Pelvic Congestion Syndrome

 

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Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Megan Petty, Cynthia Brown, Elaine Lonnemann, WikiSysop, Kim Jackson, Nicole Hills and Lucinda hampton  

Definition/Description

A manifestation of Peripheral Vascular Disease (PVD) in ovarian veins which causes the blood to flow backwards instead of forward, or up, towards the heart (1). "Vericose Veins of the ovaries" (1). This syndrome has various names such as ovarian variocele or ovarian varicocele (1).

Prevalence

Most often seen in women who are of childbearing age, or older (1). Majority of women who are affected have had a history of multiple pregnancies (1). This syndrome can also occur in men and is diagnosed through presentation of visible varicosities on the scrotum (1). Is the cause of about 10-15% of referrals to gynecologists or other pain related clinics (4).

Characteristics/Clinical Presentation 

Pelvic Congestion Syndrome may be asymptomatic and often times may go undiagnosed (4). Can cause continuous or intermittent lower abdominal or pelvic pain, ranging from a dull ache to a sharp severe pain (1). Duration of pain can last more than 6 months (2). The lower abdominal, or pelvic, pain associated with PCS can be felt unilaterally,on one side, or bilaterally, occurring on both left and right sides of the body (1). The pain usually is worse by the end of the day, with long periods of standing, or related to the onset of mensus (1,2).

Other common clinical presentations, noted in Goodman (1), associated with PCS include:

• Tenderness upon deep palapation of the ovarian point  
• Dyspareunia  
• Presence of varicose veins in the buttock and/or lower extremities
• Headache  
• Gastrointestinal pain/discomfort  
• Changes in bowel and bladder  
• Fatigue  
• Insomnia  
• Heaviness feeling felt in the lower abdomen or pelvic region  
• Lower back pain worsened upon standing upright

Ignacio et al. (2) also found other associated signs and symptoms related to PCS including:

• Increased pain at the end of the day
• Pain increased upon sitting and/or standing
• Lethargy
• Depression
• Vaginal discharge
• Dysmenorrhea
• Swollen vulva
• Lumbosacral neuropathy
• Rectal discomfort

Associated Co-morbidities

Impaired circulatory function, such as peripheral vascular disease, is often associated with PCS (1).

Medications

Patients with PCS can often be prescribed hormonal medications (4). This pharmacological management of this condition is directed towards decreasing congestion from the varicose veins, and also decreasing blood flow to the varicose veins (5).

Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

Due to clinical presentation, PCS has an extensive list of differential diagnosis to be ruled out prior to the diagnosis. Ignacio et al. has suggested the following differential diagnosis list:

• Bowel Pathology
• Cancer
• Endometriosis
• Fibroids
• Fibromyalgia
• Ovarian Cyst
• Pelvic Inflammatory Disorder
• Porphyria
• Uterine Prolapse
• Orthopedic, Neurologic, or Urogenic Pathology (2)

In addition to some characteristics above, Semmel also suggested the remaining differential diagnosis:

• Leiomyoma
• Adenomyosis
• Nutcracker Syndrome
• Inflammatory Bowel Syndrome
• Diverticulitis/Diverticulosis/Meckel's Diverticulum
• Interstitial Cystitis
  
• Fascitis
• Psychosexual Dysfunction
• Depression (6).

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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