Pelvic Congestion Syndrome Classification

There is a need for a pelvic congestion syndrome classification. There is also a need for a grading system for pelvic congestion syndrome.

Prof Mark Whiteley gave a lecture on Sunday, 10 March 2019 to the European Vascular Course entitled:

   “Suggested questionnaire and classification to evaluate outcome in PCS”.

Pelvic congestion syndrome classification – Prof Mark Whiteley speaking at the European Vascular Course 2019 in Maastricht March 2019

He presented research from The Whiteley Clinic into pelvic congestion syndrome (PCS).

Why is a pelvic congestion syndrome classification needed?

Pelvic congestion syndrome covers a variety of different symptoms and signs. All of these are related to pelvic varicose veins. However, there is a huge variability between different patients.

Although most articles still say that the pelvic congestion syndrome occurs in women who have had children, this is not true. Pelvic congestion syndrome certainly does affect women who have had children, but it also affects women who have not had children. In fact, research from The Whiteley Clinic has even shown that it occurs in women who have never had pregnancies. In addition, they have also shown it affects men. Not many men have pregnancies!

Because there are so many different symptoms and signs that can be due to pelvic congestion syndrome (PCS), there has to be some way to classify them.

Prof Mark Whiteley has recommended a simple classification.

In his classification, he divides the problem into symptoms (what the patient feels) and signs (what the doctor can see).

He then divides the symptoms into those symptoms that are felt inside the pelvis and those that are felt outside of the pelvis. Similarly, the signs are varicose veins that can be seen around the pelvis and those that can be seen in the legs.

The Whiteley Clinic classification of pelvic congestion syndrome (PCS):

• symptoms inside the pelvis
• symptoms outside of the pelvis
• signs emerging from the pelvis
• signs in the legs

Pelvic congestion syndrome symptoms inside the pelvis:

• pelvic “heaviness”
• irritable bowel
• dragging sensation in the vulva
• itching of the vulva
• bladder frequency
• bladder urgency
• deep discomfort on sexual intercourse (deep dyspareunia)
• deep discomfort after sexual intercourse
• pain in the lower abdomen on one side or other (iliac fossa)
• symptoms that change through the menstrual cycle

Pelvic congestion syndrome symptoms outside of the pelvis:

• low back pain
• flank pain
• hip pain
• leg heaviness or discomfort/itching

Signs emerging from the pelvis (in the pelvic varicose veins, “signs” are generally varicose veins):

• vaginal varicose veins
• labial varicose veins/vulval varicose veins
• buttock varicose veins
• varicose veins around the perineum
• haemorrhoids (piles)
• varicose veins over the pubic bone
• varicose veins up the flanks

Signs in the legs:

• leg varicose veins (especially upper inner thigh or backs of thighs)
• venous eczema
• swelling of the ankle
• brown stains of the skin especially around the ankle
• venous leg ulcer

Which symptoms and signs show the presence of pelvic congestion syndrome?

The difficulty with all of these symptoms and signs is that they can also be present with other medical conditions.

However, pelvic congestion syndrome gets more likely if there are signs emerging from the pelvis in addition to the symptoms inside or outside of the pelvis. It is even more likely if there are leg varicose veins in addition to varicose veins emerging from the pelvis and symptoms inside or outside of the pelvis.

Pelvic congestion syndrome classification – Prof Mark Whiteley speaking at the European Vascular Course 2019 in Maastricht

Why is a diagnosis of pelvic congestion syndrome important?

Simply, we can now cure pelvic congestion syndrome in the majority of patients. This is done by coil embolisation. Therefore if we can get an accurate diagnosis of pelvic congestion syndrome, then we can treat it. Our figures show the majority of patients undergoing treatment get a cure from the symptoms and signs.

How is pelvic congestion syndrome confirmed?

At the present time, the gold standard diagnosis for pelvic congestion syndrome in is the transvaginal duplex ultrasound scan performed by the Holdstock protocol. This was developed by Judy Holdstock and her colleagues Charmaine Harrison and Angie White at the Whiteley clinic. It is not only a venous duplex ultrasound scan but also a scan of the pelvis and abdomen from the outside to give a complete picture of the pelvic veins.

What should you do if you think you have pelvic congestion syndrome?

If you think you have pelvic congestion syndrome, please contact us at The Whiteley Clinic. We can explain the process and give you the cost of the diagnostic scanning to show if you do have pelvic congestion syndrome. The same scan will also tell doctors the optimal treatment for you.