What is Pelvic Congestion Syndrome?

Updated: August 19, 2022

Pelvic congestion syndrome, also called pelvic venous congestion, falls under a broader range of pelvic venous disorders which are a known, but often unrecognized cause of chronic pelvic pain. Varicose pelvic veins develop when the valves in veins are not working correctly, or occasionally when critical deeper veins are obstructed, causing blood to pool and distend pelvic veins.Pelvic venous insufficiency at IVC Interventional and Vein Center

To explain pelvic congestion syndrome, it it helps to understand the purpose of veins in the body:

Healthy veins return blood to the heart through one-way valves, allowing blood to travel toward the heart. Congested veins have weakened valves, allowing blood to flow backward and pool distend and pelvic veins.

Occasionally, increased pressure inside pelvic veins may be the result of an obstruction in the major veins draining the pelvis.

Commonly Recognized Associations

It is estimated that 30% of patients with chronic pelvic pain of an unknown cause actually suffer from a symptomatic pelvic venous disorder. Although the causes of pelvic venous congestion are complex and poorly understood, a few commonly recognized associations include:

  • Family history of venous disease
  • Multiple pregnancies
  • Estrogen
  • Pelvic or renal vein compression

What Are the Symptoms of Pelvic Congestion Syndrome?

Typical symptoms of pelvic congestion include:

  • Increased urination frequency
  • Bloating sensation
  • Visible varicose veins on the buttocks, vulva, and upper thighs
  • Dull achiness and/or heaviness in the pelvis, often made worse by prolonged standing
  • Painful menstrual cycles with referred pain in the legs
  • Pain during and after intercourse

How Is Pelvic Venous Congestion Diagnosed?

Unfortunately, pelvic venous congestion often goes unrecognized and untreated. Symptoms, physical exam and ultrasound findings have a high combined predictive value in diagnosing pelvic venous disorders. The ability of duplex ultrasound (DUS) to image real-time makes it an important tool in the evaluation of possible pelvic venous congestion.

Because there are many other potential causes of chronic pelvic pain, medical professionals may conduct multiple exams and tests including:

  • Pelvic exam
  • Pelvic duplex ultrasound
  • CT or MRI scan
  • Laparoscopy

In our office, a nurse practitioner, physician’s assistant, or physician will discuss pelvic symptoms with you. They will determine whether you present with pelvic congestion syndrome symptoms and order an ultrasound to look for varicose veins in the pelvis, labial area, and upper thigh. This gives information regarding the sizes of the varicose veins in the pelvis and whether they have propagated to other parts of the body. Once these veins are found, they will also order a CT scan to show the origin of the varicose veins.


Once a patient is diagnosed with pelvic venous congestion, it can often be successfully treated with a minimally invasive procedure called embolization. Pelvic venous embolization requires little or no downtime and is performed in an outpatient setting. Occasionally, a compressed iliac vein may contribute to venous congestion and a stent may be indicated to help restore normal flow.

Benefits of embolization:

  • Requires little or no downtime
  • Performed as an outpatient
  • Minimally invasive, but highly effective

After treatment, patients are typically able to return to most routine activities the same day.

Ovarian Vein Embolization Treatment Tips

  • Wear comfortable clothing to the procedure
  • Eat a light meal the evening before your procedure
  • Don’t eat or drink less than 6 hours before treatment, unless directed by your doctor
  • Over-the-counter pain medication is typically all that is needed after the procedure
  • While recovering, stay active but avoid heavy lifting
  • Reach out to your treating doctor with any questions or concerns

Follow Up

We always follow-up with the patient approximately one month post venogram to see if some you the patient’s symptoms have resolved. It may take 1-2 menstrual cycles before significant relief is noticed. Most women we have seen in the office for their post venogram follow-up have described some cramping for the first few days post procedure, and with significant relief in the weeks and months after.

For more information on pelvic congestion syndrome visit: Pelvic Congestion Syndrome

pelvic congestion syndrome infographic

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What should I address first, my pelvis or my legs?

Often times our female patients have both leg varicose veins and pelvic varicose veins. Although these veins are in different locations both sources can be symptomatic to the patient. The question then becomes “which do I treat first?”

The problematic veins although similar in pathology and symptoms are treated in different methods. The legs are treated as an in office procedure involving the use of EVLA, sclerotherapy, and ambulatory phlebectomy. The pelvic veins are treated with a same-day hospital procedure called a venogram with coil embolization. The goal with both procedures is to close down incompetent veins that cause the symptoms. And while these are very different procedures often both procedures need to be performed to reduce the symptoms. The question of which procedure to do first really comes down to which problem is causing you the most pain.

There is not a 100% right or wrong answer to this question and so mostly it is a judgment call on the patient’s part. There are a few cases where the doctor may have a reason to treat one problem over the other but this is because it will be in the patient’s best interest.