Maternity Guide 2023: Congestion Syndrome Affects Postpartum Women & Others

Pelvic pain and discomfort is commonly experienced by women at various stages of life, and more often for women who are postpartum. Finding the cause of the pain is often the first step towards relieving the symptoms. 

Heather Perné, NP-C, CWS at University of Toledo Health Physicians

“A third of all women will have chronic pelvic pain at some point in their lives,” said Heather Perné, NP-C, CWS at University of Toledo Health Physicians. Perné, who works as a nurse practitioner in the Vascular, Endovascular and Wound Surgery department, is raising awareness about a condition known as Pelvic Congestion Syndrome. 

“Pelvic Congestion Syndrome frequently goes unrecognized as a cause of chronic pelvic pain. A vascular disorder affecting the veins of the pelvic region, (the Syndrome occurs when) there is not proper drainage of blood out of these veins.” 

Diagnosis and causes

PCS is most commonly diagnosed in women between the ages of 20 and 50. Although it is much less common, it can occasionally affect men as well. 

“Pelvic Vein Dysfunction, or reflux, causes blood to flow backwards in the pelvis instead of up to the heart. This causes engorgement and inflammation of the veins in the pelvis. The affected veins can be visible or ( may be) deep in the pelvis. Visible varicose veins can be on the labia, groin, buttocks, or proximal thighs.” 

Symptoms of PCS include: 

*Aching pelvic pain which worsens after standing or sitting for prolonged periods of time. 

*Pain during or after intercourse 

*Painful periods 

*Back pain 

*Painful veins in the groin or labia 

*Ovarian tenderness on pelvic exam 

*Pain upon urination or bowel movements 

*Stress incontinence 

Risk factors for PCS include women who have experienced multiple births, have been diagnosed with polycystic ovaries, or have elevated estrogen levels. Also, women whose work requires them to stand for long periods of time may be at greater risk.

Perné noted that it is important to rule out other causes of chronic pelvic pain before seeing a specialist. 

Ruling out other potential causes of pain

“Think of Pelvic Congestion Syndrome as a possible diagnosis when someone has chronic pelvic pain for six months or longer in the absence of pelvic pathology such as fibroids, endometriosis, ovarian mass, or pelvic inflammatory disease. Once the above have been ruled out by a primary care physician or obstetrician-gynecologist, it may be time for  patients to make an appointment with a vascular specialist for evaluation of PCS as a potential cause.” 

A specialist will likely order a CT venogram to determine the amount of reflux. A transvaginal ultrasound may also be performed. 

“With a pelvic venogram, a catheter is inserted into the common femoral vein and an injection of dye enables visualization of the pelvic veins. The affected veins are treated with embolization, coiling or sclerotherapy, which block the blood flow in the affected veins. This stops the engorgement in the vein, thus reducing inflammation in the vein and reducing pressure on surrounding structures. This is an outpatient procedure, so oatients go home the same day.” 

Perné encourages anyone with chronic pelvic pain to seek a physician’s diagnosis. 

“If left untreated, the symptoms experienced may worsen, causing an increase in pain, anxiety, and an overall decrease in the quality of life,” she said.

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