Diagnosis & Treatment of PCS

What is PCS?

About 30% of women experience chronic pelvic pain at some point in their lifetime. Occasionally this pain is known to be pelvic congestion syndrome (PCS) and is believed to be associated with varicose veins in the pelvic and groin areas.  Sometimes varicose veins occur during pregnancy and then continue to progress in size, creating a constant dull pain in the pelvis, as well as the feeling of pressure and heaviness.  Defective or injured valves in the veins allow blood to flow backward rather than driving it forward, thus causing pooling of blood in the veins.  As the walls stretch under the load the veins get bigger and pressure upon the nerves surrounding the veins create pain.

Diagnosing the Problem

The symptoms of PCS are very similar to other conditions so proper diagnosis is imperative in order to treat it.  There are several tests used to make a diagnosis of pelvic congestion syndrome which include:

Ultrasound, which is the first choice of testing, normally takes about 30 minutes and is effective and inexpensive.  The uterus and other pelvic organs can be assessed and with the new advances in technologies, the ultrasound can also aid in visualizing the flow of blood to assess varicosities in the pelvic area.

Venogram, formerly a widely used tool to diagnose PCS, has been replaced with the CT scan.  A special dye is injected into a vein in the groin and x-rays are taken.  The procedure is about 30-45 minutes in length and does not require a hospital stay.  It is painless but there is some exposure to radiation and possible risk of allergic reaction to the dye.

CT Scans are frequently used to diagnose Pelvic Congestion Syndrome.  A CT scan can allow viewing of the entire pelvic anatomy, showing the veins and any problems which may be occurring.  Since it does expose a woman to radiation, it is not advised for pregnant women.

MRI, or magnetic resonance imaging is an excellent method of testing for PCS.  It is painless, does not use dye or radiation, the images are excellent and it only takes about 15 minutes as an outpatient.  Many radiologists prefer this test over others.

Possible Treatment Methods

The great variance of symptoms in PCS makes diagnosis difficult and even after making the diagnosis, treatment may not be successful or satisfactory for some women.  There is no standard protocol available since the pain levels vary so greatly. There are a number of different possible treatment options available, both surgical and non-surgical.  Radiology is being used more today in place of surgery.

Drug and hormone therapies were used at one time, but were often ineffective.  PCS may require some pain medication and antidepressants have been found to be useful in not only relieving pain, but also in addressing the often occurring depression and anxiety which is caused by pelvic congestion syndrome.  Because many women have been dissatisfied with conventional therapy due to the high rate of failure, alternative health care approaches are being used as well.