Chronic pelvic pain affects a striking number of women, and one of its most under-diagnosed causes is a vein condition called pelvic congestion syndrome. Here’s what it is, why it happens, and how to recognize it.
What Is Pelvic Congestion Syndrome?
Pelvic congestion syndrome (PCS) is chronic pelvic pain — lasting more than six months — caused by enlarged, varicose-like veins in the pelvis. It happens when the valves inside the pelvic veins (most often the gonadal, or ovarian, veins) stop working properly, allowing blood to pool and the veins to become engorged rather than draining efficiently. This is essentially the pelvic equivalent of varicose veins in the legs, and the two conditions are often related — many women with PCS also have leg varicosities.
PCS is estimated to account for roughly 16–31% of chronic pelvic pain cases in women, and it’s most commonly diagnosed in women between their 20s and 40s, often after multiple pregnancies, which can weaken the pelvic vein valves.
Common Symptoms of Pelvic Congestion Syndrome
- Dull, aching pelvic pain lasting more than six months
- Pain that worsens by the end of the day, after standing for long periods, or during/after intercourse
- A feeling of heaviness or pressure in the pelvis
- Lower back pain
- Bloating or an irritable bowel sensation
- Bladder urgency or instability
- Visible varicose veins around the vulva, buttocks, or thighs
Because these symptoms overlap with many other gynecologic and gastrointestinal conditions, PCS is frequently underdiagnosed — many women see multiple providers before someone identifies pelvic vein reflux as the underlying cause.
What Causes Pelvic Congestion Syndrome?
PCS most often results from reflux (backward flow) or obstruction in the gonadal veins, which drain blood from the ovaries and uterus back toward the heart. When the valves in these veins fail, blood pools instead of flowing efficiently, increasing pressure in the pelvic venous network. Pregnancy is a major risk factor, since it significantly increases pelvic blood volume and can stretch and weaken vein valves — which is part of why PCS is more common in women who have had multiple pregnancies.
How Is Pelvic Congestion Syndrome Diagnosed?
Diagnosis typically starts with imaging — ultrasound, CT, or MRI — to evaluate the pelvic veins and rule out other causes of chronic pelvic pain. The definitive diagnostic step is a venogram, a minimally invasive procedure using contrast dye and X-ray imaging to directly visualize blood flow through the pelvic veins and confirm reflux or obstruction.
Is Pelvic Congestion Syndrome Treatable?
Yes. While conservative options like pain medication and hormonal therapy exist, they often provide limited or temporary relief. A minimally invasive procedure called gonadal vein embolization has become the leading treatment, closing off the problematic veins and redirecting blood flow through healthier vessels — all without surgery.
Want to learn more about how this procedure works? Read our companion post, Gonadal Vein Embolization: How It Treats Pelvic Congestion Syndrome, or visit our Pelvic Congestion Syndrome page to learn more about care at MIVA Medical. Book a consultation if you think PCS may be affecting you.