The pelvis is the lower part of the abdomen. Pelvic congestion syndrome (PCS) causes chronic pelvic pain in women. The gynecologic organs -- uterus, ovaries, cervix, vagina, and fallopian tubes -- are located in the pelvic area. When the veins that transport blood from these organs to the heart become widened, blood can accumulate in the pelvic area, causing significant pain. For some, this pain is debilitating. It gets worse as the day goes on and is not always relieved by over-the-counter pain relief. A procedure called an embolization is very effective in improving the symptoms of PCS. During an embolization, specialized particles are inserted into the problematic vein to block it off, stopping blood from pooling and eliminating the source of the pain.
Why Pelvic Congestion Syndrome Embolization is Performed
In the United States, an estimated ten million women of child-bearing age suffer from PCS. Despite being a fairly common problem, PCS is not well understood. The pain that PCS causes feels like a constant, dull ache that is worse after long periods of standing. Other women report pain during sexual intercourse. The menstrual cycle also appears to have a role in worsening pain with PCS.
Diagnosis is usually based on an ultrasound that visualizes the problematic vein(s). Treatment for PCS focuses entirely on pain reduction. When over-the-counter pain relief is not effective in reducing the pain, embolization may be recommended. This is a minimally invasive procedure to stop the blood flow to the problematic vein(s).
What to Expect During Pelvic Congestion Syndrome Embolization
Pelvic congestion syndrome embolization is performed by an interventional radiologist in a procedure suite. The patient is given an intravenous (IV) line for the delivery of sedative medication. Skin in the pelvis area is numbed and the physician makes a small incision. From here, a catheter (thin plastic tube) is threaded through the incision until it reaches the pelvic veins. This process is aided by imaging technology, such as CT or ultrasound, to ensure safe access to the correct vein. Next, the physician injects a dye, called contrast, that helps to make x-ray images of the veins more clear. Once the malformed vein is located, embolic agents are injected into the vein. Embolizing agents are synthetic particles that may be tiny coils or a gluelike substance. Once the agent(s) lodge into the deformed vein, blood flow is stopped, leading to significantly reduced pain.
Risks and Benefits of Pelvic Congestion Syndrome Embolization
Embolization is a safe procedure that has many uses. When used to address the pain of PCS, it has been shown to be very effective. Nearly 80 percent of women that underwent embolization for PCS reported success with the procedure. As embolization is non-invasive, it has fewer complications than a surgical intervention, including less chance of bleeding, and no hospital stay. But since it is a medical procedure involving catheter placement, there are some risks. For example, a blood vessel could be damaged during the insertion process. There is also a risk of infection at the incision site, as well as bleeding or bruising. Lastly, it is possible that a piece of the embolic agent could unintentionally reach healthy tissue. However, serious complications are uncommon.
How to Prepare for Pelvic Congestion Syndrome Embolization
The care team will review the patient’s medications to identify any that may need to be paused prior to the procedure. These include therapies like blood thinners. Routine pre-procedural bloodwork to assess overall health status and the ability of the patient’s blood to clot may also be ordered. Transportation arrangements for getting home following discharge should be made according to instructions from the care team.
Post Pelvic Congestion Syndrome Embolization
Most women who undergo embolization for pelvic congestion syndrome are discharged after no more than a single overnight hospital stay for observation and pain management. Any residual pain after this point can be treated with over-the-counter pain relief medication. A woman should be able to resume her normal daily activities within a week following the procedure.