Pelvic congestion syndrome (PCS) has always been a challenging diagnosis for health care providers. The difficulty comes from the vague presenting symptoms, arising from a broad spectrum of pelvic varicosities. These pelvic varicose veins share a similar pathology as elsewhere in the body (e.g lower limbs) with individual patient symptoms corresponding to the specific location of these varicosities.
Recent publications suggest up to 30% of women with chronic pelvic pain have PCS(1). With the advent of improved imaging modalities, we are now able to detect these enlarged pelvic veins to support this previously elusive diagnosis. The interventional radiologists at St Josephs’ Hospitals have been offering minimally invasive outpatient pelvic venous embolization with great success in the recent years. The procedure usually takes less than an hour and is performed through a small needle puncture at the groin or neck. The recovery process is fast with significant improvement of symptoms within a few weeks.
All of our recent cases of PCS embolization demonstrated complete resolution of symptoms: for example diarrhea, constipation, bloating, irritable bowel/bladder, lifestyle limiting pelvic pain with prolonged activities, dyspareunia, etc(2). Most of these symptoms correlate directly with the location of the venous reflux seen during the venogram, which remains the gold standard for diagnosis.
Many of these chronic symptoms result in frequent visits to the emergency department and subsequent subspecialty referrals. In order to improve patient care, a multidisciplinary approach to the detection and treatment of this highly underdiagnosed entity is advised by the Society of Interventional Radiology. This requires raising awareness for this disease process in order to aid detection. If there is a high clinical suspicion for PCS, interventional radiology consultation for further clinical evaluation is recommended.
(1) Dos Santos SJ, et al. (2016). Pelvic congestion syndrome masquerading as osteoarthritis of the hip. DOI: . 10.1177/2050313X16683630
(2) Lopez A. Embolization for Pelvic Congestion Syndrome. Endovascular Today. April Vol , No.4; 56-60