There are many potential explanations for chronic or persistent pelvic pain, including endometriosis, adenomyosis, fibroids, bladder pain syndrome (interstitial cystitis), pelvic floor tension (pelvic floor myofascial pain), and fibromyalgia. There’s also pelvic venous disease (also called pelvic congestion syndrome or pelvic venous insufficiency), which is essentially varicose veins inside the pelvis.
Pelvic venous disease is estimated to explain around a third of “unexplained” pelvic pain, and likely more.
Symptoms of pelvic congestion syndrome
Characteristic symptoms include:
- Chronic, dragging pelvic pain or heaviness
- Painful periods
- Pain during or after sex
- Varicose veins around the vulva or thighs
- Irritable bowel-type symptoms (alternating diarrhoea and constipation)
- Stress urinary incontinence (leaking urine when you cough or laugh)
- Painful urination
The condition typically affects women between the ages of 20 and 45, especially those who have had at least one pregnancy. (Pregnancy increases the risk for PCS because the increased blood volume and pressure stretch the pelvic veins.)
Diagnosis of pelvic congestion syndrome
The gold standard for diagnosis is a transvaginal duplex ultrasound, which measures blood flow through the pelvic veins. Other imaging methods like MRI or CT can help rule out other conditions, but are less sensitive for detecting pelvic venous disease, partly because they are usually performed lying down, reducing vein engorgement.
đź’ˇTip: PCS often co-occurs with other conditions like adenomyosis, endometriosis, pelvic floor dysfunction, interstitial cystitis, and irritable bowel syndrome. In fact, co-occurrence is a big reason PCS is often missed!
Treatment of pelvic venous disease
Milder cases of pelvic venous disease can benefit from:
- Gentle exercise
- Managing constipation
- Pelvic floor physiotherapy
More severe cases require ovarian (or internal iliac) vein embolisation. This is a minimally invasive, usually day-stay procedure performed under local anesthesia with light sedation. A thin catheter is threaded into the affected veins, and tiny coils and/or a sclerosing solution are delivered to block them. By closing off the dysfunctional veins, blood flow is naturally redirected through healthy veins, relieving congestion and reducing pain. A 2025 study found that pelvic venous interventions, including stenting, can provide long-term relief for the majority of women with chronic pelvic pain.
How to speak with your doctor about the possibility of pelvic venous disease
Start by describing your symptoms clearly, especially any heaviness or worsening pain with standing, walking, or sex. Also, mention any vulvar or leg varicose veins you might have noticed.
You might try saying:
“I’ve been reading about pelvic congestion syndrome or pelvic venous disease. Could this be worth investigating in my case?”
And:
“Could I be referred for a transvaginal venous ultrasound to check for pelvic venous disease?”
If your doctor is unfamiliar with this type of scan, you could suggest a referral to a vascular specialist or a pelvic pain clinic. Pelvic congestion syndrome is real, treatable, and worth asking about.
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