If you experience a persistent ache or heaviness in your pelvis that becomes worse after standing, during your period, or following sexual intercourse, you may assume the problem is gynecological. However, swollen, poorly functioning veins can sometimes be responsible. You might even notice varicose veins around your thighs, buttocks, or vaginal area.
At St. Louis Vascular Surgical Specialists, PC, double board-certified general and vascular surgeon Dr. Robert Hacker evaluates patients throughout the greater St. Louis area to identify vascular causes of pelvic pain, including pelvic congestion syndrome (PCS).
What is pelvic congestion syndrome?
Pelvic congestion syndrome develops when veins within your pelvis become enlarged and have difficulty efficiently returning blood toward your heart. Blood can flow backward and pool within these veins, increasing venous pressure and contributing to pelvic discomfort.
You may experience dull or aching pelvic pain, pressure or heaviness, lower back pain, painful periods, or discomfort during or after intercourse. Symptoms of PCS commonly become more noticeable after you have been standing for an extended period. Pregnancy is also associated with PCS because changes during pregnancy can place additional strain on pelvic veins.
How are PCS and varicose veins connected?
PCS and varicose veins share a fundamental problem: veins that are not moving blood efficiently. Your veins contain valves that help direct blood toward your heart. However, when venous function is impaired, blood can flow backward and accumulate, causing enlargement of the affected veins.
With typical varicose veins, you may notice swollen or twisted veins in your legs. With PCS, the problematic veins are located deeper within your pelvis. However, increased pelvic venous pressure can also contribute to visible veins around your thighs, buttocks, or vulvar region. This means that seemingly unrelated symptoms, such as pelvic discomfort and varicose veins, can sometimes be different manifestations of an underlying venous circulation problem.
When could varicose veins indicate a deeper problem?
Visible varicose veins do not automatically mean you have PCS. However, their location and the symptoms accompanying them can provide important clues.
If you have varicose veins around your upper thighs, buttocks, or vaginal area along with persistent pelvic pain, heaviness, or pressure, an evaluation may be appropriate. Symptoms that worsen after prolonged standing, around menstruation, or during or after intercourse can further suggest that your pelvic veins should be evaluated. Rather than focusing only on the visible veins, your vascular specialist can investigate whether an underlying problem with pelvic blood flow is contributing to your symptoms.
How is pelvic congestion syndrome diagnosed?
Because chronic pelvic pain can have numerous causes, diagnosing PCS requires a careful evaluation. Your assessment begins with a discussion of your symptoms and medical history.
Imaging can then help evaluate your pelvic veins and identify enlargement or abnormal blood flow. Depending on circumstances, diagnostic testing may include Doppler ultrasound, MRI, CT imaging, or venography. Dr. Hacker personally evaluates your symptoms and can use vascular imaging to determine whether venous dysfunction is contributing to your discomfort.
How can PCS be treated?
Your treatment depends on your symptoms, anatomy, and the veins involved. Conservative approaches may be appropriate in some cases, while other patients may benefit from minimally invasive vascular treatment.
One option for appropriately selected patients is ovarian vein embolization. During this minimally invasive procedure, a catheter is guided to the abnormal vein so it can be closed, redirecting blood away from the malfunctioning vessel. The goal is not simply to address visible varicose veins, but to identify and treat the underlying source of pelvic venous pressure when possible.
Schedule your vascular evaluation in St. Louis
If pelvic pain, heaviness, or unusual varicose veins are interfering with your daily life, understanding whether your circulation is contributing to your symptoms is crucial.
At St. Louis Vascular Surgical Specialists, PC, fellowship-trained, double board-certified vascular surgeon Dr. Robert Hacker provides personalized evaluation and treatment for pelvic congestion syndrome and other venous conditions across the greater St. Louis area. Schedule your consultation to learn more about your vascular health and appropriate treatment options.
