This past year, Kristina launched a website, whatareavcs.com, and an Instagram platform, @avcs.awareness, to share information and raise awareness about pelvic congestion syndrome and abdominal vascular compressions. It’s a pleasure to have her guest speak on The Happy Pelvis blog!
Disclaimer: Kristina and I are not healthcare professionals, and this should not be taken as medical advice. This is for informational purposes only. The information in this post has been gathered from medical-based sources including but not limited to Cleveland Clinic and Mayo Clinic.
Pelvic Congestion Syndrome is the cause in about 30% of chronic pelvic pain sufferers
Understanding Pelvic Congestion Syndrome (PCS)
Urinary retention, pelvic and abdominal pressure, digestive issues, pain with intercourse, and the list goes on. These are some of the common symptoms associated with pelvic floor dysfunction. Pain can be attributed to issues with pelvic floor muscles, nerves, tissue, lesions from endometriosis, fibroids, etc. However, a trigger of pain that has been long overlooked is pain from vascular structures in the pelvis and abdomen.
Vascular Pain in the Pelvis and Abdomen
When people think of vascular conditions, they often think about the heart or legs. Vascular issues with the pelvis and abdomen are more common than have long been discussed, however, and more research and information has been coming out about these conditions.
In fact, numerous studies state that pelvic congestion syndrome is the cause in about 30% of chronic pelvic pain sufferers with female anatomy. Unfortunately, despite this relatively high percentage, it takes many patients a very long time to get diagnosed – years or even decades.
What is Pelvic Congestion Syndrome?
Pelvic congestion syndrome is characterized by dilation of the veins in the pelvis, which can include gluteal and periuterine veins and the ovarian vein in particular. One potential cause of pelvic congestion is pregnancy due to increased pressure on the veins, hormonal changes, and increased blood volume. Yet, it’s not the only cause, and in some cases, pelvic congestion is triggered by May-Thurner syndrome and/or nutcracker syndrome, which are both abdominal vascular compression syndromes.
Symptoms of Pelvic Congestion Syndrome
Symptoms of pelvic congestion include sensations of heaviness and pressure in the pelvis, labia, and glute – generally on the left side. Increased menstrual pain can be present in those who menstruate. Shortly before menstruation, blood flow to the uterus drops sharply. A high resistance against the transit of blood develops, and if blood pooling is already present due to faulty veins, this exacerbates pressure in the left ovarian, uterine, and pelvic veins. Also, pelvic congestion can trigger pudendal neuralgia from pressure on the pudendal nerve.
Types of Pelvic Congestion Syndromes
May-Thurner syndrome, considered the most common vascular compression, is the compression of the left iliac vein by the right iliac artery. This can lead to symptoms of pressure, pain, and pooling of blood on the left side of the pelvis and (in some cases) the leg. The left common iliac vein is compressed, and the left internal iliac vein and uterine vein join, so the pooling of blood can thus trigger pelvic congestion.
In nutcracker syndrome, compression of the left renal vein can lead to dilation of the left ovarian (or gonadal vein in males) as blood is not flowing properly through the renal vein. This results in abdominal and left flank pain, and when pelvic congestion is present, pelvic pain.
Two other abdominal vascular compressions are SMAS and MALS. Superior Mesenteric Artery (SMA) Syndrome is the compression of the upper part of the small intestines by the superior mesenteric artery and abdominal aorta. Median Arcuate Ligament Syndrome (MALS) occurs when the median arcuate ligament in the lower part of the chest sits lower than normal and compresses the celiac artery, which supplies blood to the stomach, liver, and other digestive organs. Both conditions are associated with pain with eating, digestive problems, and resulting malnourishment and weight loss.
Pelvic Congestion Syndrome (PCS) Diagnosis
One of the barriers to diagnosis, other than present lack of awareness, is the testing required to properly diagnose the conditions. Many of the standard imaging tests, including ultrasound, CT, and MRI, don’t always detect the conditions clearly, and medical providers interpreting the imaging may not be looking out for these conditions. The good news is that there are tests that can adequately diagnose these conditions. Some examples are a doppler ultrasound to assess blood flow in veins, CT or MR angiogram to visualize blood vessels and tissues, and intravascular ultrasound (IVUS) to measure compression within a vein.
Some patients even get misdiagnosed with endometriosis due to the presence of pelvic and abdominal pain (while others have endometriosis as well). This is why it’s so important for medical providers to conduct the appropriate tests for diagnosing and ruling out certain conditions.
Treatment options for Pelvic Congestion Syndrome (PCS)
Treatment options vary and are dependent on the number of compressions a patient has and whether or not pelvic congestion is present without compressions. Additionally, the order by which certain treatments are performed is based on the different conditions present. For instance, if someone has pelvic congestion accompanied by nutcracker syndrome, then it’s important to address the vein compression before potentially doing an ovarian vein embolization for the pelvic congestion. Some treatment options include stenting, vein transposition surgery, and other surgeries depending on the compression syndrome.
Medical providers that a patient might see include interventional radiologists, vascular surgeons, and other surgeons. Sometimes, a gynecologist may perform an ultrasound and diagnose pelvic congestion.
Certain patient populations are more susceptible to developing vascular compression syndromes. First, those with female anatomy are predominantly affected by abdominal vascular compressions. Abdominal vascular compression syndromes are associated with lordosis, or inward curvature, of the lumbar spine. During female puberty, the lumbar spine tends to take on an inward curve in response to a wider, deeper pelvis. Also, patients with Ehlers-Danlos syndrome (EDS) are more predisposed as the lack of connective tissue support can leave blood vessel walls weakened.
Getting diagnosed with vascular compressions is an arduous process for too many, unfortunately. Yet, knowledge is power. Increased recognition of these conditions will shorten the time to diagnosis and care for patients. Having names for the conditions, and knowing the symptoms and treatment options, elucidates what might have initially seemed so elusive and never-ending!
Please visit Kristina’ at whatareavcs.com, and @avcs.awareness, for more information about Pelvic Congestion Syndromes and Abdominal Vascular Compression Syndromes
References:
- Pelvic congestion syndrome. (2024, May 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24213-pelvic-congestion-syndrome
- Dorobisz TA, Garcarek JS, Kurcz J, et al. Diagnosis and treatment of pelvic congestion syndrome: single-centre experiences. (https://pubmed.ncbi.nlm.nih.gov/28791845/) Adv Clin Exp Med. 2017;26(2):269-276. Accessed 9/27/2022.
- Lopez AJ. Female pelvic vein embolization: indications, techniques, and outcomes. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500858/) Cardiovasc Intervent Radiol. 2015;38(4):806-820. Accessed 9/27/2022.
- Knuttinen MG, Xie K, Jani A, Palumbo A, Carrillo T, Mar W. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. (https://pubmed.ncbi.nlm.nih.gov/25615769/)AJR Am J Roentgenol. 2015;204(2):448-458. Accessed 9/27/2022.
