For patients
Pelvic venous disorders
Pelvic venous disorders are clinical problems (conditions) that can result when veins in the pelvis are not functioning properly. This can lead to pooling of blood in certain areas of the pelvis and this excessive blood can lead to symptoms, mostly in women.
Venous
Women's Health
Embolization
Stenting
Overview
Signs and symptoms
What are pelvic venous disorders?
Pelvic venous disorders are clinical problems (conditions) that can result when veins in the pelvis are not functioning properly. This can lead to pooling of blood in certain areas of the pelvis and this excessive blood can lead to symptoms, mostly in women.
Chronic pelvic pain is one of the most common symptoms associated with pelvic venous disorders. In the past, this condition was referred to as pelvic congestion syndrome. Veins throughout your body have one-way valves that help keep blood draining flowing toward your heart. If the valves in the veins become weakened, blood pools in the veins and causes them to swell, forming varicose veins. This is what happens when varicose veins form in the legs and this can happen in the pelvis as well, often in women who have delivered several children. This is because the ovarian and pelvic veins widen to accommodate the increased blood flow from the uterus during pregnancy. After the pregnancy, some of these veins remain enlarged and fail to return to their previous size, allowing blood to pool.
In some women, the vein that drains one of your legs can get compressed by one of the adjacent arteries, just like when someone steps on a garden hose blocking the flow of water. In the pelvis, this can cause the leg vein blood to be redirected through the veins in the pelvis adjacent to the ovaries and uterus to allow the blood to get back to the heart. This can also lead to varicose veins in these locations.
The chronic pain is the result of the stretching of these enlarged varicose veins around the ovaries and pelvis.
What are the symptoms of pelvic venous disease?
Women who have venous cause of chronic pelvic pain note that:
- Pain and pressure in the pelvic area is worse with long standing, sitting and with strenuous activity, and is better with lying down
- Prolonged discomfort after sexual intercourse
- Enlarged veins on their vulva or upper inner and posterior thighs
IR treatment options
How is pelvic venous disease diagnosed?
If your physician has ruled out other causes of pelvic pain, such as uterine fibroids, endometriosis pelvic floor pain and ovarian cysts, ask your doctor if your symptoms could be related to a pelvic venous disorder. Evaluation for this condition ideally includes a referral to an interventional radiologist (IR) for a consultation.
During the consultation, the interventional radiologist will discuss your clinical condition to see if your symptoms could be related to a venous cause. A number of imaging tests can be performed to determine whether your chronic pelvic pain may be a result of pelvic varicose veins. These tests include:
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Pelvic and transvaginal ultrasound
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Computed tomography (CT scan)
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Magnetic resonance imaging (MRI scan)
Pain from dilated veins can be improved with minimally invasive outpatient procedures that require only light sedation. After these outpatient treatments, there is only a minimal amount of discomfort, and women can return to normal activities almost immediately.
Embolization
If the pain is due to leaky valves causing pelvic varicose veins, these varicose veins can be easily closed, which reduces or eliminates pain just like with varicose veins in the legs.
The procedure involves a tiny nick in the skin at a place where a vein can be easily found, usually at the top of your thigh or just above the clavicle. A small tube is passed through the nick and directed to the varicose veins with X-ray guidance, and the affected varicose veins are closed through this small tube.
Stenting
If the pain is caused by a compressed vein, a small metal spring called a stent can be inserted to buttress the vein open from the inside using a similar small skin nick usually at the top of the thigh.
Follow up and recovery
What is the treatment’s recovery like?
After either a varicose vein embolization or a venous stent procedure, the patient goes home the same day and can resume most normal activities almost immediately, with minimal discomfort.
What are the risks of ovarian vein embolization?
These procedures are extremely safe. The most common side effect is a minor discomfort in the pelvis or low back or a minor fever that may require an over-the-counter pain medication for a few days. A small amount of bruising at the access site is also common and any significant bleeding is very rare.
Last review
Reviewed by Neil M. Khilnani, MD, FSIR; September 2024