When we think of the pelvic floor, our most immediate thoughts go the pelvic floor muscles and although they are a VERY important part of our pelvic health, there several other significantly important parts. We cannot overlook the importance of a sufficient and competent network to provide the blood supply to all parts of the pelvis. The arteries of the pelvis provide oxygenated blood to the organs and tissues of the pelvis and transmit blood that supplies the lower limbs. The veins of the pelvis will drain the deoxygenated blood and return this blood to the heart.
Pelvic Congestion Syndrome (PCS) is a condition that occurs when this vascular system is disrupted, and this blood flow is not happening the way that it should be. PCS is often misdiagnosed because its symptom presentation may be similar to other conditions. If you have been experiencing pelvic pain for longer than 6 months…it is important to keep reading!
Pelvic Congestion Syndrome occurs when the pelvic veins, particularly the veins that surround the uterus and the ovaries, become distended and congested, and no longer allow for adequate drainage. As a result, the blood begins to pool, and the veins become engorged. This can result in pelvic pain, along with several other symptoms. Herein lies the dilemma in proper diagnosis…but we will get back to that later!
Symptoms will differ amongst individuals however people suffering with PCS will experience one or many of the following symptoms:
· Feelings of “fullness” in the pelvis, the vagina, the perineum and/or the labia
· Pain in the pelvis, the abdomen and/or the low back which is often described as sharp and heavy or dull and aching. The pain is persistent and is typically present for longer than 6 months. Pain may be felt on one side or bilaterally.
· Swelling in the vaginal canal, the perineum, and/or the labia/labial folds.
· Pain during or after intercourse.
· The presence of varicosities (varicose veins) in the front, back or inside of the thighs, in the vagina, the labia (labial folds), the perineal area, and/or the area over the pubic symphysis (mons pubis).
· Bladder and/or bowel issues including urinary incontinence, urgency and frequency, constipation and/or diarrhea.
· Fatigue, insomnia, and/or depression and anxiety.
· Pain will often worsen around menstruation and after periods of prolonged standing or prolonged sitting. The pain is typically worse by the end of the day.
In order to test for venous insufficiency in PCS, healthcare providers may utilize diagnostic testing. This testing may include pelvic, abdominal, and/or labial ultrasounds, doppler ultrasounds, MRI and/or CT scans, and venography. Diagnosis is often one of exclusion, whereby other pelvic conditions are ruled out and this can be frustrating and time consuming. It requires the dedication of a determined healthcare team.
Risk factors for PCS include but are not limited to:
· Multiple pregnancies
· Multiple births
· A family history of PCS
· Hormone dysfunction
· Polycystic ovaries
· Retroverted “tipped” uterus.
· Varicose veins in the lower limbs
Pelvic Congestion Syndrome is more common in females, but males may experience PCS as well. Males present with similar symptoms to females and may present with varicosities in the scrotum, and the testes. PCS in males is often misdiagnosed as prostatitis.
A Pelvic Physiotherapist is a vital member of your healthcare team. They will perform a thorough objective examination, and develop a detailed, individualized treatment plan. This treatment plan may include advanced manual therapy techniques including myofascial release, elongation/relaxation of the pelvic floor muscles, tender point release, retrograde massage, lymphatic drainage, posture, and positioning to assist blood flow, therapeutic exercise, and pelvic floor muscle strengthening to assist with blood and lymphatic drainage as well as bowel and bladder education.
There are other treatment options including hormone therapy, sclerotherapy, or embolization of the affected veins, and/or surgical removal of the damaged veins or organs. Pelvic physiotherapy is the least invasive form of treatment and can significantly improve your pain and your quality of life. If you have been experiencing unexplained pelvic pain for longer than 6 months, and the symptoms above are familiar, it may be time to discuss the possibility of PCS with your healthcare provider. If you are concerned that you have PCS and have questions, a pelvic physiotherapist can be an incredible resource.