Varicose veins in the pelvis
Varicose veins are usually caused by valve failure within the veins in the legs, but in some people, mostly women, the veins with the faulty valves can be found in the pelvis.
Pelvic venous congestion syndrome (PCVS) is also a common cause of pelvic pain in women.
Contents
Overview and definitions
Varicose veins are usually caused by valve failure within the veins in the legs, but in some people, more commonly women, the veins with the faulty valves can be found in the pelvis.
Pelvic venous congestion syndrome (PVCS), also known as pelvic venous insufficiency or pelvic vein incompetence (PVI), is a condition that occurs when the veins in the pelvis are unable to adequately drain blood back to the heart. This can cause a build-up of blood in the pelvic region, causing symptoms such as pelvic pain and a feeling of ‘heaviness’ in the pelvis and abdomen.
Sometimes PVCS causes visible varicosities in the pelvis, including vulval varicose veins, buttock veins or veins around the perineum. Occasionally, PVCS also contributes to varicose veins in the legs, but it is actually quite rare that this is a significant cause that needs treating to control leg varicose veins. If you are told that you require this, please ask us for a second opinion, as it is often advised but unnecessary.
Causes
The valves in your veins pump blood from your legs up to your heart. If any of these valves fail it causes the blood to flow in the wrong direction (pelvic venous reflux) and to dilate the veins (causing varicose veins).
As with varicose veins in the legs, if valves fail in the pelvic veins, blood that should be pumped out of the pelvis and back to the heart stays inside the pelvic varices (dilated veins within the pelvis). This both stops the normal blood circulation to the pelvic organs and also causes these large varicose veins to push on the pelvic organs – the bladder, bowel, vagina and also the pelvic floor. The symptoms of PVCS predominantly come from the weight of the blood pushing on these structures.
PVCS can also sometimes cause visible varicose veins in the pelvis, including vulval varicose veins, buttock veins or veins around the perineum, or on the upper thigh, close to the buttocks.
Risk factors
Whilst there is no one definitive cause of PVCS, a number of risk factors have been identified:
- Age – women in their childbearing years between the ages of 20 to 45 years are at higher risk
- Pregnancy and childbirth – PVCS is more common in women who have given birth to more than one child. Blood vessels expand 50% of their normal size during pregnancy to manage the extra blood flow needed to support a developing foetus. These changes may cause long-term damage to your blood vessel walls, causing veins to remain dilated even after you’ve had your baby. Pregnancy can also alter the structure of the pelvis, which can affect the blood vessels. In addition, during pregnancy, the volume of blood in a woman’s body increases, putting more pressure on the veins, whilst at the same time increased estrogen might weaken the walls of the blood vessels
- Hormonal changes – PVCS is uncommon among people who’ve experienced menopause, suggesting that estrogen may be involved, since estrogen levels decrease after menopause. Estrogen’s effects on your blood vessel walls may make you more susceptible to defects that lead to PVCS. Use of birth control pills or hormone replacement therapy (HRT) could therefore increase risk of PVCS
- Family history – evidence suggests that there is a genetic component to venous insufficiency, varicose veins and PVCS, so if other members of your family have these conditions, particularly your mother, then you are more likely to develop them too
- Polycystic ovarian syndrome (PCOS) – if you have PCOS, you may develop cysts (fluid-filled sacs) on your ovaries. These ovarian cysts can cause imbalances in the levels of estrogen and trigger PVCS
- Having a “tipped” or retroverted uterus – this is when the uterus points towards the lower back instead of sitting upright or being tipped forward towards the bladder
- Obesity – Being overweight or obese puts added pressure on the veins which means they have to work harder to send blood back to your heart
- Sedentary lifestyle – movement helps blood flow so sitting for long periods can hinder circulation, whereas with standing, the problem is that it becomes harder for blood to circulate upwards (it simply goes against gravity!)
- History of blood clots– if you have had a blood clot or DVT in the past, this may have caused damage to the valves and/or walls of your veins, leading to increased pressure
Prevention
As with varicose veins, there is no way to prevent PVCS, since even women who have never had children can develop the condition.
The best things you can do to help prevent PVCS or minimize the symptoms include:
- Eating a healthy diet rich in fresh, whole foods and minimally processed and refined foods
- Getting plenty of exercise
- Avoiding or quitting smoking
Symptoms
PVCS and pelvic varicose veins can put pressure on the ovaries, uterus, bladder and rectum, which can result in the following symptoms:
- Pain in the pelvis, lower abdomen, legs, hips and lower back
- Worsening pain during the menstrual cycle or during/after sexual intercourse
- A ‘heaviness’ or ‘dragging’ sensation in the lower abdomen and/or pelvis
- A feeling of fullness in the legs
- Leg cramping or restless leg syndrome
- Worsening of stress incontinence through increased pressure on the bladder
- Worsening of the symptoms associated with irritable bowel syndrome (IBS) through increased pressure on the bowels
Diagnosis
PVCS can be difficult to diagnose, as there are many things that can cause pelvic pain, particularly in women. Diagnosis is likely to involve a discussion of symptoms and medical history, followed by a pelvic examination, before any further tests are done.
