Understanding pelvic congestion syndrome

A hidden source of chronic pain

There are many common chronic conditions that the population suffers from every day.

Chronic back pain.

Neck pain.

Headaches.

You can probably think of a few more off the top of your head.

However, there’s another condition that can make people feel too embarrassed to mention – simply because of where it is.

Let’s make the uncomfortable, comfortable. Gather around.

What is pelvic congestion?

Chronic pelvic pain is a silent struggle for many individuals, and one of its lesser-known culprits is pelvic congestion syndrome (PCS).

Similar to the way we develop varicose veins, pelvic congestion starts when the valves of the pelvic veins become weak and normal blood flow is disrupted.

As the blood starts to pool, the pelvic veins enlarge, often causing pain and a sense of fullness or pressure.

The symptoms of PCS can vary, but often involve:

1. Chronic pelvic pain: A dull, uncomfortable pain that worsens throughout the day, especially after sitting or standing for long periods
2. Pain during or after sex
3. Swollen vulva or visible varicose veins in the vaginal area, buttocks or thighs
4. Pain that worsens during period cycles or after exercise
5. Lower back pain or a feeling of heaviness in the pelvis
6. Fatigue
7. Changes in bowels and bladder

Because these symptoms overlap with many conditions, PCS is often misdiagnosed or overlooked.

It shouldn’t be. That’s why we want to bring this conversation to light, because your voice and the advocation for your health deserve to be heard.

For example, PCS has been found to have similarities to endometriosis, painful periods, pelvic heaviness and other reproductive issues, so diagnosing it can be incredibly challenging.

Why does this happen?

Since this chronic condition is difficult to diagnose, multiple factors play into why PCS occurs:

1. Valve dysfunction: Veins have one-way valves that make sure blood flows back to the heart. With PCS, these valves can weaken, making blood flow backward. This can cause blood to pool in the pelvic veins, leading to increased pressure and swelling.
2. Hormonal influences: High levels of estrogen, a hormone that increases during pregnancy and in the reproductive years, can weaken vein walls and make them more prone to dilation. This explains why PCS is more common in women of childbearing age and women who have had multiple pregnancies.
3. Pregnancy: This is a significant risk factor for PCS because of an increased blood volume to support a growing baby, which causes extra pressure on the veins, an enlarged uterus throughout pregnancy and a lot of hormonal changes.
4. Obstruction of blood flow: In some cases, pressure from a mass or tumor, can clog the veins, causing blood to pool in the pelvic area.
5. Lifestyle and postural factors: Prolonged standing or sitting can worsen venous insufficiency, because these positions increase the gravitational pull on blood, making it difficult for the veins to return blood back to the heart.

How it affects men and women

PCS is more likely in women, but the underlying mechanism of vein congestion can affect both men and women.

Let’s break it down.

In women, PCS is primarily associated with varicose veins in the pelvic region, often due to hormonal changes, pregnancy and other factors that compromise vein function.

Causes in women:

• Pregnancy/multiple pregnancies: Increased blood flow, estrogen and pressure from an enlarged uterus contribute to vein dilation.
• Hormonal factors: High levels of estrogen weaken vein walls.
• Varicose veins: Often seen in the vulva, legs or other pelvic regions.

In men, pelvic congestion is less commonly diagnosed, but can occur due to enlarged veins in the scrotum.

Causes in men:

• Pelvic venous insufficiency: Venous reflux in the pelvic region.
• Prostate issues
• Lifestyle factors: Obesity, prolonged sitting or heavy lifting can worsen venous congestion.

Some symptoms that men typically experience include scrotal pain or heaviness, visible veins in the scrotum, lower back pain or pelvic pain and, in severe cases, erectile dysfunction.

Related to this topic is genital lymphedema.

This condition can occur in both men and women, but it tends to be seen more in men due to external genitalia providing more surface area for fluid accumulation.

In women, this condition is commonly seen in the vulva area, but the extent of external swelling is less prominent because of differences in tissue structure. It’s caused by postpartum changes, pelvic or gynecological cancer treatments or chronic venous insufficiency.

Genital lymphedema is an accumulation of lymphatic fluid in the genital tissues, leading to swelling, discomfort and functional impairments. It occurs when the lymphatic system, which is responsible for draining excess fluid and waste products from tissues, is disrupted or overwhelmed in the genital region.

