As outlined in the introduction, pelvic congestion syndrome is the name given to the condition caused by swollen varicose veins in the female pelvis. Due to the male anatomy, it is rare in males although males can get problems with pelvic vein incompetence including varicoceles, haemorrhoids, leg varicose veins and even impotence. However male pelvic vein problems are a very specialised area that will be discussed elsewhere.
In females, there are four major veins involved in pelvic congestion syndrome. These are the right and left ovarian veins and the right and left internal iliac veins.
As with all veins, in the normal situation blood is pumped up the veins towards the heart. In the very large veins such as the common iliac vein and the inferior vena cava, there is fairly continuous flow and so valves are not needed and so do not usually appear. However in the internal iliac veins draining blood from the anus, perineum, vulval and vagina and also in the ovarian veins, draining blood from the ovaries and uterus, the flow is slow enough to require valves to be present.
Similarly with all varicose veins, the underlying cause of the pelvic varicose veins are when these valves fail. The valves can fail in 1, 2, 3 or 4 of these veins causing blood to fall the wrong way down the veins (pelvic venous reflux) and causing the veins lower down to dilate (varicose veins).
Because the ovarian veins are long, they are easier to see on scanning and easier to treat and so a lot of doctors and clinics concentrate on ovarian vein reflux only. However research published in peer review journals from The Whiteley Clinic has shown that only 3% of women with pelvic venous reflux have only ovarian vein reflux and the commonest pattern of pelvic vein reflux is left ovarian vein and both internal iliac veins. Hence those concentrating on only the ovarian veins will be missing the vast majority of patients with pelvic venous reflux.
The pelvic venous reflux occurs passively when standing or sitting, as the blood falls back down the veins due to gravity. When the woman lies flat, gravity then helps the blood return to the heart normally and so the symptoms of pelvic congestion syndrome improve. This is improved further still if the woman lies down on a slope up, with her bottom raised above her chest.
This is also a reasonably good way to check whether pelvic symptoms might be due to pelvic congestion syndrome. If the symptoms worsened during the day when the patient is up and about, but improve after a night’s sleep in bed, then pelvic congestion syndrome is much more likely.
(If you would like to read more about how venous reflux causes varicose veins both in the legs and pelvis, please see the book “Understanding Venous Reflux – the cause of varicose veins and venous leg ulcers” by Mark S Whiteley)