The cause of pelvic congestion syndrome
Pelvic congestion syndrome can be thought quite correctly as “varicose veins of the pelvis”. There are two very long veins down the back of the abdomen that come from nearby the kidneys and end up around the ovaries in women. These are called the ovarian veins. In normal life, they take blood from the ovaries, against gravity, and return it back to the heart. Just as with varicose veins in the legs, this can only happen if there are good valves in the veins stopping the blood from falling backwards.
In some people these valves fail. When they do the blood falls back down the ovarian veins, causing the veins around the ovaries to dilate and become enlarged (to become “varicose”). In males, the same veins are associated with the testicles which come out through the muscle wall and into the scrotum. When the valves fail in these testicular veins, there are varicose veins in the scrotum which are called varicoceles. As these are on the inside, they are easily diagnosed and they do not push on any internal organs and hence do not cause a congestion syndrome in men.
Women also have two shorter veins in the pelvis called the internal iliac veins. These too can lose their valves causing varicose veins in the pelvis (pelvic congestion syndrome) or if they run to the bottom of the bowel, can cause haemorrhoids. There has been quite a lot of interest as to the cause of haemorrhoids with many bowel surgeons looking at the arteries. However a chapter written by Mark Whiteley MS FRCS (Gen) FCPhleb (Consultant Vascular Surgeon, UK) in a book published for the 34th Charing Cross symposium in 2012 has suggested that haemorrhoids may be due to the loss of valves in these internal iliac veins.
Therefore in women, pelvic congestion syndrome can be due to the loss of valves in any of the four veins – whether one, two, three or even all four veins of these pelvic veins.