Pelvic venous disorders (PeVD) occur when veins in the pelvis do not work properly. It is the second leading cause of chronic pelvic pain behind endometriosis. PeVD is more common in women than men with the typical age of onset ranging from age 25-40. Women who have been pregnant two or more times are at a higher risk, yet these disorders can also occur in women who have not been pregnant.
Veins are vessels that carry blood from the body back to the heart. Four main veins can be involved in PeVD: the renal veins, gonadal veins, iliac veins, and internal iliac veins. If a vein is compromised, it can narrow or close off, or blood can flow in the wrong direction (reflux). An increase in pressure results in venous enlargement. Symptoms can arise from blood reflux or when there is an obstruction causing a partial or complete blockage.


While pelvic pain is a hallmark, depending on which veins are involved, symptoms could also be in the perineal area and/or in the leg.
Common Symptoms:
-dull, unilateral or bilateral ache in the pelvis over 6 months
-prolonged postcoital ache
-pelvic floor heaviness
-urinary urgency
-pain with menstruation
-pelvic varicosities
Common Presentation:
-Ovarian point tenderness upon palpation
-Worse with prolonged sitting or standing or exercise
-Better with lying, compression garments and inversion positions
Pelvic health physical therapists need to recognize patterns and signs to know when to refer to a vascular specialist or a gynecologist depending on the presentation. PeVD can easily be ruled in or out with a non-invasive transabdominal ultrasound. If more investigation is required for surgical recommendations other imaging is often required.
Pelvic floor therapy can be continued while awaiting a diagnosis. The pelvic floor acts as a sump pump to help move lymphatic fluid and blood back to the heart, so ensuring optimal function of these muscles is recommended. An ortho-pelvic physical therapist who understands the thoracic and pelvic compensation patterns well may be the best physical therapist to offer symptom relief. The overarching goal is improving venous return in multiple areas. Most importantly quality and caring education is key as hypervigilance, anxiety, and depression can often be present.
Treatment recommendations would involve a close look at breathing, pelvic floor length and strength, posture, and how to adjust biomechanics to create a decompression around vessels. Nerve compression, especially in nerves that run in a neurovascular bundle (nerve, artery, and vein) can add to discomfort as the veins distend and cause nerve compression.
Determining which symptoms are venous, from a neural structure, and which are from the musculoskeletal system and treating each without compromising another requires high skill. Finding a physical therapist who has taken advanced coursework in treating this disorder is best.
In terms of surgical procedures, embolization and stenting are the most common. Embolization creates a physical blockage of the vein in order to redirect the flow and stenting improves the flow of a narrow vein by opening it. Sclerotherapy, a minimally invasive procedure that uses a chemical to treat abnormal vessels can also be used.
Please note that there is no accreditation for the vascular surgeons and interventional radiologists who treat PeVD. It is wise to ask the vascular surgeon questions such as their PeVD caseload percentage, how long they have been treating PeVD, how long they have performed the surgical techniques, and for the outcomes for their procedures.
The American Vein and Lymphatic Society (AVLS) is the leading organization providing research and resources for these clinicians. The website could be a great place to start to find a knowledgeable physician in your area: https://www.myavls.org
Any questions? Brentwood Pelvic Health would love to hear from you.
*Blog content is for informational purposes only and is not considered medical advice