Pelvic Venous Insufficiency (PVI) Explained

posted in: Varicose Veins

The pelvis is a basin-shaped bony structure that supports the spinal column and houses and protects numerous abdominal organs. Pelvic pain can be due to multiple reasons. Women of childbearing age more likely to report pelvic pain.

The heart is the organ entrusted to pump blood throughout the body. In order to perform its vital role, the heart is connected to arteries and veins with an interconnection of capillaries. Arteries transport oxygenated blood away from the heart while veins bring back deoxygenated blood to the heart. Due to the low pressure of blood in veins, veins have valves that are vital in preventing stasis or backflow.

Pelvic Venous Insufficiency (PVI) Explained - Vein Solutions

What is Pelvic Venous Insufficiency

Pelvic Venous Insufficiency (PVI) occurs due to compromised venous circulation in the pelvic area. PVI may present with pain, swollen legs, or abdomen.

When the veins of the pelvis are unable to transport blood back to the heart adequately, there is a build-up of blood in the pelvic region; a condition called Pelvic Venous Insufficiency. Numerous veins and arteries populate the pelvis. Compromised drainage by the main pelvic veins leads to pelvic insufficiency.

Due to pelvic insufficiency, blood that gets to the pelvis is not completely drained away. Poor drainage causes stasis of blood in the veins. The veins being elastic, they are forced to dilate to accommodate blood flow.

When this stasis occurs for an extended period, the one-way valves in the veins weaken and allow backflow of blood. The continued blood pooling becomes a vicious cycle, and the adjacent organs and tissues become victims of an ever-expanding vein. Eventually, you end up with pelvic congestion syndrome (PCS).

When left untreated, the veins permanently adapt to accommodate the pressure from the static blood. Permanent damage to the veins may necessitate surgical intervention to undo the damage. Sometimes, PVI can lead to pelvic varicosities. Pelvic varicosities are enlarged veins that are visible under the skin. Sadly, even though PVI and PCS are leading causes of pelvic pain, these conditions remain largely undiagnosed.

Who is at Risk of Developing PVI

While it is true that all women are at risk of developing Pelvic Venous Insufficiency, several risk factors may increase your chances of developing the condition. Women between 20 and 45 years (the median childbearing age) are at a greater risk of developing PVI. Pregnancy, especially multiple pregnancies, increases the risk of developing PVI due to the growing fetus compressing veins and other organs in the pelvis. Other risk factors include.

Being Obese or Overweight

Obesity is defined as having a Body Mass Index (BMI) greater than 30, while overweight is defined as a BMI between 25 and 29.9. Being overweight or obese leads to numerous hormonal disturbances and may also affect body fat distribution, leading to a reduced circumference of veins and arteries.

Having a History of Blood Clots

A history of blood clots or thrombi may be due to genetic predisposition. People who get thrombi have problems with clotting factors in the blood. Therefore, individuals have a higher risk of developing a clot or thrombi. Clots in the pelvis may interfere with venous drainage and predispose you to PVI.

Chronic Use of Hormonal Birth Control Pills

Hormonal birth control pills act by mimicking the action of the endogenous hormones produced by our bodies. Due to the large dosage of hormones ingested within the pill, normal hormone production is disrupted. Pills containing large amounts of estrogen have been shown to increase blood clot formation and predispose users to PVI.

Living a Sedentary Lifestyle

Regular muscular contractions and exercise aid venous blood flow. A sedentary lifestyle leads to being overweight or obese. It also affects blood flow since active muscles are motivators of blood flow.

A Genetic Predisposition to Venous Insufficiency

Venous insufficiency may run in your family, and in such a scenario, there is little that you can do to protect yourself from the condition.


Menopause can be a difficult time for many women. Menopause is associated with hormonal disturbances and variations in blood hormone levels that affect many aspects of a woman’s life. Hormonal changes may lead to increased blood coagulability and thus predispose a woman to PVI.

How does PVI Present

Due to the disease process of Pelvic Venous Insufficiency, the symptoms of PVI may vary. Symptoms can be severe or present as minor discomfort. Pelvic pain is the most common presenting complaint. Pelvic pain is characterized by ranging from dull aching pain to sharp cramp-like pain. The pain is often worse during menstruation or after long periods spent standing.

The pain is due to the pooled blood compressing other organs in the pelvis. Other symptoms are

  • Pain during intercourse (dyspareunia)
  • Painful menstruation
  • Swelling of the legs or feet that may or may not be painful
  • Abnormal bleeding
  • Infertility
  • Pressure or heaviness in the pelvis
  • Feeling constipated or bloated
  • Urinary incontinence (Inability to hold your urine)
  • Varicose veins (Hard fibrous veins) in the legs or pelvis
  • Chronic pain in the pelvis

The dilated veins may produce chemicals that affect your brain chemistry, and can lead to anxiety or depression associated with pelvic pain. If you have any of these symptoms, you ought to get checked by a doctor to establish whether you have PVI.

How your Doctor Diagnoses Pelvic Insufficiency

When you visit your doctor with the suspicion of PVI, your doctor will likely perform an ultrasound on your pelvis to see the dilated veins or utilize any other suitable imaging technique. An ultrasound is a non-invasive technique that uses sound waves to create an image of your abdominal organs. An ultrasound allows your doctor to visualize abnormal blood flow and dilated veins.

Other than the Doppler Ultrasound that allows visualization of speed and direction of circulation in real-time, other techniques available to your doctor are:

Computerized Tomography (CT) Scans

CT Scans are excellent tools to determine the diameter of the affected veins and assess the damage to the veins. A CT scan is useful when developing a management plan.

Magnetic Resonance Imaging (MRI) without Contrast

MRIs allow your doctor to visualize how much blood is pooling and the extent of congestion in the affected areas.

Pelvic Venography

Your doctor injects a dye into the affected veins and then uses an X-ray to visualize (take pictures) the pelvic veins. Venography is an invasive procedure and is usually the go-to when non-invasive imaging fails to provide the necessary information. The contrast dye is injected using a catheter, and measurements are done to establish the severity of dilation.

Treating PVI

The treatment modalities available for PVI range from conservative management to surgery, depending on venous damage. Your response to conservative treatment may also dictate the need to escalate or de-escalate the treatment option of choice.

Conservative Treatment

Conservative treatment will involve using compression socks, elevating your legs, and avoiding standing or sitting for extended periods. Weight loss for overweight or obese people is also ideal.

Medicines used in PVI or PCS help deal with ovarian dysfunction. Progesterone-based birth control pills help to contract blood vessels and may also reduce the estrogen-induced coagulation of blood.

Invasive Management

Interventional treatment aims to correct engorgement of pelvic veins by preventing blood flow to the affected areas via embolization. Your doctor may inject agents that close off the affected veins and then remove the affected veins.

Major surgery may also be used to strip the affected veins. Full or partial hysterectomy may be done in cases where the offending veins are unresponsive to medicines or conservative treatment.

In summary, pelvic venous insufficiency affects millions of women and can lead to a range of debilitating symptoms. If you suspect PVI, you are encouraged to see your primary care physician get an accurate diagnosis and get the most suitable treatment option for you.


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