What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome occurs when the veins that are supposed to drain the pelvis cannot do their job adequately. The vein that most commonly has problems is the left ovarian or testicular vein.

Women or men can experience this syndrome and is characterized by

• Pelvic pain of >6 months duration
• Possible external genitalia varicosities
• Possible lower extremity varicosities or insufficiency
• Pain after or during sex (most diagnostic symptom)
• Pain worse with standing and walking
• Bladder or rectum discomfort
• Painful menstruation
• Swelling of lower extremities

Risk factors for pelvic congestion syndrome include

• PCOS
• Having had at least one baby
• Obesity
• Varicose veins

Biomedical Treatment

• Mobilization of the incompetent veins is considered to be the best treatment,

My Natural Approach
I recommend a trial of conservative therapy for patients to are interested in, and able to, exercise. Passive care without exercise might not be enough to improve function
My approach includes

• Treating any underlying conditions (such as PCOS, which generally is related to insulin-resistance, so requires dietary and lifestyle changes)
• Visceral manipulation (left kidney is commonly involved, as is uterine retroversion, pelvic organ prolapse, and adhesions from prior surgeries)
• Vascular manipulation (draining the veins, opening up the main venous and lymphatic returns to optimize movement)
• Botanical support for strengthening vessels and mobilizing lymph, fish oil to thin the blood, nattokinase to prevent clots associated with venous congestion
• Homeopathic suppositories for hemorrhoids (which are varicose veins)
• Instruction on physiologic breathing
• Hydrotherapy such as sitz baths or cold plunges to reset veins and wring out pelvic congestion
• Instruction on core strengthening

When I start working with you using manual hands-on therapy, I will start by putting my hand on the sternum (breastbone) close to the clavicles (collarbones).

In my opinion this is the area of the most important transverse plane (i.e. horizontal plane) in the body because all the lymph and blood drain here. If the structures in this area are not moving properly, it will be difficult to achieve permanent change elsewhere.

The lymph drains up from the belly and lower body, left check, left arm, and left head through the thoracic duct to the left subclavian vein. The lymph drains from the right chest, right arm, and right head into the right lymphatic duct into the right subclavian vein.

The blood drains up from the lower body into the inferior vena cava, and down from the upper body into the superior vena cava to go back to the heart for recirculation.

The axilla (armpit) is part of the shoulder transverse plane and needs to be supple and open for proper lymph and blood return.

Because most of our activities involve using the arms down and in front of us, we experience tightness in the armpits.

Also, because we do not practice physiologic breathing that moves the ribs and intercostal muscles with each breath, we experience armpit tightness.

The video below will teach your how to release the fascia in your armpits.

It is important to also incorporate overhead activities (like jumping jacks, windmills, swimming etc. or even hitting the top of the door frame when you walk through) and retrain to breathe physiologically to retain an open arm pit after therapy.

The armpits must be open in order for the blood and lymph to drain properly in the chest cavity because the blood and lymph are closed circuits. If fluid is not in the channels and in the tissue instead, the fluid system will not move well.

To Release Armpit Fascia

1. Lay on your stomach on a bed or couch or floor
2. If you want to work on your left armpit, put your right arm under your chest and insert the hand into the left armpit
3. Use your fingers to feel around in the armpit looking for a sore spot
4. When you find the sore spot you can either gently rub it, or you can apply pressure to it and move your arm and shoulder around it. Either way, you can release the fascia.
5. Continue going a little deeper with each layer that you release.
6. Check both sides

What is a normal period?

When I ask women about their periods, they will often say they have the “normal” amount of pain, or a “normal” length period, or a “regular” colored period.

What they really are trying to say is that they have a culturally normative, or commonly experienced, type of period.

Today we are going to talk about what a physiologically “normal” period is, and what your body is trying to tell you when you don’t follow this pattern.

First off, there should be no pain or disability with your period.

This is the most important thing because culturally we have come to believe that a painful, grouchy, fatigue-ridden period (or start of the period) is normal, expected, and experienced by everyone.

No.

This is not normal.

Pain and disability is experienced by many girls and women with their periods.

But it is not normal, and should not be tolerated.

We must change out cultural expectation around this because a dysfunctional period leads to a dysfunctional menopause.

And believe me, if you think a dysfunctional period is bad . . . . it’s got nothing on a dysfunctional menopause.

Ok. That’s my intro tirade.

Now let’s look at other components of a normal period

1) Length of Cycle

The normal/optimal length of a cycle is 28 days.

The first day of the cycle is the first day that you bleed.

The last day of the cycle is the last day you do not bleed – that is the day before you bleed again.

The first half of the cycle (first 14 days or until ovulation) is called the follicular (proliferative) phase.

This phase will come to an end when sufficient follicle stimulating hormone (FSH) is produced in the brain to mature the oocyte (egg) that will mature enough to be ovulated mid-cycle.