This can arise from a variety of underlying issues, including:

1. Primary lymphedema: A rare condition caused by dysfunction of the lymphatic vessels.
2. Secondary lymphedema
   1. Surgery or radiation therapy: Commonly seen after cancer treatments, such as prostate, cervical or gynecological surgeries.
   2. Infection: Repeated infections, like cellulitis, can damage lymphatic vessels.
   3. Trauma: Physical injury to the lymphatic system or genital area.
   4. Cancer: Tumors in the pelvis or lower abdomen can block lymphatic drainage.
3. Obesity: Excessive weight can place pressure and strain on the lymphatic system, leading to dysfunction.
4. Vein insufficiency: Poor blood flow in the veins can contribute to lymphatic overload.

Genital lymphedema symptoms include swelling in the genitals, thickened skin, pain, reduced mobility or recurrent infections.

Managing and treating genital lymphedema is similar to treating PCS, which is what we’re going to dive back into.

Diagnosing and treating PCS and other conditions

Diagnosing PCS can be challenging because it presents itself as other conditions, such as endometriosis, other gynecological conditions and some areas of genital lymphedema.

The important thing to remember is the more open and honest you are about your symptoms and what you’re experiencing, the easier it will be to get an accurate diagnosis.

It’s understandable why you probably want to keep some symptoms a secret because these conditions affect private areas.

Do you want the good news? This information will stay between you and your health care provider.

Here’s what the diagnostic process can look like:

1. Starting with a conversation: Talk to your health care provider about any pelvic symptoms you may be having. Your vascular health isn’t limited to spider veins or swelling in your ankles, so don’t be self-conscious when discussing varicose veins near the groin or swelling in private areas.
2. Medical history: A health care provider will ask you questions about your overall health, family history and other symptoms you’re experiencing.
3. Imaging: It’s best practice to get a pelvic exam and other routine imaging, like an ultrasound, MRI or venography to assess venous reflux or dilation.
4. Testing: Pelvic venography is the most conclusive imaging technique for diagnosing PCS. This is a minimally invasive procedure performed by a vascular specialist.
5. Treatment:
   1. Lifestyle changes: Weight management, exercise and avoiding prolonged sitting or standing
   2. Medications: Hormone therapy in women; anti-inflammatory medications for pain relief in both men and women
   3. Vein embolization: To redirect blood flow

Finding a pelvic health specialist at a physical therapy center is an excellent step toward managing symptoms of both PCS and genital lymphedema.

These specialists have expertise in addressing the complex issues of the pelvic region, including swelling, pain and functional impairments through a multidisciplinary approach.

A pelvic health physical therapist has the knowledge to diagnose the root cause of your symptoms, develop an individualized plan that works best for you and provide strategies to improve quality of life and minimize discomfort.

What to expect during physical therapy

A comprehensive evaluation will be conducted to assess your medical history as well as a physical examination. A physical therapist will assess the pelvic area for swelling, tenderness and visible varicose veins for PCS.

Based on these findings, a pelvic health physical therapist will recommend a combination of solutions, such as lifestyle modifications, including posture adjustment and avoiding prolonged standing and sitting, and exercise therapy involving gentle movements to improve blood flow and reduce venous pressure.

For genital lymphedema, a few different forms of physical therapy can be integrated, such as manual lymphatic drainage — a specialized massage technique to promote lymphatic flow and reduce swelling — compression garments to reduce fluid buildup in the genital area and pelvic health therapy to strengthen the pelvic floor muscles, improve circulation and alleviate discomfort.

A pelvic health therapist will be there for you emotionally as well. They understand and believe the symptoms you’re experiencing. You can trust them with this process.

Living with PCS, genital lymphedema and other gynecological conditions can be challenging, but understanding the condition is empowering and finding a specially trained pelvic health physical therapist is the first step you can take toward relief.

If you’re experiencing any of these chronic issues, it’s time to advocate for yourself and seek a specialist.

Early diagnosis and targeted treatment can significantly improve quality of life and help individuals return to daily activities without debilitating pain.

We hear you and understand you. There’s no need to be afraid when you see our pelvic health experts.