Pelvic Congestion Syndrome: Is this the cause of my pain?
Amy Gildner, PT, MSc PT
Pelvic Health Physiotherapist
Key Takeaways
Pelvic congestion syndrome (PCS) is one possible cause of ongoing pelvic pain
Symptoms can include aching or heaviness in the pelvis, pain that gets worse after standing for long periods, and pain during or after sex
PCS can be difficult to identify as symptoms mimic other pelvic floor conditions and disorders
Pelvic floor physiotherapy may help with some of the muscular dysfunction and movement-related symptoms that develop with PCS
What is pelvic congestion syndrome?
PCS involves problems with blood flow in your pelvic veins, causing the blood to pool in the pelvic veins, leading to swelling and discomfort. Over time, these veins can become enlarged, similar to varicose veins that you might see in the legs. This can create a feeling of pressure, heaviness or aching in the pelvis.
Symptoms often worsen after prolonged standing or sitting, while others find their pain increases later in the day, around their period, or after intercourse.
Common symptoms of PCS may include:
Dull pelvic pain
Heaviness or pressure in the pelvic region
Lower back or leg discomfort
Pain during or after sex
In some cases, visible varicose veins around the vulva or upper thighs
What causes pelvic congestion syndrome?
While researchers are not exactly sure of the cause of PCS, there are some factors that likely contribute to it. Problems with blood flow in ovaries and the pelvic veins likely play a critical role, often known as pelvic venous insufficiency. With PCS, veins are widened so the pelvic valves flow backwards, causing blood pooling. This is particularly common in pregnancy or with fluctuations in estrogen.
Risk factors of PCS include:
Multiple pregnancies
Biological family history of pelvic pain
Polyendocrine metabolic ovarian syndrome (PMOS)
Estrogen therapy
Varicose veins in lower limbs
Previous pelvic surgeries
How is PCS diagnosed?
Diagnosing PCS can be challenging as vein issues don’t necessarily guarantee that PCS is the cause of pelvic pain, with some people having vein abnormalities without symptoms. Pelvic pain is also multidimensional, and can be caused by other issues, such as mechanical tension. The best way to diagnose PCS is through imaging procedures, including:
Ultrasound which shows vein dilation and blood flow
MRI or CT scan which show details in veins that an ultrasound may miss
Pelvic venogram, which is an x-ray procedure using contract dye to show the blood flow in the veins
Laparoscopy to determine is veins are dilated
How is PCS treated and can pelvic physiotherapy help?
While pelvic floor physiotherapy does not treat the veins themselves, pelvic floor therapy can still be a valuable tool in the management of symptoms. When your body has been in pain for a long time, you may start to respond by tightening or guarding the muscles around the pelvis, causing tension through the muscles. This can lead to pain, much like tightness in other areas in the body, and can contribute to pelvic discomfort.
Pelvic floor therapy treatment will depend on what is found. For someone with an overactive or tight pelvic floor, relaxation and down-training may be more appropriate than strengthening exercises, which is why kegel exercises are not always the answer! If your muscles are already overworking, doing more contractions may be unhelpful and exacerbate the issue.
Other treatments for PCS include medication, compression therapy, such as compression socks, and potential surgery.
Frequently Asked Questions
Can PCS cause pain with intercourse?
It can. Pain during or after intercourse is one symptom that may occur with PCS. However, pain with intercourse is complex and if this is an ongoing concern, should be assessed by a member of your healthcare team.
Is pelvic congestion syndrome the same as pelvic floor dysfunction?
No. PCS involves the pelvic veins, while pelvic floor dysfunction relates to how the pelvic floor muscles are functioning. The two conditions are different, although they can occur together.
Can pelvic floor physiotherapy cure pelvic congestion syndrome?
Not directly. Pelvic floor physiotherapy does not treat the underlying vein problem but can he helpful in addressing muscle tension and correcting movement patterns that may be contributing to your symptoms.
Should I do Kegel exercises if I have PCS?
Not necessarily. Kegel exercises strengthen the pelvic floor, but strengthening already tight muscles may make symptoms worse. This is why an assessment with a pelvic floor physiotherapist is best to accurately assess your needs.
What if I don't know what is causing my pelvic pain?
That's very common. Start by discussing your symptoms with your healthcare provider. Depending on your history, you may benefit from medical investigations as well as a pelvic floor assessment to see whether the muscles are contributing to your symptoms.
Can men have PCS?
Yes! While much rarer, men can experience enlarged scrotal veins causing pain and pressure.
References
Cleveland Clinic. Pelvic Congestion Syndrome: Causes & Treatment.
Brown CL, et al. Pelvic Congestion Syndrome: Systematic Review of Treatment Success. Seminars in Interventional Radiology. 2018.