This first phase of the cycle is largely brain dependent and reflective of the vitality and responsivity of the ovary.

The second half of the cycle (second 14 days or until the bleed starts) is called the luteal (secretory) phase.

The length of your cycle is largely based on hormone fluctuations that are influenced by the mileau of your body.

Hormones

Estrogen causes tissue proliferation.

For the uterus, that means the higher estrogen is the more the uterine lining is built.

Progesterone causes the proliferation to be maintained.

So you need enough estrogen and progesterone to be able to make the uterine lining (called the endometrium).

And you need the estrogen and progesterone to decrease enough so the uterus releases the endometrium and you start bleeding.

Now in standard biomedicine (AKA Western medicine, conventional medicine, standard medicine, allopathic medicine) a cycle is only considered to be abnormal if it is less than 21 days (polymenorrhea), or longer than 37 days (oligomenorrhea), or less frequent than every 90 days (amenorrhea).

The bleeding that we are talking about here is for women who are still cycling and this is the bleeding part of their cycle. We will talk about other types of bleeding outside of the menses on a different video. We are also assuming no pathology, like cancer, is present. We will talk about that type of bleeding in a different video.

2) How many days of bleeding

3-5 is considered normal

For me factors that influence whether someone has a 3 or 5 day cycle have to do with their reproductive vitality.

So women in their 20s and 30s will tend to have bleeds of 4-5 days, and women in their 40s will tend to have bleeds of 3-4 days. Women who are experiencing a physiologic normal perimenopause in their late 40s and early 50s will have periods between 2-3 days.

Over 7 days of bleeding is metrorrhagia.

Long bleeds recapitulate long bleeds.

That is because the underlying hormonal issue persists, and the more blood you lose, the more iron you lose, so it is hard to stop bleeding because iron is one of the things that helps to stop the bleed.

3) Amount of blood

The normal amount of blood lost in a period is 30-50 ml (2-3 tablespoons)

This is hard to measure.

If women have to change a regular tampon, pad, or cup more often than every 2 hours, this is considered to be a heavy bleed.

A light bleed means they only need to change a regular tampon, pad or cup a couple times a day.

Now with menstrual underware it is harder to measure how much you bleed, so you need to check using a pad, tampon, or cup.

4) Color of blood

Normal menstrual blood is bright red.

If your bleed is pink, or light red with kind of a separation of a clear (serous) fluid this means low estrogen

If your bleed is brick red or darker this means you have high estrogen or oxidized (old blood)

If your bleed is brown and sticky this means old blood, probably from that last cycle

5) Clotting

There should be no clotting with a normal period

If you clot, that means you have high estrogen

If you use a cup, you could see clots that are not related to estrogen.

Blood has clotting agents in it, and any blood that sits around will start clotting.

Thank god.

6) Spotting

There should be no spotting running up to your period, or after the bulk of your flow

Often times people who experience spotting will note the spotting is a different color than the period blood.

If the blood is dark and sticky spots before or after the period, this suggests the uterus is not in ideal position.

If the spotting is pink and thin or watery, this suggests there is low estrogen.

The three major things that influence the nature of a menstrual bleed are

1) Hormone levels

2) Iron levels

3) Uterine position or other factor related to the uterus (such as fibroid)

References

James AH. Heavy menstrual bleeding: work-up and management. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):236-242. doi: 10.1182/asheducation-2016.1.236. PMID: 27913486; PMCID: PMC6142441.

There is one normal position of the uterus: slight anteflexion.

The uterus should be slightly bent forward, hovering over the bladder.

In biomedicine there is only one abnormal position of the uterus, and that is prolapse – or falling out.

All other positions of the uterus are considered to be normal variants.

I think biomedicine has come to this conclusion for two reasons:

1) The paradigm that biomedicine functions under is largely biased toward the diagnosis and treatment of pathology.

Things that are not pathology are often considered to be normal variants.

2) Biomedicine does not have a form of intervention that suits addressing a uterus that is not in the optimal, or normal, position of slight anteflexion.

So there is no reason to identify a problem if there is no way to address it.

Possible Positions of the Uterus

In natural medicine and in indigenous medicine, such as Maya medicine, there is one normal position of the uterus:

In slight anteflexion.

The standard medical literature talks about normal variants for the position of the uterus as

Retroversion – Uterus Leaning back

Retroflexion – Uterus bending back

Anteflexion – Uterus leaning forward too far

In my practice, I also see the uterus leaning to one side, or torqued. I have not seen these positions mentioned in the medical literature.

The normal position of the uterus is for the non-gravid (not pregnant) fundus to be two inches above the pubic bone.

The uterus should also palpate as two inches wide in this area.

If the uterus is lower than two inches above the pubic bone, this suggests prolapse.