The valve failure that causes PVCS normally occurs in the veins that drain the ovaries, especially the left ovary, although sometimes other veins, such as the iliac veins, may be the issue.
Even though the treatment itself needs to be done in a hospital, diagnosis can potentially be carried out at our clinic using an ultrasound scan. Further imaging of pelvic veins will often be needed but that is usually done during the treatment.
Pelvic venography, or a catheter venogram, is usually considered the ‘go to’ diagnostic technique for PVCS, as whilst doing that test the treatment can be carried out at the same time, saving both time and money.
During pelvic venography, your consultant inserts a thin plastic tube (a catheter) into a large vein in the groin or neck. They then use X-ray imaging to guide the positioning of the catheter into each of the pelvic veins on the right and left sides of your body. A safe high contrast dye is then injected into the veins, making them more visible on the X-ray scan. This then highlights where the dilated and twisted veins are, which valves are faulty, how the blood is flowing and where the blood is pooling. This will determine whether you need pelvic vein embolisation (PVE) and which veins need treatment. PVCS often affects more than one vein.
Once it is determined which valves have failed, the same catheter can be used as a conduit through which tiny metal coils and foam sclerosant are inserted, thereby blocking and killing off the abnormal veins.
Treatment
There are three types of treatment for pelvic veins depending on whether the issue is PVCS alone or together with varicose veins:
- If the issue is PVCS alone then the best treatment is PVE, which requires sophisticated X-Ray equipment. As such, if you need PVE, we will refer you to a local hospital with the required specialist equipment.
- If you have varicose veins in the legs, together with visible vulval or buttock veins, then PVE is also the best treatment. This will deal with the underlying cause of PVCS. The visible veins will then need treatment with foam sclerotherapy as well.
- If the main issue is with the veins in the legs and there is a small pelvic component, then the visible pelvic veins can be treated with foam sclerotherapy. The legs will subsequently be treated with endovenous laser ablation (EVLA) and/or foam sclerotherapy.
If you suspect that you have a pelvic source of your problems, please let us know prior to making any bookings. If you require EVLA or foam sclerotherapy treatment, we can undertake this at our UKVC clinic, in addition to any follow-up procedures.
Treatment costs
Unfortunately, we cannot quote a fixed price for PVE, because it requires specialist X-Ray equipment and must be undertaken in a hospital environment. As these hospitals are not UKVC clinics, we regrettably have no control over what each hospital charges.
If you have issues with vulval varicose veins, PVCS, or suspect that your varicose veins may have a pelvic source, please contact us to discuss this before making an appointment.
If you require EVLA or foam sclerotherapy treatment, we can undertake this at our UKVC clinic, in addition to any follow-up procedures. These treatments will be charged in line with our fixed-cost self-funded pricing. Alternatively, many health insurance providers will cover the costs of treatment for PVCS or varicose veins.
Treatment risks
PVE is a very safe procedure designed to avoid the necessity of a larger operation. However, as with any medical procedure, there are some minor risks and complications that can sometimes arise:
- Rarely patients may develop a rash due to an allergic reaction to the contrast X-Ray dye. This responds rapidly to medical treatment, which would be given during the procedure should this occur.
- There may be a small bruise (haematoma) around the site where the needle has been inserted. This is quite normal. If this becomes a larger bruise you may need to contact your usual doctor, as there is a risk of infection. This may require treatment with antibiotics. Very rarely, the vein may be damaged by the catheter. This may need to be treated by surgery or another radiological procedure.
- A few patients may experience mild discomfort in and around the pelvis after the procedure, which can last a few days. This can usually be treated with over the counter pain relief medications.
- There is a very small risk that a coil, used to block the vein, could migrate to your lungs. If this happens and it cannot be retrieved it can safely stay within the body and is very unlikely to cause any problems other than a cough and mild chest pain for a few days.
- In some cases, it may not be possible to obtain a satisfactory result using embolisation, in which case a surgical operation may be offered.
- There is also a possibility that the veins may enlarge again. If this happens, then the procedure may be repeated, or you may be advised to have an operation.
Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side effects. You can find a full list of treatment risks on our treatment FAQs page.
Aftercare
You will have to avoid strenuous exercise, heavy lifting and sexual intercourse for 2-3 days following the PVE procedure.
Most patients experience some mild side effects after PVE. Pain is the most common side effect and can be controlled with over the counter pain relief medications. You may also feel very tired for a few days. For women, the following menstrual cycle may also cause mild pain.
During your recovery, it’s important to remain hydrated. We also encourage you to walk for at least 10 minutes every day to reduce the risks of blood clots.
Most patients are able to return to work and their normal activities within a few days.
It could take up to three months after the PVE treatment before it is clear whether symptoms have been controlled or eliminated.
On rare occasions, complications following PVE can occur. If you experience pain or discomfort please contact your doctor straight away.
Frequently asked questions
Are pelvic varicose veins dangerous?
How do I know if the varicose veins in my legs have a pelvic source?
You can find the answers to these questions and many more in the varicose veins section of our conditions FAQs page.
If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.
