Pelvic Congestion Syndrome Ultrasound: Diagnostic Techniques

A pelvic congestion syndrome ultrasound is a key diagnostic tool for identifying this often-misunderstood cause of chronic pelvic pain. Your doctor mentions a possible explanation for your chronic pelvic pain – Pelvic Congestion Syndrome (PCS). You’ve never heard of this medical condition before and it fills you with both a trill of nervousness and a shred of cautious hope. Is there finally a name to go with your recurring pain?

What’s involved in Pelvic Congestion Syndrome? How can your healthcare provider confirm his suspicions? Let’s dive into PCS to learn more about this vascular condition and understand what to expect on the road ahead.

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome is a condition characterized by an irregular or even reversed blood flow in the pelvic area. It is often seen in premenopausal women of childbearing age. It is actually quite common in multiparous women – those who have given birth to multiple children. The condition may be referred to by several names:

• Pelvic Venous Insufficiency
• Pelvic Venous Incompetence
• Pelvic Venous Reflux

While the symptoms of this condition are common across multiple disorders, some specific signs point to Pelvic Congestion Syndrome as a diagnosis. Let’s conduct a systematic review of this symptom list and then examine the preferred method of diagnosing.

What to Expect From Pelvic Congestion Syndrome: From Chronic Pelvic Pain to Varicose Veins

What are the clinical symptoms of PCS? Pelvic Congestion Syndrome features chronic pain that just won’t go away. Chronic pelvic pain complaints are often described as a dull ache in the pelvis or lower back. Pain worsens with standing or sitting for long periods. Sometimes laying in a supine position will provide a measure of pain relief. Some women experience pain during sexual intercourse too.

Another evidential symptom of Pelvic Congestion Syndrome is pelvic varicose veins. Due to hormonal changes associated with pregnancy or other blood flow issues, pelvic varices develop. The name Pelvic Venous Insufficiency is apt because in many cases the veins form incompetent valves that don’t prevent blood from flowing backward. With venous reflux of this sort, blood can pool in the pelvic veins creating a feeling of heaviness.

As the retrograde flow worsens, a physical examination may reveal visible pelvic varicosities that develop on the abdomen, thighs, butt, and vulva. Varicose veins are an outward sign that dilated veins are becoming enlarged and weakened. But internal damage is also happening. Ovarian veins can also become enlarged, twisted, or blocked.

Because of venous obstruction or stretching, some women also experience irritable bowel pain with alternating diarrhea and constipation. Urinary frequency and urgency can also increase.

Now that we understand what symptoms many go through, what methods are used in the diagnosis process?

Transabdominal and Transvaginal Sonography

Several types of imaging are used to visualize pelvic veins. The first method often chosen is one of the least invasive. A sonogram picture is taken using Color Doppler ultrasound. Sound waves show the venous flow with blood moving toward the ultrasound device showing red and blood flow away displaying as blue.

The Color Doppler ultrasound is especially useful while performing the Valsalva maneuver. The patient is asked to push out their breath against a pinched nose and closed mouth. This creates a temporary rise in blood pressure to help reveal the body’s reaction under stress and strain.

Transvaginal ultrasound can help to spot enlarged ovarian veins that are a common cause of Pelvic Congestion Syndrome. While the ovarian veins are the most commonly affected blood vessels in PCS, other veins can develop pelvic varices, including:

• Circumflex femoral and obturator veins: Dilated pelvic veins can cause pelvic venous reflux in the legs or vulvar varicose veins.
• Internal iliac veins: Compression of the left common iliac vein by the right iliac artery or the left renal vein by the aorta and superior mesenteric artery may cause incompetent valves.
• Inferior vena cava: Obstruction can cause swelling and other symptoms of PCS.

Computed Tomography

In a CT scan, X-rays are used to create a cross-sectional slice that helps the doctor determine if venous dilatation is the culprit behind your pelvic pain. It is a higher resolution than pelvic ultrasound and can help determine the diameter of the right and left ovarian vein or other potential areas of concern.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) uses strong magnetic fields to force the atoms to align. They are bombarded with radio waves that bounce off the atoms and create a high-definition 3D scan. An MRI can show details of the pelvic veins that an ultrasound may miss.

Pelvic Venography

Like the CT, pelvic venography uses X-rays to image the pelvic organs and blood vessels. A contrast dye is injected to help highlight veins so pelvic varices can be more readily seen.

Why Have I Developed Pelvic Venous Insufficiency?

This question is probably on your mind if you’ve received an official PCS diagnosis. While there are lifestyle factors at play, there are also many complex relationships between conditions that affect pelvic veins. For example, anatomical variations in blood vessels can reduce blood flow, create vein damage, and lead to Pelvic Congestion Syndrome.

May-Thurner Syndrome, also known as iliac vein compression syndrome occurs when the right common iliac artery compresses the left common iliac vein against the spine. This can create leg pain, swelling, and varicose veins in the upper legs.

Nutcracker Syndrome happens when the left renal vein compresses the abdominal aorta and superior mesenteric vein. This leads to left-side or back pain, headaches, bloating, abdominal pain, and leg swelling.

Please speak with your doctor if you think your symptoms match Pelvic Congestion Syndrome (aka Pelvic Venous Insufficiency) so they can begin a detailed physical exam and diagnosis.

Conclusion

Pelvic Congestion Syndrome, or Pelvic Venous Incompetence, is a condition where chronic pelvic pain caused by improper blood flow paired with varicose veins leads to reduced or reversed venous flow. There are treatment options available but the diagnosis phase can be quite lengthy. Health professionals have a variety of tools at their disposal to aid in providing a comprehensive analysis, including ultrasound, CT, and MRI technologies. Reach out to your doctor today to start on the path to relief.