By Emily Quinn PT

What is Pelvic Congestion Syndrome?:

Pelvic Congestion Syndrome (PCS) is a pelvic pain condition that affects the veins in the pelvis. With the help of one-way valves in our veins, under normal circumstances, blood from the pelvis will travel towards the heart. In PCS, pelvic veins become distended and no longer function as optimally as they once did, leading to blood pooling in the affected areas.

Photo retrieved from tampacardio.com on January 31st, 2021.

Symptoms:

People with PCS typically experience lower abdominal and/or low back discomfort. Often times, due to hormonal changes, pain tends to worsen immediately prior to menses. Symptoms generally worsen throughout the day and with prolonged standing or activity. There may also be pain during and/or following intercourse.  Varicose veins in the lower extremity (including the vulva and legs) and hemorrhoids are also common.  Due to the close proximity of veins and nerves in the pelvis, some nervous structures may also be affected in some people, which can result in altered sensation and/or weakness in certain areas of the lower extremity.

 Who does it affect?

Estrogen weakens venous walls, making it more difficult for veins to support and direct blood flow to their target area. As such, PCS tends to affect women during periods of heightened estrogen levels. This may help to explain why PCS is most common in women of childbearing age between the ages of 20-45. Due to an increased blood volume that occurs during pregnancy, women with multiple pregnancies are at a higher risk of developing PCS. In addition, individuals that perform frequent heavy lifting are also at a greater risk of developing PCS.

Diagnosis:

As many of the symptoms listed above may also occur in many other pelvic pain conditions, a PCS diagnosis is challenging and is often made by exclusion of other conditions after 6 months of symptom onset. Many imaging techniques may be used to help diagnose PCS including venography, pelvic and abdominal ultrasounds, Doppler ultrasound, CT imaging, MRI and laparoscopy.

Treatment:

As PCS can affect many aspects of an individual’s overall well being, a comprehensive, multidisciplinary treatment approach is often recommended. From a medical perspective, hormonal medications and analgesics may be indicated. In addition, some people may require surgical interventions. Psychotherapy and pelvic floor physiotherapy may also be involved for symptom management.

How does pelvic floor physiotherapy help?

As with many other pelvic pain conditions, symptoms may arise from or be exacerbated by pelvic floor dysfunction. In some cases, these muscles become weak, overactive and tight and/or have difficulties coordinating. This can in turn influence bowel, bladder, sexual function and can cause or amplify pain in the pelvis, low back and genital regions. Further, as one of the key functions of the pelvic floor muscles is to serve as a sump-pump by pumping blood towards the heart, pelvic floor dysfunction may also contribute to pelvic congestion. Pelvic floor physiotherapists are trained to use a biopsychosocial approach and consider mechanical, emotional and psychological contributors to an individual’s symptoms. By using a multimodal treatment approach including education, exercise prescription, posture correction and hands- on techniques to tissues, pelvic floor physiotherapists help individuals optimize their pelvic floor function and assist them in getting back to the things that they love doing.

References:

https://www.pelvicpain.org/common/Uploaded%20files/Patient%20Handouts/PELVIC%20CONGESTION%20SYNDROME.pdf

Ignacio, E. A., Dua, R., Sarin, S., Harper, A. S., Yim, D., Mathur, V., & Venbrux, A. C. (2008). Pelvic congestion syndrome: Diagnosis and treatment. Seminars in Interventional Radiology, 25(4), 361–368. http://doi.org/10.1055/s-0028-1102998

Level 1: The Physical Therapy Approach to Female and Male Urinary Incontinence. Pelvic Health Solutions. 2019.