Vascular
Pelvic Congestion Syndrome
A chronic condition in women caused by varicose veins in the lower abdomen and pelvis, leading to persistent pelvic pain.
Pelvic congestion syndrome is a vascular cause of chronic pelvic pain in women, resulting from dilated and incompetent pelvic veins. It is often misdiagnosed but highly treatable through minimally invasive intervention.
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Pelvic congestion syndrome involves varicose veins in the pelvis, which can cause chronic, heavy pelvic pain that worsens throughout the day.
Pelvic Congestion Syndrome: A Vein Problem Behind Chronic Pelvic Pain
Pelvic congestion syndrome is, in effect, varicose veins in the pelvis. The valves inside the ovarian and pelvic veins, which should keep blood moving upward, stop closing properly. Blood then pools in the pelvis, the veins stretch and become engorged, and the result is a dull, heavy ache low in the abdomen.
It is common in women who have had more than one pregnancy, yet it is often missed for years and simply labelled ‘unexplained pelvic pain’. That is a shame, because the pattern is recognisable and the condition is very treatable with a keyhole procedure.
It is common in women who have had more than one pregnancy, yet it is often missed for years and simply labelled ‘unexplained pelvic pain’. That is a shame, because the pattern is recognisable and the condition is very treatable with a keyhole procedure.
How the Pain Behaves
The story is usually more telling than any single test. The pain is a deep, dragging heaviness rather than a sharp pain, and it follows gravity.
- A dull ache or heaviness low in the abdomen, present for more than six months
- Worse after standing or sitting all day, and worse by the evening; relieved by lying down
- Worse around periods, and during or after intercourse
- Sometimes visible varicose veins on the vulva, buttock or inner thigh
- Occasionally bladder urgency or a feeling of pelvic fullness
Why It Happens
Pregnancy is the main driver: the pelvic veins carry a much larger volume of blood, they stretch, and the hormones of pregnancy relax the vein walls. In some women the valves never fully recover afterward, and blood refluxes downward with every change of posture.
A family tendency to varicose veins adds to the risk. Less often, a vein is being squeezed elsewhere — the left kidney vein (Nutcracker) or the left iliac vein (May-Thurner) — which is important to identify because it changes the treatment.
A family tendency to varicose veins adds to the risk. Less often, a vein is being squeezed elsewhere — the left kidney vein (Nutcracker) or the left iliac vein (May-Thurner) — which is important to identify because it changes the treatment.
Getting the Diagnosis in Singapore
Pelvic congestion syndrome is diagnosed by putting the symptom pattern together with imaging, after gynaecological causes such as endometriosis have been considered. We usually start with a pelvic or transvaginal duplex ultrasound, then a CT or MR venogram to map the refluxing veins and check for a compression point.
Catheter venography gives the definitive picture and is generally performed as the first step of treatment rather than on its own. This works best as a joint effort between a vascular specialist and a gynaecologist, which we coordinate from Paragon Medical Centre on Orchard Road.
Catheter venography gives the definitive picture and is generally performed as the first step of treatment rather than on its own. This works best as a joint effort between a vascular specialist and a gynaecologist, which we coordinate from Paragon Medical Centre on Orchard Road.
Treatment: Embolisation, a Keyhole Fix
The main treatment is pelvic vein embolisation. Through a small puncture in a vein in the neck or groin, under local anaesthetic, the refluxing ovarian and pelvic veins are sealed with tiny coils and a foam agent. It is a day-case procedure, and around 70 to 80% of women get meaningful, lasting relief of the pain.
Associated varicose veins on the vulva or thigh can be treated with sclerotherapy at the same time. For milder symptoms, or while you decide, compression garments, simple analgesia and certain hormonal treatments can take the edge off. If a vein compression is found, that is addressed first, sometimes with a stent.
Associated varicose veins on the vulva or thigh can be treated with sclerotherapy at the same time. For milder symptoms, or while you decide, compression garments, simple analgesia and certain hormonal treatments can take the edge off. If a vein compression is found, that is addressed first, sometimes with a stent.
Pelvic Congestion Syndrome: Common Questions
Concerned About Pelvic Congestion Syndrome?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.