By John S. Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS
Founder, Medical Vein Clinic
September is Pain Awareness Month, and a good time to talk about pelvic venous disorder, also known as pelvic congestion syndrome. This is a vascular condition that can contribute to chronic pelvic pain and, in many cases, can be treated with minimally invasive techniques.
Varicose Veins of the Pelvis
Most people associate varicose veins with the legs, but the same problem can occur deep within the pelvis. Like the veins in your legs, the pelvic and ovarian veins rely on tiny one-way valves to keep blood moving back toward the heart. When those valves weaken, blood begins to pool instead of flowing normally. As pressure builds, the veins stretch and enlarge, which can irritate nearby tissues and nerves and lead to the dull, heavy pelvic pain many women describe.
Pelvic venous disorder affects nearly one in three women during their lifetime, although not everyone develops symptoms. Among women living with chronic pelvic pain, studies suggest a venous condition contributes in as many as 30 to 45 percent of cases. After minimally invasive treatments for pelvic venous disorder, nearly 85% of women find relief from the pain and symptoms within two weeks.
Recognizing the Symptoms
Pelvic pain can have many causes, which is why a thorough evaluation is important.
Women with pelvic venous disorder often describe a dull, aching pain that gradually worsens throughout the day, particularly after standing or walking for long periods. Many also experience discomfort during or after intercourse. Unlike menstrual cramps, the discomfort is often present throughout the month and may become more noticeable with prolonged standing or physical activity. Other women may experience various gastrointestinal disorders, alternating constipation or diarrhea, or intermittent back pain.
Some women also notice bulging veins around the vulva or upper thigh, along with bladder symptoms that don’t have another clear explanation. While these symptoms don’t necessarily mean someone has pelvic venous disorder, they can provide important clues during the evaluation.
Evaluating Your Circulation
Pelvic pain is usually evaluated first with a routine pelvic ultrasound to look at the uterus and ovaries. That’s an important part of the workup, but pelvic venous disorder affects the veins rather than the pelvic organs themselves.
When symptoms suggest a circulation problem, additional vascular imaging may be recommended to evaluate blood flow through the pelvic veins. Because every woman’s anatomy is different, the evaluation begins with a detailed medical history and imaging that helps identify the source of the problem and guide the most appropriate treatment.
Treatment Without Major Surgery
Treatment depends on what’s causing the abnormal blood flow.
For many women, a minimally invasive procedure called embolization closes the affected vein, allowing blood to reroute through healthy veins naturally. Others may benefit from treatment for a compressed pelvic vein using a stent to open the vein. The right approach depends on each woman’s anatomy and imaging findings.
These treatment procedures are performed through a small catheter using conscious sedation, without the need for major surgery. Most patients return home the same day and gradually resume normal activities over the following days and weeks.
When to Talk With Your Physician
Persistent pelvic pain deserves medical attention, especially when it interferes with everyday life.
If your pain becomes worse after standing for long periods, continues beyond your menstrual cycle, or is accompanied by discomfort during or after intercourse, ask your physician whether your veins could be contributing to your symptoms. A conversation about your circulation may help determine whether additional vascular evaluation is appropriate.
Pelvic venous disorder is one of several possible causes of chronic pelvic pain. Identifying the source is the first step toward choosing the treatment that’s right for you.
John S. Hogg, MD, DABR, DABVLM, RPVI, RPhS, RVT, RVS, is a board-certified physician specializing in Vascular and Interventional Radiology and Founder of Medical Vein Clinic in San Antonio. Medical Vein Clinic’s vascular team includes board-certified vascular surgeon Thomas Gianis, MD, FACS, FSVS, DABVLM, RPVI, RVT, CWSP, who specializes in the diagnosis and minimally invasive treatment of Pelvic Venous Disorder.
