Pelvic venous congestion is one of the most common causes of chronic pelvic pain. This is a venous problem that can lead to significant dysfunction. Pelvic venous congestion is often associated with ovarian or pelvic venous dilation most likely due also from venous reflux. The ovarian vein reflux in females presenting as pelvic congestion syndrome or the testicular vein reflux in males presenting as varicocele.

Evaluation and management of pelvic venous congestion entail the need for a multidisciplinary team approach.

Risks Factors

Some of the risk factors identified include:

  • Multiple pregnancies

  • Retroverted uterus

  • Chronic venous reflux in the lower extremities

  • Polycystic ovaries

  • Conditions that lead to hormonal increases or dysfunction

Signs & Symptoms

Pelvic venous congestion may present in several ways:

  • Dull or aching pain in the lower abdomen and pelvis (worse on standing and relieved by lying down)

  • Low back ache/pain

  • Irritable bladder leading to incontinence

  • Irritable bowel (alternating with periods of diarrhea and constipation)

  • Dyspareunia (pain during sexual intercourse)

  • Vaginal or vulvar varicose veins in females

  • Varicocele (enlarge veins in the scrotum) in males

  • Varicose veins at the inner or back thigh

Diagnostic Study

Transabdominal ultrasound of the abdomen and pelvic is the initial test performed among patients suspected with pelvic venous congestion. A transvaginal ultrasound may be performed to further study the vessels of the pelvic region.

An added imaging study such as the CT Venography or the MR venography may be requested to determine any vascular abnormalities or obstruction and evaluate surrounding pelvic structures. Pelvic venography is the most definitive test to confirm pelvic venous congestion.

Venous Intervention

Treatment of pelvic venous congestion depends on the venous problems identified - be it venous reflux or obstruction. Procedures are done in the cathlab. Venous interventions for ovarian/testicular venous reflux are venous embolization with or without sclerotherapy. In the presence on venous obstruction due to external compression, venous procedures available include balloon venoplasty and venous stenting.