Symptoms of pelvic congestion syndrome
The symptoms of pelvic congestion syndrome are mainly:
“aching” or “dragging” feeling in the pelvis, particularly during the time of the period
discomfort on sexual intercourse
All of these symptoms can be understood by understanding the anatomy of the pelvis and what would happen if enlarged veins pushed on those different areas.
The sensation of “aching” or “dragging” is simply the feeling of the weight of excess blood in pelvic veins resting on the pelvic floor. Not surprisingly this is worse when patients are standing, and better when they are lying down. During the time of the period, it is thought that it is worse as the veins distend more at this time of the month.
The bladder lies at the front of the pelvis and the rectum (bowel) at the back of the pelvis. If the distended veins pushed forwards, the bladder can be affected and if they pushed backwards, the bowel can be affected. The pressure of the distended veins can irritate the muscle of either bladder or bowel making it more irritable.
Finally if the veins are enlarged and causing some mild irritation in the pelvis around the vagina, then sexual intercourse may be uncomfortable as this will irritate the area further.
In males, the testicular veins start from the testicles rather than inside the pelvis. As such, when the valves fail and blood refluxes down the testicular vein, it causes varicose veins around the testicle called a varicocele.
Reflux in the internal iliac veins however can cause prominent varicose veins in the buttocks and perineal area, and research from The Whiteley Clinic suggests that they can also cause haemorrhoids. There is also likely to be a link with erectile dysfunction in some men.
Unfortunately the whole area of pelvic venous congestion in both males and females is complex – particularly as the research is showing that in some people, the reflux is secondary to veins that are narrowed and preventing blood from leaving the pelvis easily. In females, transvaginal duplex ultrasound scan and IVUS (intra vascular ultrasound) is allowing us a better understanding of the problem. In males, we do not have a test at the moment that allows us good understanding of this complex problem.