Chronic pelvic pain can be attributed to a variety of causes, but for some women it may be attributed to varicose veins in the pelvic region, a condition known as pelvic congestion syndrome.

A common sign of this syndrome is that the women may feel pelvic pain while standing but not when they are lying down. That can sometimes make it difficult to diagnose because women are usually asked to lie down for a pelvic exam, relieving the painful pressure that brought them to the doctor in the first place.

As with varicose veins in the legs, varicose veins in the pelvis are caused by valves in the veins becoming so weakened that they don't close properly. That allows blood to flow backwards and pool in the vein, causing bulging veins and pain.  

A dull, aching pain in the lower abdomen and lower back is most often associated with this condition. Some women report that the pain usually comes after intercourse, during their menstrual cycles, when tired after standing and during pregnancy. Other related signs may include an irritable bladder, abnormal menstrual bleeding, vaginal discharge or visible varicose veins on the vulva, buttocks or thighs.

Doctors can diagnose pelvic congestion syndrome with the following tests:

• Pelvic venography: Doctors perform a venogram by injecting dye into the veins of the pelvic organs to make them more visible during an X-ray. Patients are examined on an incline because the veins being examined often decrease in size when a woman is lying flat.
• MRI: Images that provide a detailed view of specific pelvic blood vessels can be used to diagnose this condition.
• Pelvic ultrasound: Patients are asked to stand while an ultrasound is performed
• Transvaginal ultrasound: Used to view inside the pelvic cavity, this test is not usually good for providing images of the pelvic veins unless the woman is standing.

Treatment
Treatment often consists of closing off varicose veins in the pelvic area. During an outpatient procedure, an interventional radiologist inserts a thin catheter, into a vein in the groin and guides it to the varicose vein in the pelvis, using X-ray guidance. To seal the varicose vein, tiny coils are inserted with a sclerosing agent. After treatment, patients can return to normal activities immediately.

Although a woman’s is often eased, the veins never return to normal, and in some cases, other pelvic veins may also be affected and may require additional treatment.