Many people ask "What is PCS" or "What causes PCS"?
The simplest understanding of pelvic congestion is that varicose veins in the pelvis cause it. As most people understand, varicose veins are usually normal veins that are dilated.
However, there are two main reasons why veins might become varicose.
1 - Venous reflux: the commoner reason of the two is that the valves do not work in the veins. This means that when the patient stands up, blood falls backwards down the veins by gravity, causing the vein to distend and the vein wall to stretch.
2 - Obstruction: much less common is when a vein can be compressed, causing a resistance to blood flow through the vein. This increases the pressure in the blood trying to get through the compressed segment, stretching the vein wall and making the veins varicose.
The treatment of venous reflux is to close the vein, usually by embolisation.
The treatment of obstruction is to relieve the compression using a stent.
One of the major problems we have in pelvic congestion is that compression seems to be overdiagnosed in many patients by doctors keen to do stenting. Most patients have venous reflux and are curable by embolisation of the pelvic veins alone.
Not everyone with pelvic congestion gets symptoms. Many just get the signs (see "Signs of Pelvic Congestion").
However, my research has shown that many women without any symptoms, who have pelvic veins treated because of signs (such as leg varicose veins), find that their pelvs feels much better! In other words, they did have pelvic symptoms - but have had them for so long, they thought the pelvic discomfort was normal.
Pelvic congestion symptoms can be either A] inside the pelvis or B] Outside of the pelvis.
A] Symptoms inside the pelvis:
B] Symptoms outside of the pelvis:
Many patients have been investigated with ultrasound, MRI and or laparoscopy - and often told there is "nothing wrong" or that they have enodmtriosis.
The best investigation for Pelvic Congestoin is a transvaginal ultrasound performed using the Holdstock-Harrison Protocol.
The signs of pelvic congestion are varicose veins showing on surface around the lower abdomen, pelvis or in the legs.
The commonest signs of pelvic congestion are varicose veins of the vulva and vaginal in females, and around the testicle and scrotum in males. Also, varicose veins at the top iner aspect of the thigh, on the backs of the thighs, and in the perineum or on the buttocks, are almost always due to pelvic congestion. hese signs are almost always due to pelvic vein reflux.
Rarely, varicose veins can appear across the pubic area, or up the flanks. IN these rare cases, the pelvic ongestion is due to blocked pelvic veins, and these varicose veins are bypassing the blockage (obstruction).
A] Signs in the lower abdomen / pelvis
B] Signs in the legs
Many outdated doctors and nurses still say that pelvic congestion is found in fertile women who have had children. This is incorrect.
Although there is a link between worsening pelvic congestion and number of pregnancies, we have found 10% of our patients with pelvic congestion have never been pregnant, and 25% are post-menopausal.
In addition, men get haemorrhoids, varicose veins around the testicles (varicoele) and leg varicose veins arising from pelvic veins. Also, new research shows that male pelvic congestion can present as erectile dysfunction.
Therefore both men and women, fertile or not, can suffer from pelvic congestion.
The first step is to suspect it and to look for it!