Parts of the uterus

The uterus is divided into sections

The cervix is the lowest section. It is in the top of the vagina and is the neck of the uterus

Above the cervix is the lower uterine segment.

The top of the uterus is the fundus

The arms of the uterus, called the fallopian tubes, come out of the fundus and end in hands, called the infundibulum, and fingers, called the fimbriae.

The fimbriae reach to draw the egg up into the uterine hand and arm.

Ligaments of the uterus

The ligaments of the uterus are different from most other ligaments in the body because some have muscles fibers in them, and all have some capacity to stretch and lengthen to respond to the uterine changes of pregnancy.

The main ligaments of the uterus are the

Broad ligament: The broad ligament is actually a big sheet of fascia that goes over the front an back of the uterus, in which the fallopian tubes and ovaries are inserted. It hooks on to the sides of the pelvis and is a major stabilizer of the uterus. I call the broad ligament the wings of the uterus. (The yellow in the picture)

Round ligaments: The round ligaments are also embedded in the broad ligament; one on each side of the uterus. But they are true ligaments, even though they have smooth muscle fibers in them. Each of the two round ligaments originates in the cornu of the uterus (the upper outer part of the fundus close to where the fallopian tubes attach), travels through the inguinal canal (like the spermaticord in males), and inserts into the labia majora by the perineum.

Utero-sacral ligaments: These ligaments originate below the broad ligament on the cervix and go on either side of the rectum to insert onto the sacrum. They also have smooth muscle fibers in them.

Cardinal ligaments

The cardinal ligaments originate on either side of the cervix and insert into the sides of the pelvis.

 Pubocervical ligaments

The pubocervical ligaments originate in the front of the cervix and insert into the pubic bone

Why the uterus is in a non-ideal position

The uterus generally moves out of its normal anteflex position due to trauma.

This trauma could happen at any time of life.

I have treated little girls all the way through to elderly women who have a uterus out of position.

Many times people do not even have an overt association of injury when we start to talk about the position of the uterus.

For active children and adults, falls are a normal part of athletics, and play.

Our shared cultural paradigm does not indicate that playful falls could cause alterations to our insides.

But they can.

Slip and falls, falls off horses, falls skiing or snowboarding, cannon balls, falls rollerskating, and pregnancy/birth are some of the common ways a uterus becomes displaced.

When an organ is displaced, commonly there is no immediate associated symptom.

If there was a fall, there could be a muscle or joint injury that will heal up within a matter of days or weeks.

If an organ is displaced, the associated symptoms will arise gradually over time, and are generally due to an alteration of venous or arterial blood, or lymph flow.

These symptoms, although caused primarily by the displaced organ and secondarily by the change in fluid flow, will often present as musculoskeletal complaints.

If you have a musculoskeletal symptom that does not respond to chiropractic, massage, acupuncture, stretching and strengthening think of the possibility of an organ or fluid component.

When I work with a displaced uterus, the body will usually indicate when the injury occurred and what type of injury it was.

Once we are working with the organ and have an idea of the time-period when the organ became displaced, the patient will also usually have a recollection of some type of trauma at that point in their life, even if it didn’t seem major at the time.

As the patient recounts the trauma, the uterus will begin to move to reposition herself.

The uterus and all the organs like to have their stories told and listened to.

That is part of the healing journey.

What happens if the uterus is in a non-ideal position

If the uterus is not in slight anteflexion the whole relationship of the pelvic organs and abdominal organs are thrown off.

The uterus in strong anteflexion will impair the function of the bladder.

The uterus that is retroverted or retroflexed will lay on the rectum and could cause constipation.

This leaning or bending back of the uterus can also cause low back pain and pelvic pain because the uterus is laying on the vascular or lymph drainage pathways.

The uterus that is leaning to the side or twisting can influence the function of the sigmoid colon, the cecum, and the ovaries or ureters.

Any of these altered positions can challenge the vascular and lymphatic drainage out of the pelvis.

Sometimes the symptoms are subtle and seemingly unrelated.

Sometimes the symptoms are dramatic and the relationship between the uterus and the symptom is overt.

Movement

Everything in the body is designed to move.

All movement occurs in relationship to all other movement.

Organ position can throw off proper relationship.

Proper movement is also influenced by a variety of experiences including a history of surgery, a history of inflammation or infection, trauma to connective tissue, congenital variants, chronic spasms, and deconditioning.

What to do

In the next video I will teach you how to palpate your own uterus and give you tips on treating it yourself.

You can also look for a practitioner of Arvigo Maya Abdominal Therapy or the Barral Technique to help you out.

The Mayans say the uterus is the queen of the body.

When the uterus is in her ideal/normal position she is on her throne.

When she is out of her normal position she is not on her throne and nothing in life will be easeful.

Find a way to put your queen back on her throne so you can have the easeful life you deserve and yearn for.