Pelvic congestion syndrome
Pelvic congestion syndrome describes ongoing pelvic pain that may be linked to problems with blood flow through veins in the pelvis. These veins can become enlarged when blood flows backwards or has difficulty draining. It is one way that pelvic venous disease can affect people. The pain is often described as a dull ache or feeling of heaviness. It may become more noticeable after standing for a long time or towards the end of the day. Pelvic pain has many possible causes, so enlarged veins on a scan need to be considered alongside your symptoms and other findings. Dr Ryan McConnell assesses pelvic vein problems and can explain whether they may be contributing to your symptoms. This page covers what pelvic congestion syndrome is, how it is investigated and the treatment options that may be considered. Book a consultation
What are the symptoms of pelvic congestion syndrome?
The main symptom is an ongoing dull ache or feeling of pressure in the lower pelvis. It may be present on most days and often becomes worse:
- After standing or sitting for a long time
- Towards the end of the day
- During or after sex
- Around a menstrual period
What causes pelvic congestion syndrome?
Veins normally carry blood away from the pelvis towards the heart. In some people, blood flows backwards through the ovarian or other pelvic veins. This is called venous reflux. The extra blood can collect in smaller pelvic veins, causing them to enlarge. In others, a narrowing or compression of a larger vein can make it harder for blood to drain from the pelvis. Reflux and impaired drainage can also occur together. Pregnancy may contribute to changes in the pelvic veins, but it is not the only factor. Understanding why the veins are enlarged matters because the pattern of blood flow helps guide assessment and any treatment discussion.
How is pelvic congestion syndrome diagnosed?
Assessment starts with your symptoms: where you feel pain, how long it has been present and whether it changes with standing, your menstrual cycle or sex. Dr McConnell will review any previous investigations and consider other possible causes of pelvic pain. A pelvic ultrasound, including Doppler assessment of blood flow where appropriate, may show enlarged veins or blood flowing backwards. Depending on the findings, MRI or CT may help map the pelvic veins and look for a narrowing in a larger vein. If a procedure is being considered, a catheter venogram can show how blood moves through the veins in more detail. Enlarged veins alone do not confirm that they are causing pain. The diagnosis depends on how the imaging findings fit with your symptoms and the rest of your assessment.
MRI of the pelvic veins (front view), showing enlarged, twisted veins in the pelvis. Imaging findings are considered together with your symptoms and assessment.
What treatments are available for pelvic congestion syndrome?
Treatment depends on your symptoms and what the assessment shows about blood flow through the pelvic veins. Your doctors may first address other possible causes of pelvic pain and discuss ways to manage your symptoms. If backward flow through the ovarian or pelvic veins appears to be contributing to persistent symptoms, pelvic vein embolisation may be an option. An interventional radiologist uses a catheter to close the affected veins so blood can drain through other pathways. The procedure and recovery are explained on our separate pelvic vein embolisation page. When a larger vein is significantly narrowed, assessment and treatment may differ. Dr McConnell will review the pattern of reflux and drainage before recommending an approach. Finding enlarged veins on a scan does not automatically mean they need treatment. Learn about pelvic and ovarian vein embolisation →
How treatment is decided
Your symptoms and assessment
Your symptoms, examination and imaging of blood flow through the pelvic veins.
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Symptom management
Addressing other possible causes of pelvic pain and ways to manage your symptoms.
Further investigation
When the pattern of reflux and drainage needs more assessment, for example if a larger vein is significantly narrowed.
Discussing a vein procedure
If backward flow through the ovarian or pelvic veins appears to be contributing to persistent symptoms.
Pelvic vein embolisation →Finding enlarged veins on a scan does not automatically mean they need treatment.
Discuss persistent pelvic pain with Dr Ryan McConnell
If you have ongoing pelvic pain and previous imaging has shown enlarged pelvic veins, Dr McConnell can review whether the vein findings may be relevant to your symptoms. He will consider the investigations you have already had and explain whether further vein assessment is worthwhile. You can also be referred for an opinion if pelvic venous disease is suspected but the cause of your symptoms remains unclear. Where appropriate, Dr McConnell can discuss treatment alongside your GP or gynaecologist. Book a consultation to discuss your symptoms and imaging. Book a consultation
Frequently asked questions about pelvic congestion syndrome
Is pelvic congestion syndrome the same as pelvic venous disease?
Pelvic venous disease is a broader term for problems with blood flow through the veins in and around the pelvis. Pelvic congestion syndrome is commonly used to describe ongoing pelvic pain associated with these vein problems.
Do enlarged pelvic veins always cause pain?
No. Enlarged pelvic veins can be found in people who have no symptoms. Dr McConnell considers the scan findings alongside your pattern of pain and other possible causes before discussing treatment.
Is pelvic congestion syndrome the same as endometriosis?
No. They are different conditions, although both can be associated with ongoing pelvic pain and may occur together. An assessment may involve your GP or gynaecologist as well as a review of the pelvic veins.
Can pelvic vein problems cause varicose veins around the vulva or thighs?
Yes. Blood flowing backwards through pelvic veins can contribute to varicose veins around the vulva, buttocks or upper thighs. The location of these veins can help guide which pelvic veins need to be assessed.
Is pelvic congestion syndrome dangerous?
Pelvic congestion syndrome is not usually dangerous. Its main effect is ongoing pain that can affect daily life, work and relationships, rather than a risk to your health. Serious complications from enlarged pelvic veins are uncommon. Sudden or severe pelvic pain, fever, heavy bleeding, or new swelling and pain in a leg should be assessed promptly, as these can point to other conditions.
Can pelvic congestion syndrome cause miscarriage or affect pregnancy?
Pelvic congestion syndrome is not known to cause miscarriage. Pregnancy can, however, enlarge the pelvic veins, and symptoms are more common in women who have had more than one pregnancy. Pelvic vein embolisation is not performed during pregnancy. If you are planning a family, the timing of any treatment can be discussed at your consultation.
Can pelvic congestion syndrome cause bloating or weight gain?
Some people describe a feeling of fullness, pressure or bloating in the lower abdomen along with pelvic pain. Pelvic congestion syndrome is not a recognised cause of weight gain. Bloating and changes in weight have many other possible causes, so they are worth discussing with your GP as part of your assessment.
Will I need pelvic vein embolisation?
Not necessarily. Treatment depends on your symptoms, the results of your investigations and whether the veins appear to be contributing to the problem. Dr McConnell will explain the options relevant to your findings.