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

As with varicose veins in the legs, varicose veins in the pelvis develop when valves in the veins become weak and don't close properly. This allows blood to flow backwards and pool in the vein, causing bulging and pain.  


Women with pelvic congestion syndrome typically feel pain while standing but not when they are lying down. This can make diagnosis difficult 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. Other symptoms include:

  • A dull, aching pain in the lower abdomen and lower back that comes after intercourse, during their menstrual cycles, after standing and during pregnancy
  • Related signs include an irritable bladder, abnormal menstrual bleeding, vaginal discharge or visible varicose veins on the vulva, buttocks or thighs

Diagnosis and Treatment 

Doctors can diagnose pelvic congestion syndrome with the following tests:

  • Pelvic venography: Interventional radiologists 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 and/or transvaginal ultrasound: Provides views of the pelvic cavity and veins (not effective funless the woman is standing for the yest)

Treatment often consists of closing off varicose veins in the pelvic area during an outpatient procedure. Although pain is reduced, the veins never return to normal, and in some cases, other pelvic veins may also be affected and may require additional treatment.