Pelvic compression syndrome

Pelvic compression syndrome is characterized by an intermittent or persisting pain in the abdomen, which is exacerbated by abdominal pressure. It is caused by a swelling of the veins in the valveless pampiniform plexus.

Pelvic Compression Syndrome
SpecialtyGynecology, Urology
Symptomsconstant to intermittent, dull to sharp pain to pelvis especially with increased abdominal pressure, dyspareunia.
Usual onsetpuberty
Durationthree months or longer
Diagnostic methodVenography, physical exam
Differential diagnosisPainful bladder syndrome, pelvic inflammatory disease, interstitial cystitis, endometriosis, pelvic neuralgia, irritable bowel syndrome, myofascial pain, and pelvic floor myalgia
TreatmentLigation of incompetent veins
MedicationGonadotropin-releasing hormone agonists, danazol, combined oral contraceptives, progestins, phlebotonics, and non-steroidal anti-inflammatory drugs
Frequencyunknown

Pathophysiology

While varicocele is the diagnostic term for swelling in the valveless venous distribution of the male pampiniform plexus, this embryological structure, common to males and females, is often incidentally noted to be swollen during laproscopic examinations in both symptomatic and asymptomatic females.[1] Diagnosis of female varicocele, properly called pelvic compression syndrome, should be expected to be as frequent as male varicocele (15% of healthy asymptomatic men which are thought to develop primarily during puberty and prevalence increases approximately 10% per decade of life [2]).

Signs and symptoms

While one may expect that the female to have equal prevalence of pelvic compression syndrome due to the identical embryological origin of the valveless pampiniform plexus, this condition is thought to be underdiagnosed due to the broad differential of the pain pattern: unilateral or bilateral pain, dull to sharp, constant to intermittent pain worsening with any increase in abdominal pressure.[3]

Diagnosis

Physical exam has specificity of 77% and sensitivity of nearly 94% when the patient is noted to be tender over adnexa during physical examination with a history of postcoital pain for differentiating pelvic congestion syndrome from other pathologies of pelvic origin [4]

Imaging

Confirmatory imaging requires ultrasound while performing Val Salva, while the gold standard remains ovarian and iliac catheter venography showing veins 5-10mm in diameter during Val Salva.

Prognosis

Complete resolution of symptoms after menopause indicates the influence of hormones on pelvic congestion syndrome. Estrogen is a venous dilator and can thus produce the venous dilation implicated in the pathophysiology of the PCS.[3]

References
  1. Tu FF, Hahn D, Steege JF. Pelvic congestion syndrome-associated pelvic pain: a systematic review of diagnosis and management. Obstet Gynecol Surv. 2010 May;65(5):332-40.
  2. Alsaikhan, B.; Alrabeeah, K.; Delouya, G.; Zini, A. (2016). "Epidemiology of varicocele". Asian Journal of Andrology. 18 (2): 179–181. doi:10.4103/1008-682X.172640. PMC 4770482. PMID 26763551.
  3. Saadat Cheema, Omer; Singh, Paramvir (June 16, 2023). "Pelvic Congestion Syndrome". StatPearls. StatPearls Publishing. PMID 32809625 – via PubMed.
  4. O'Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015 Jan;3(1):96-106.
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