We know that varicose veins occur in the legs but this painful condition can also affect the pelvis. By Kirsten Braun.
Our veins carry blood back to the heart from all over the body. When the blood flow is against gravity, tiny valves within the veins open and close to stop the blood from flowing backwards. Sometimes, however, these valves become weak and this allows the blood to flow backward and to pool in the veins, causing varicose veins. We are familiar with varicose veins forming in the legs but there are also veins in the pelvic area, the uterus, ovaries, vulva and vagina which can be similarly affected. Varicose veins in the pelvis are often referred to as pelvic congestion syndrome or pelvic venous flow disorder.
Who is at risk of developing the condition?
The main risk factor for women is pregnancy. In fact, the condition is quite rare in women who have not been pregnant and most common in women who have had two or more pregnancies. During pregnancy, the veins in the pelvis dilate to allow for the increased blood flow to the uterus and they experience extra pressure from the weight of the baby. In addition, the hormones progestogen and oestrogen relax the vein walls contributing to the formation of varicose veins. While varicose veins that first develop during pregnancy often improve after delivery, for some women they remain.
Women with pelvic varicose veins are more likely to also have varicose veins in the legs. However, some women with pelvic varicose veins have never had leg varicose veins. Additionally, women with a family history of varicose veins or women who are obese also appear to be more at risk.
What are the symptoms?
Some women will have visible varicose veins around the vulva, inner thigh and buttocks but others will not have any visible signs. The symptom women most commonly experience is pain in the pelvis, upper thigh or lower back which is typically described as a heavy or dull ache. The discomfort tends to worsen throughout the day and after standing or sitting for long periods of time. The pain is lessened when women lie down. Women may also find the pain occurs during sexual intercourse and for some time afterwards. The pain can also be worsened before and during menstruation.
Varicose veins in the pelvis can also cause urinary symptoms such as a need to go to the toilet frequently and urge incontinence. In addition, women who experience the chronic pelvic pain associated with pelvic varicose veins may develop depression and/or anxiety.
How is the condition diagnosed?
Unfortunately, pelvic varicose veins can be quite difficult to diagnose. Women may initially be thought to have other conditions such as endometriosis, fibroids, uterine prolapse or urinary incontinence as some of the symptoms are similar. Sometimes it is only after these other conditions are ruled out that pelvic varicose veins are considered. If pelvic varicose veins are suspected an ultrasound is usually the first diagnostic test conducted. Advances in ultrasound technology can evaluate the blood flow in the various veins. Venography may also be conducted which uses a contrast dye in conjunction with a CT or MRI scan to examine blood flow in the veins.
What are the treatments?
There are various treatments available depending on the type of symptoms experienced and the severity of the pelvic varicose veins. Initial treatments include medications for pain relief and/or the oral contraceptive pill. The oral contraceptive pill is prescribed to reduce the frequency of menstruation which can reduce symptoms. The most common treatment is embolisation. Embolisation involves a radiologist inserting a thin catheter into the affected veins with the guidance of imaging. Tiny coils and a hardening solution are then injected into the vein causing it to collapse and permanently close. This procedure is non-surgical and can be performed under local anaesthetic. While some women will experience a significant reduction in pain symptoms following embolisation, for other women their symptoms may persist. Over time other veins can become affected and require further treatment. Surgical treatments for pelvic varicose veins include hysterectomy and/or oophorectomy (removal of ovaries) and the tying off (ligation) of affected veins.
Last updated: December 2015
© Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee in December 2015. It was first published in Health Journey 2015 Issue 3-4.