Diagnosis of pelvic congestion syndrome
As with all medical diagnoses, the first and most important thing is to suspect it. With simple pelvic congestion syndrome, any one or more of the symptoms above should raise suspicion of pelvic congestion syndrome.
In addition, any woman who has had a baby naturally (by normal vaginal delivery) and has either noticed varicose veins around the vulva or vagina (vulval varicose veins), or varicose veins on the legs next to the vagina or down the backs of the thighs, is likely to have pelvic congestion syndrome that has linked with leg varicose veins following the delivery of the child. It is the passage of the child through the vagina that disrupts the final valves in these veins connecting the varicose veins of the pelvis with the leg veins.
Whether a woman has symptoms alone, or notices these veins after childbirth, she should undergo tests for pelvic congestion syndrome.
It is quite interesting to note that many gynaecologists do not recognise pelvic congestion syndrome. Many women attend gynaecology clinics with discomfort or pain in their pelvis and are told there is “nothing wrong with them” when the gynaecologists is happy that there are no ovarian cysts, ovarian tumours, adhesions or endometriosis. In most countries it appears the gynaecologists are not trained to look for enlarged varicose veins in the pelvis as a cause of these symptoms.
The optimal way of testing for pelvic congestion syndrome is a transvaginal duplex ultrasound scan performed by a specialist. Using this technique, provided the specialist is adequately trained, the pelvic varicose veins can easily be seen. In addition, it is possible to know exactly which of the four veins are affected in which are not.
Some centres have used ultrasound from outside of the body. Scanning across the abdomen, the ovarian veins can be seen in slim people and scanning across the perineum, the internal iliac veins can often be seen. However the images are not as good as with a transvaginal duplex ultrasound scan.
More traditional radiologists will perform CT scanning or MRI scanning to see if there are enlarged veins in the pelvis. Although these scans do tell if there are very large varicose veins in the pelvis, they do not always see smaller varicose veins which might still be symptomatic and they do not diagnose which of the veins are causing the problem and which veins have also dilated. Therefore these tests, although easy to perform, are much less helpful than a transvaginal duplex ultrasound scan.
Rarely some doctors will still perform venograms for this condition. Under x-ray control, a catheter can be passed into the ovarian or internal iliac veins in contrast can be injected. X-rays are then taken to see which way blood is flowing. However this is very inaccurate as the contrast used is cold and heavy and does not flow as one would expect blood to.