{"id":20738,"date":"2025-08-07T13:28:12","date_gmt":"2025-08-07T13:28:12","guid":{"rendered":"https:\/\/venaziel.de\/pelvic-congestion-syndrome-pcs-when-chronic-lower-abdominal-pain-is-not-normal\/"},"modified":"2026-04-01T11:10:25","modified_gmt":"2026-04-01T11:10:25","slug":"pelvic-congestion-syndrome-pcs","status":"publish","type":"post","link":"https:\/\/venaziel.de\/en\/pelvic-congestion-syndrome-pcs\/","title":{"rendered":"Pelvic congestion syndrome (PCS): when chronic lower abdominal pain is not &#8220;normal&#8221;"},"content":{"rendered":"<h2><b>Invisible pain in the pelvis &#8211; but not imaginary<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Many women suffer from a dull, pressing pain in the lower abdomen &#8211; often independent of the menstrual cycle, chronic and aggravated by prolonged sitting or standing. But too rarely is a serious cause considered: Pelvic Congestion Syndrome (PCS), also known as ovarian varicosis or pelvic vein congestion.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One in three women could be affected by it in the course of her life &#8211; but hardly anyone knows the diagnosis. Today, there are modern, minimally invasive treatment methods such as endovascular coiling, which is offered at VenaZiel\u00ae.<\/span><\/p>\n<h2><b>What is Pelvic Congestion Syndrome (PCS)?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Pelvic congestion syndrome is a chronic venous disease. It is caused by varicose veins in the pelvic veins, particularly in the ovarian veins (ovarian veins) or internal iliac veins. These dilated, overstretched veins lead to blood congestion, similar to varicose veins in the legs &#8211; only inside the body.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">These pelvic varices exert pressure on surrounding organs, irritate nerves and lead to a number of unpleasant symptoms.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2><b>How common is PCS &#8211; and why is it so often overlooked?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">It is estimated that every third woman of childbearing age is affected by pelvic varices &#8211; with or without symptoms. Despite this, PCS often remains unrecognized. Why?<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The symptoms are non-specific (e.g. abdominal pain, back pain).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Many symptoms also occur with other illnesses (e.g. endometriosis, irritable bowel syndrome).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Many doctors are not yet sufficiently aware of PCS.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">PCS occurs particularly frequently with:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Women between the ages of 20 and 50<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Women with multiple pregnancies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Pre-existing family history (varicosis)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prolonged, inconspicuous pelvic pain<\/span><\/li>\n<\/ul>\n<p><b>Typical symptoms: How Pelvic Congestion Syndrome manifests itself<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Not every woman with ovarian varicosis has symptoms. But when symptoms occur, they can have a significant impact on life:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">  Chronic pelvic pain, especially after prolonged sitting or standing<\/span><\/li>\n<li><span style=\"font-weight: 400;\">  Pain during sexual intercourse (dyspareunia)<\/span><\/li>\n<li><span style=\"font-weight: 400;\">  Increasing discomfort before menstruation<\/span><\/li>\n<li><span style=\"font-weight: 400;\">  Feeling of pressure and heaviness in the lower abdomen<\/span><\/li>\n<li><span style=\"font-weight: 400;\">  Varicose veins in the external genital area or on the thighs<\/span><\/li>\n<li><span style=\"font-weight: 400;\">  Back pain or pain in the groin<\/span><\/li>\n<li><span style=\"font-weight: 400;\">The pain is usually dull, aching, cannot be localized precisely &#8211; and often subsides when lying down.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Diagnosis of Pelvic Congestion Syndrome: How PCS is recognized<\/b><\/p>\n<p><span style=\"font-weight: 400;\">As the symptoms are non-specific, targeted diagnosis is crucial. The following procedures are used:<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li><b>  Medical history and clinical examination<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Detailed questioning about menstrual cycle, pain, vein problems, pregnancies<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Visible varicose veins in the genital or thigh area can provide clues<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><\/li>\n<\/ul>\n<ol start=\"2\">\n<li><b>  Ultrasound (duplex sonography)<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">First choice: visualization of the pelvic veins and blood flow<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Very meaningful in experienced hands<\/span><\/li>\n<\/ul>\n<ol start=\"3\">\n<li><b>  MRI (magnetic resonance imaging)<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Visualization of deeper veins and congestion<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Particularly helpful for unclear complaints<\/span><\/li>\n<\/ul>\n<ol start=\"4\">\n<li><b>  Phlebography (contrast medium X-ray of the veins)<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">&#8220;Gold standard&#8221;: shows exactly which pelvic veins are abnormally dilated<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Allows targeted therapy (coiling) at the same time<\/span><\/li>\n<\/ul>\n<h2><\/h2>\n<h2><b>Treatment of PCS with VenaZiel\u00ae: minimally invasive with coiling<\/b><b><br \/>\n<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">The modern standard therapy today is endovascular coiling &#8211; a minimally invasive procedure that VenaZiel\u00ae offers for affected women.<\/span><\/p>\n<p><span style=\"font-weight: 400;\"> <\/span><\/p>\n<h3><b>What is coiling?<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">With coiling, the diseased veins are closed from the inside using a thin catheter, usually via the groin vein. Platinum coils or sclerosing agents are used to divert the blood flow and relieve the abnormally dilated vein.<\/span><\/p>\n<h3><b>Advantages of the coiling process:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient procedure<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">No large incisions, just a small incision in the groin<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Short recovery time, hardly any pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">High success rate of over 80-90% with the right indication  <\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Low complication rate<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\"> <\/span><\/p>\n<h2><b>PCS therapy at VenaZiel\u00ae in Berlin: Discreet, competent and holistic<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">VenaZiel\u00ae offers affected women individualized care &#8211; from diagnostics to therapy and aftercare. The treatment takes place:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Interdisciplinary: phlebology, vascular surgery, radiology<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Minimally invasive outpatient treatment in modern operating theaters at the DAYKLINIK\u00ae<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">With state-of-the-art imaging and technology<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Trustworthy: gynaecological and vascular specialist advice<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\"> <\/span><\/p>\n<h2><strong>Frequently asked questions (FAQ) about Pelvic Congestion Syndrome<\/strong><\/h2>\n<ol>\n<li><b>  Is the PCS dangerous?