Pelvic congestion syndrome (PCS)

• Ovarian vein and pelvic varicosities
• Pelvic venous incompetence

• 625.5 Pelvic congestion syndrome

• G89.4 Chronic pain syndrome
• R10.2 Pelvic and perineal pain
• N94.89 Other specified conditions associated with female genital organs and menstrual cycle

• As of July 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology
• Associated or secondary musculoskeletal patterns include:
  • Pattern 4C: Impaired muscle performance1
  • Pattern 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction1

• 729.1 Myalgia and myositis, unspecified
• 782.3 Edema

Description2

• Non-cyclical, poorly localized pelvic pain
• Pain worsened by sitting, standing, at the end of the day, during or after intercourse
• Blood pooling in the pelvic and ovarian veins
• Pain associated with varicose veins in the thigh, buttock regions, and vaginal area

Essentials of Diagnosis

• Initially is a diagnosis of exclusion
• Multidisciplinary approach to rule out other end organ pathology
• Standard workup includes abdominal and pelvic examination, Pap smear, routine blood work, cross sectional imaging

General Considerations

• Chronic pain condition
• Often misdiagnosed
• PT intervention is often appropriate for associated musculoskeletal impairments
• Diagnosis is a process of exclusion and often takes time, requiring intensive diagnostic testing
• Urogenital pain disorders frequently affect nearby body areas; especially back, pelvic, hip, and groin regions, and may be inappropriately referred to PT
• May mimic other visceral pain conditions including colon cancer or tumor, irritable bowel, colitis
• May mimic gynecologic problems in females: endometriosis, uterine fibroids, ectopic pregnancy

Demographics

• Only in females, typically between ages of 20 to 452
• More prevalent in multiparous women
• Exact prevalence of pelvic congestion syndrome is unknown

Signs and Symptoms2

• Symptoms often worsened by prolonged sitting or standing, anxiety, bowel movements, physical activity, or sexual intercourse
• Pain becomes progressively worse throughout the day
• Generalized lethargy, depression
• Abdominal or pelvic tenderness
• Vaginal discharge
• Dysmenorrhea
• Swollen vulva
• Lumbosacral neuropathy
• Rectal discomfort
• Urinary frequency
• May have tenderness of the uterine cervix, ovaries, or uterus
• Pain during sexual intercourse
• Report of vaginal, rectal, or lower abdominal pain.
• Symptoms are usually vague and poorly localized

Functional Implications

• Pain
• Painful urination, defecation, and sexual activity
• Urinary urgency and frequency
• Fatigue, lethargy

Possible Contributing Causes

• Pregnancy and vaginal childbirth

Differential Diagnosis

• Bowel pathology
• Cancer
• Neurologic pathology
• Musculoskeletal pathology or impairment
• Gynecologic problems in females
  • Endometriosis
  • Menses
  • Ectopic pregnancy
  • Ovarian cyst
  • Fibroids
  • Menopause
  • Uterine prolapse
• Fibromyalgia
• Urologic pathology
• Pelvic inflammatory disease

Laboratory Tests

• Blood tests
• Pap smear
• Urine culture/urinalysis
• H&H for signs of bleeding, anemia, pathogens, immune status, vitamin deficiencies, white blood cell count