Mother of three Siti Haiza experienced chronic pelvic pain that was so excruciating she could not sit or stand, but her doctor said she was ‘overthinking it’.

Forty-two year-old stay-at-home mother of three Siti Haiza was generally fit and healthy, had no chronic medical conditions, rarely visited the doctor, and when she had aches or fevers, she stayed off pain medications as much as she could. Then she began experiencing abdominal pain on a daily basis.

We spoke to her about how she was diagnosed with Pelvic Congestion Syndrome (PCS).

What symptoms did you experience and why did they prompt a visit to the doctor?

In mid-March 2020, about five years after delivering my youngest child, I started experiencing abdominal pain daily, which peaked a week before and during my menses. It felt like a combination of menstrual cramps and gastric discomfort and it was so debilitating I could not stand, sit or even lie down for more than 20 or 30 minutes.

If I stood for more than 30 minutes, for example, I would need to sit with my feet propped up to relieve the pain. I was losing sleep because I would be awakened by the pain regardless which position I was sleeping in. Even passing motion could lead to aches which lasted all day.

At first I consulted a general practitioner (GP) who prescribed me gastric medication. When the gastric medications did not work, I returned to his clinic and this time, I was prescribed heartburn medication. I did not think they would help, as the pain was nothing like the heartburn I experienced during pregnancy, and they did not. When I returned to the same GP a week later, he ordered a full blood test and an abdominal scan to try to identify the problem. As the test results were normal, he dismissed my symptoms, saying it was ‘all in my head’.

Consultant Vascular Surgeon, Dr Sriram Narayanan at The Venus Clinic

How did being misdiagnosed repeatedly make you feel?

I was very frustrated as I had started taking painkillers for the pain, which I had actively avoided before. I could not shake off the nagging feeling I was dealing with a potentially serious condition, and my mental health suffered for it.

I waited till I was due for an annual check-up with my gynaecologist in July of that year. He listened to my symptoms and prescribed a series of tests which did not show up anything of concern, and this led him to recommend a CT scan. My CT scan results revealed prominent, dilated pelvic veins, a symptom of Pelvic Congestion Syndrome (PCS), which he believed caused my pain. I was then referred to Consultant Vascular Surgeon, Dr Sriram Narayanan at The Venus Clinic.

How was your condition diagnosed and confirmed?

When I visited Dr Sriram a week later, I was asked to fill in a self-assessment questionnaire called the PCS Score Test. He also sent me to undergo a duplex ultrasound scan.

Within 15 minutes of listening to my symptoms and seeing my scan results, Dr Sriram diagnosed me with PCS. He pointed out my veins had dilated three to four times their normal size and that this was caused by something called the ‘Nutcracker Syndrome’, a feature of PCS. This was surprising news to me, as all along I had thought that I was dealing with a gynaecological condition and had never heard of PCS before.

What treatment options did Dr Sriram offer? And did you go through with them?

Because my condition was severe, Dr Sriram recommended the coil embolization procedure in my left renal vein and sclerotherapy. I underwent the procedure in October 2020, which was performed under general anaesthesia.

Fortunately, the procedure resolved 90% of the pain and I was finally able to take long walks with my family again. However, I was still experiencing residual aches along my lower abdomen and groin after sitting and standing for long periods. 

I returned to Dr Sriram for a check-up in October 2021 and told him I still experienced some residual discomfort after the procedure. I was asked to undergo another ultrasound scan, and upon seeing the results, Dr Sriram referred me to a physiotherapist to help strengthen my weak pelvic floor muscles which should in turn resolve the residual discomfort.

I made my first appointment to see the physiotherapist in January 2022. At first I saw her twice a week, but now I only see her once every three weeks. She taught me exercises to strengthen the muscles supporting my pelvic floor to practise at home such as bridges with pelvic tilts and squats with weights. She has been checking in regularly with me on how I feel and whether the exercises are working.

The exercises have been effective in reducing some of the residual discomfort, so I can safely say I am now very nearly completely pain-free. As well as long walks with my family, I am now taking up dance classes with my girlfriends again. I also rarely take painkillers now, although I may pop a paracetemol in the evenings when I begin to ache, usually at the onset of my menses.

The best thing of all is that my husband and my children are relieved that I am finally myself again.


Photos courtesy of The Venus Clinic.