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">No, it is not a life-threatening condition &#8211; but if left untreated it can have a significant impact on quality of life.<\/span><\/p>\n<ol start=\"2\">\n<li><b>  How long does the procedure take?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Coiling therapy usually lasts 45-60 minutes and is carried out on an outpatient basis.<\/span><\/p>\n<ol start=\"3\">\n<li><b>  Is the treatment covered by health insurance?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">In many cases yes &#8211; if there is a medical indication. We will advise you individually on the costs.<\/span><\/p>\n<ol start=\"4\">\n<li><b>  Can PCS recur after therapy?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">In rare cases, recurrences can occur, especially if other pelvic veins are affected. Careful diagnostics prevent this.<\/span><\/p>\n<ol start=\"5\">\n<li><b>  Do I have to wear compression stockings afterwards?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Usually not &#8211; the coiling works mechanically and closes the vein permanently.<\/span><\/p>\n<ol start=\"6\">\n<li><b>  Is the treatment painful?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">No, the treatment is usually carried out under local anesthesia or light sedation. Most patients only report a feeling of pressure.<\/span><\/p>\n<ol start=\"7\">\n<li><b>  Can PCS also occur during the menopause?<\/b><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">It usually occurs before the menopause, but can also persist later &#8211; especially if the veins are already damaged.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b>Summary: Your symptoms are treatable &#8211; and you are not alone<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Pelvic congestion syndrome is common but curable. If you suffer from chronic abdominal pain that no one can explain, you deserve a thorough examination. VenaZiel\u00ae is at your side with interdisciplinary expertise &#8211; and offers a modern, effective and gentle treatment with the coiling procedure.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><strong>References<\/strong><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Meissner, M. H., &amp; Gibson, K. (2018). Pelvic Venous Disorders: Symptoms, Diagnosis and Treatment. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 6(3), 408-418.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Whiteley, M. S. et al. (2021). Pelvic congestion syndrome &#8211; A systematic review of definitions, diagnostic criteria, and treatments. Phlebology, 36(10), 746-756.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chung, J. W. et al. (1999). Pelvic congestion syndrome: diagnostic usefulness of MR imaging. Journal of Magnetic Resonance Imaging, 10(4), 477-482.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dos Santos, S. J. et al. (2022). Consensus statement on pelvic congestion syndrome. International Union of Phlebology (UIP).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nadkarni, S. R., &amp; Kabnick, L. S. (2016). Diagnosis and Management of Pelvic Congestion Syndrome. Seminars in Interventional Radiology, 33(4), 330-336.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Koo, S. et al. (2007). Pelvic congestion syndrome: venographic findings and treatment with transcatheter embolization. Korean Journal of Radiology, 8(4), 286-291.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cazalbou, S. et al. (2020). Pelvic vein embolization in pelvic congestion syndrome: A systematic review. Diagnostic and Interventional Imaging, 101(8), 499-509.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hahn, C., &amp; M\u00fcller-H\u00fclsbeck, S. (2015). Interventional pelvic vein embolization for ovarian varicosis. R\u00f6Fo &#8211; Fortschritte auf dem Gebiet der R\u00f6ntgenstrahlen, 187(7), 622-628.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">NICE Guidelines UK. Pelvic vein embolization for pelvic congestion syndrome. Interventional Procedures Guidance (IPG) 2020.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">ACOG (American College of Obstetricians and Gynecologists). (2017). Committee Opinion No. 760: Chronic Pelvic Pain.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.venaziel.de\/wissenszentrum\/\"><span style=\"font-weight: 400;\">venaziel.de &#8211; Knowledge center for venous diseases<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Internal source: &#8220;Common venous diseases&#8221;, VenaZiel\u00ae 2024  <\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Internal source: &#8220;VenaZiel 2025 knowledge database&#8221;, internal specialist publication and SOP reference document<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Park, S. J. et al. (2004). Imaging findings and clinical treatment of PCS. Radiographics, 24(5), 1211-1221.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Kim, H. S. et al. (2006). Embolization of the ovarian vein for pelvic congestion syndrome: long-term technical and clinical results. Journal of Vascular and Interventional Radiology, 17(2), 289-297.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ahmed, K. et al. (2012). Pelvic congestion syndrome: an overview. BJU International, 110(8), 1198-1206.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">McClure, T. D. et al. (2011). Imaging the Pelvis: Vascular Pathology in Women. Radiologic Clinics of North America, 49(6), 1065-1083.<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Invisible pain in the pelvis &#8211; but not imaginary Many<\/p>\n","protected":false},"author":1,"featured_media":20733,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48],"tags":[],"class_list":["post-20738","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vein-center"],"_links":{"self":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/20738","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/comments?post=20738"}],"version-history":[{"count":4,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/20738\/revisions"}],"predecessor-version":[{"id":47395,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/posts\/20738\/revisions\/47395"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media\/20733"}],"wp:attachment":[{"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/media?parent=20738"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/categories?post=20738"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/venaziel.de\/en\/wp-json\/wp\/v2\/tags?post=20738"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}