Eliza Etter PT, DPT, CLT
Do you ever notice at the end of the day your feet or ankles seem swollen? If you were on your feet for a long portion of the day, your feet, ankles, and legs may feel achy or heavy. This is not an uncommon experience and most of us have probably felt this at some point in our lives. But have you ever felt a similar sensation in your pelvis? If so, it could be related to something called Pelvic Congestion Syndrome.
What is Pelvic Congestion Syndrome?
Pelvic Congestion Syndrome (PCS) is essentially varicose veins in the pelvic region. There are several large veins coursing through the pelvis and around the pelvic organs. These veins can become “incompetent” meaning that they are no longer pumping blood back up towards the heart as effectively as they should. As a result, the blood begins to pool in these veins of the pelvis, termed “pelvic congestion.”
Symptoms of PCS often include chronic pelvic pain not associated with menstruation or a heaviness feeling in the pelvis which may frequently worsen with prolonged standing. PCS also has been found to have associations with painful periods, pain with sex, urinary urgency, and varicosities in the genitals or legs. A systematic study conducted in 2018 found that PCS was associated with pelvic pain in 30-40% of individuals with chronic pelvic pain diagnoses. The majority of the current literature describes PCS in women, with the prevalence increased in women compared to men, at least in part, due to hormonal changes and pregnancy.
What causes Pelvic Congestion Syndrome?
Similarly, to varicose veins of the legs, there are a number of factors that contribute to PCS.
· Dysfunction in the valves of the veins – These valves inside the veins are supposed to allow blood to travel only in the direction back to the heart, but can become weak and allow some of the blood to flow backwards.
· Anatomy differences in the veins themselves
· Pressure or kinking on the veins – One of the ways this can occur is from the position of the uterus.
· Structural and hormonal changes – These types of changes are often associated with pregnancy.
It is possible that pelvic varicosities may be present for a period of time without any pain or symptoms at all. Slower flow of blood return, inflammation, blood clots and insufficiency can be the result of pelvic varicosities that were possibly already present, but are just now starting to cause pain or symptoms.
How do I know if I have Pelvic Congestion Syndrome?
To be diagnosed with PCS requires medical imaging, such as pelvic venography, ultrasound, or MRI. However, based on your symptoms alone there are things that you can do that may give you some relief from your symptoms.
Tips to Help Relieve Symptoms of Pelvic Congestion Syndrome:
· Stay moving! Sitting or standing in one position for too long can increase the pooling of blood in the veins. When you move, the movement of your muscles assists the veins in pumping blood upward and towards the heart.
· Stay hydrated and eat a low-sodium diet. This can help with decreasing swelling and inflammation throughout your body which can overload your venous system.
· Elevate your pelvis. Just as you would elevate your feet if they were swollen, elevating your pelvis will use gravity as your friend to assist the veins with returning the blood from your pelvis back towards your heart.
· Pelvic floor exercises. Pumping the muscles in your calves can help decrease swelling in the feet and legs, and similarly contracting and relaxing the pelvic floor muscles can help pump the blood out of the pelvis. Not sure how to do this? Contact your pelvic health PT.
· Manual Lymphatic Drainage Massage. This is a particular type of skilled manual therapy that helps to stimulate the lymph vessels, which run along with and help the veins, that further assists and decreases the load on the veins, with moving the excess blood out of the pelvis and returning it towards the heart. Contact your Certified Lymphedema Therapist for this treatment.
For further information and non-invasive treatment options contact a Pelvic Health or Lymphedema therapist who has experience with Pelvic Congestion.
Brown et al. “Pelvic Congestion Syndrome: Systematic Review of Treatment Success.” Seminars in Interventional Radiology, 35.1 (2018): 35–40.
Jurga-Karwacka et al. “A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain.” PLOS One, 14.4 (2019): e0213834.