Pelvic Congestion Syndrome May Be Far More Common in Pelvic Pain Patients
Imagine trying to live with agonizing migraine headaches every day. Then add in chronic pelvic pain, severe constipation, fainting spells (POTS), seizures, tachycardia, anxiety, and, inevitably, depression. Overwhelming, right? But then memory problems set in. You are easily confused, unable to complete sentences or stay on task. You can’t study; thus, you have to drop out of graduate school. You contacted 60 physicians, none of whom could explain why this was occurring. At one appointment, a doctor finds something so obscure that it is almost impossible to believe that it would lead to your cure. You have varicose veins “down there.” How, you ask, would varicose veins be involved?
In January 2026, a case study of a 42-year-old woman with all of the above symptoms was published in Frontiers in Cardiovascular Health(1). Doctors were particularly concerned about her brain health and cognition. At appointments, she appeared confused and distracted. She was quite intelligent but simply unable to concentrate. When her pelvic exam found abnormal and swollen veins in her vulva, a new diagnosis was considered.
Pelvic Congestion Syndrome
Pelvic congestion syndrome (aka Venous Origin Chronic Pelvic Pain or VO-CPP) is found in both men and women. Symptoms can include an aching, throbbing pain. Heaviness, as if you are carrying a bowling ball in the pelvis or scrotum, often worsens throughout the day but is relieved after lying down. Urinary symptoms can include pain during urination, frequency, urgency, and/or incontinence from laughing, coughing, or sneezing. Men may experience scrotal swelling, often on the left side. Erectile dysfunction can occur, as well as pain during ejaculation. Sitting or standing for long periods can become uncomfortable.
Patients often have visible varicose veins inside the body, such as within the pelvis and vagina. But you may also see swollen veins on the upper legs, butt, scrotum, and vulva.
Causes & Diagnosis
The cause of pelvic congestion syndrome is unclear. Blood is supposed to flow up towards the heart. There are tiny valves that normally prevent blood from flowing backwards. Among women with children, varicose veins are a common complaint. Why? Because the veins become dilated during pregnancy to support more blood flow to the baby. In some cases, the veins simply stay that way.
Veins can also be compressed and/or obstructed, perhaps the result of obesity, heavy lifting, and/or sitting for long periods of time, thereby restricting blood supply.
The diagnosis of VO-CPP is usually made using ultrasound and/or magnetic resonance venography, with veins appearing either markedly dilated or markedly restricted.
The Case Study
After the discovery of the varicose veins, a magnetic resonance venography was ordered. It found that her left iliac vein was more than 50% blocked. Why is this important?? This vein returns blood to the heart. When blood volume is reduced, the heart sends a reduced blood supply to the brain.
She was treated with a stent to open the blood vessel, a blood thinner to prevent clots, and was encouraged to drink 100oz of electrolytes every day and wear waist-high compression stockings for 30 days. After the first month, her confusion and dizzy spells had completely resolved. At six months, her cognition had returned to normal, and she was able to return to graduate school. She had fewer headaches, though a slight dizziness continued and was resolved with medication.
Her pain with intimacy persisted, however. Examination found mild varicose veins in her vaginal wall. These were treated with injections of a .5% sotradecol foam, which is normally used to close small veins in the legs. Her vaginal pain resolved after 3 months.
Just one year later, neuropsychological testing showed that her memory was at the 95th percentile, and her IQ had increased. Yet, she experienced a setback when her dizziness and pain with intimacy returned. Doctors found that the stent they had implanted was pressing on her right iliac vein. She was then treated with a second stent to open the right vein.
At thirty months post-treatment, her migraines were greatly reduced, from daily to perhaps 4 a month. She had no fainting episodes. She completed graduate school and started a business. Her doctor noted that she was very alert. She had no vulvar tenderness or vulvar varicose veins. Her vulvodynia had completely resolved.
The Importance of Blood Flow
We cannot overestimate the importance of blood circulation in the pelvis. Patients with tight pelvic floor muscles, for example, may suffer from ischemia, where tissues (such as the bladder) do not receive adequate blood supply. This could explain why patients with PFD may suffer from diet sensitivity, which often improves after physical therapy relaxes these muscles and restores good blood flow. When the bladder receives full oxygenation and nutrition, it may heal.
However, if blood pools in the pelvis in large quantities or blood flow is constricted, it doesn’t reach the heart and then the brain, thereby explaining the onset of cognitive and memory deficits. Thankfully, it can be treated fairly easily with a simple stent or, for some women, a hysterectomy.
Conclusion
Consider what this patient struggled with on a daily basis. Intense, persistent pain in various parts of her body. She struggled with memory. She had difficulty communicating. She was anxious and depressed. I have no doubt that some suggested to her that her symptoms were “all in her head,” minimizing her struggles.
It took dozens of doctor’s visits to find the underlying cause of her problem, a blood vessel disorder. For men and women who have visible varicose veins, who aren’t responding to therapy, and/or are struggling with cognition issues and confusion, it is worth asking your physician to assess for varicose veins and/or pelvic congestion syndrome.
References:
1. Smith SJ, et al. Case Report: Neuropsychiatric improvement after treatment of pelvic venous disorder in a multisyndromic patient. Front Cardiovasc Med. 2026 Jan 12;12:1574432.
