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Pelvic Congestion Syndrome

I have been seeing more cases of this in recent years, mostly in pregnant and postpartum women. It can happen in any woman at anytime, but due to the growing and changing organs it is seen more commonly during pregnancy and postpartum. I think this is something that often gets missed by doctors, midwives and even pelvic floor therapists.

Many women come to me because of some form of pelvic pain. Sometimes it is pain with sex. Sometimes it is a feeling of heaviness in the vagina or just discomfort in the pelvis and vagina.

It usually feels worse by the end of the day. This is common in a lot of diagnoses, which is why I think this diagnosis gets overlooked. Recently women have been coming to me convinced they have a prolapse, and sometimes they do or have had prolapse, but that is not what I find on examination.

The symptoms of pelvic congestion mimic prolapse, which I can understand why women get misdiagnosed, or if they are google searching will think they have prolapse. With prolapse and pelvic congestion both feel worse as the day goes on and the pelvis feels heavy. Patients feel weak and think they need to do more kegels, but that isn't helping. Once again, kegels aren't always the answer.

Some women have enough swelling that they notice and bring it to my attention, but not all have a visible swelling. The swelling is subtle. Especially for a new postpartum mom when the vaginal tissues are usually slightly thinner due to decreased estrogen, they can appear "normal" so pelvic congestion is never really a consideration.

I've had some amazing results that are usually apparent immediately with treating these women. Often one treatment doesn't permanently cure them, but with 1-2 months of treatment in the office and working on it themselves at home, they then feel better. Sex feels better. Exercise feels better. Walking is more comfortable. The heaviness at the end of the day is gone. Again all symptoms that parallel prolapse symptoms.

The treatment is not invasive either. When I googled this the treatments I came across are to surgically change the veins. PT treatment is manual lymphatic drainage massage to the pelvic region. It has worked so well for my patients. Even I am amazed sometimes. I'm not trying to toot my own horn, but the difference can be apparent immediately.

Patients are taught how to do this at home as well and are recommended to wear compression garments. These can be anything from leggings, bike shorts, spanx or specialized garments. Everyone's comfort is different in what works for them and the season, but compression is necessary.

The medical view of pelvic congestive syndrome, also known as varicose veins of the pelvis, is to get an ultrasound because medically it is often caused by twisting of the veins around the ovaries, which causes the swelling in the pelvis. Let me say, I don't think an ultrasound is necessary for everyone. If you have tried treating it conservatively without results, then maybe ultrasound for confirmation is beneficial. In our modern medical environment doctors and patients often want a diagnosis and a picture, like an x-ray, MRI, or ultrasound, to confirm what they think they have. I would ask you: will this change what you are doing about your symptoms? If the answer is yes, like conservative treatment isn't helping, then I would recommend pursuing that route. If the answer is no, what you are doing is helping, then what is the purpose of getting an ultrasound? Peace of mind? Knowledge of a diagnosis? Maybe the pursuit of surgical intervention? Also know that if we x-ray or ultrasound anyone we often find anatomical variability that may not be the cause. There is a great example of this in a study of MRI images of people's spines who did and did not have back pain. I wrote about it in a blog post from a few years ago.

My point is, if you identify with the symptoms in this blog, you don't necessarily need to run to your doctor asking for an ultrasound.

If you have googled and think you have prolapse and maybe even have been treated, unsuccessfully, for prolapse but still have symptoms seek help again from a different healthcare provider. Again, most pelvic floor physical therapists aren't aware of this. This isn't taught in the standard pelvic floor classes until the PT takes very advanced classes. I'm not trying to put down any PTs because we are all working with the knowledge we have, but you are not a failure if PT didn't help you. Seek out another PT. You may have to pay out of pocket but it could be life changing and worth the investment, and it is almost certainly less costly and definitely not as interruptive to your life as surgery. There are almost no side effects to pelvic floor PT and very minimal risk.

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