MRI can also demonstrate reflux in the  ovarian vein, in addition to congested pelvic veins . However, MRI for this condition is not covered by Medicare. CT scans can clearly demonstrate pelvic varicose veins as well as the refluxing ovarian vein.  CT scan is most useful for planning the embolisation (blocking) treatment, but involves some radiation and a contrast (X-ray dye) injection.

Dilated pelvic veins can sometimes incidentally discovered at laparoscopy looking for something else. However, laparoscopy is not the appropriate test if one is looking for pelvic congestion syndrome. Pelvic veins are usually collapsed during laparoscopy, due to the head down body tilt and gas used to distend the abdomen.

Pelvic congestion syndrome seems to be an under-recognised and under-diagnosed cause of pelvic pain in women. As chronic pelvic pain can be caused by a variety of conditions, diagnosis of pelvic congestion syndrome is often delayed as doctors are more inclined to organise tests to rule out more sinister conditions like infection, inflammation and cancer in the bowel and other pelvic organs.