Pelvic congestion syndrome: understanding chronic pelvic pain and finding relief
Chronic pelvic pain from pelvic congestion syndrome? Learn what pelvic congestion syndrome is, symptoms to watch for, and treatments to manage it.
Table of Contents
Maybe you’ve noticed a dull ache or heaviness in your lower abdomen that seems to worsen as the day goes on. Standing too long — or even sitting too long — becomes uncomfortable, and during your period the pain seems to intensify.
When symptoms like this stick around for months, it can be both frustrating and worrisome. You may start to wonder what’s causing the pain and how to address it.
In some cases, these symptoms may be linked to pelvic congestion syndrome, a condition caused by problems with veins deep in the pelvis. It’s estimated to affect up to 30% of women who experience chronic pelvic pain.
Living with ongoing pelvic pain can take a toll on daily life. But pain from pelvic congestion syndrome can often be managed through simple treatments, and in some cases, your doctor may recommend hormone-based medications.
Here’s everything you need to know about pelvic congestion syndrome, including its causes, symptoms, and at-home treatments recommended by Hinge Health physical therapists that can help relieve pelvic pain.
Fully Covered Pelvic Care
What is pelvic congestion syndrome?
Pelvic congestion syndrome — now more commonly referred to as pelvic venous disease (PeVD) — is a condition that causes chronic pain (pain that lasts three months or longer) in your pelvic region. It occurs when veins in the pelvis don’t circulate blood as efficiently as they should.
Normally, blood flows from pelvic veins back toward the heart. Small structures called valves help keep blood moving in the right direction. "Your pelvic floor muscles also help move blood and fluid up from the pelvis toward the heart," says Holly Tipp, PT, DPT, a physical therapist at Hinge Health.
With pelvic congestion syndrome, or PeVD, those veins can become stretched or widened. When this happens, the valves may not work properly, allowing blood to flow backward and pool inside the veins. Over time, the veins can become enlarged and twisted, similar to varicose veins in the legs.
This buildup of blood increases pressure inside the veins and surrounding tissues, which can lead to pelvic pain and other symptoms.
Pelvic congestion syndrome often affects premenopausal women who have had multiple pregnancies, though it can occur in others as well.
Symptoms of pelvic congestion syndrome
The most common symptom of pelvic congestion syndrome is dull, aching pelvic pain or feeling of heaviness that lasts for three months or longer. The discomfort often begins during or after pregnancy. Other common symptoms include:
Pain on one or both sides of the pelvis
Pelvic pain that worsens throughout the day but improves after resting or sleeping
Pain that increases with certain activities, including:
Walking
Prolonged standing or sitting
Posture changes
Before or during menstruation
Some people may also experience:
Visible varicose veins on the thighs, buttocks, or vulvar area
Urinary urgency or frequency
Note: Because pelvic congestion syndrome can share symptoms with other pelvic conditions, a healthcare provider may use imaging tests to confirm the diagnosis.
Causes of pelvic congestion syndrome
Think of your pelvic veins like a network of small highways carrying blood back to your heart. Normally, one-way valves keep traffic moving in the right direction. With pelvic congestion syndrome, those valves don’t work as well, causing the flow of traffic to go in the opposite direction. Researchers and health professionals alike don’t know exactly why this happens, but several factors may increase risk. These include:
Pregnancy. Pregnancy significantly increases blood flow to the pelvic region to support a growing baby. During this time, blood vessels expand and blood flow through the pelvic veins can increase up to 60 times, research suggests. The walls of your pelvic veins and valves are resilient, but these normal pregnancy changes can sometimes weaken them. In some cases, veins remain enlarged well after you’ve delivered your baby. Having multiple pregnancies over the course of a few years may increase the likelihood of pelvic congestion syndrome because of the added strain on pelvic veins.
Past pelvic surgeries or injuries: Pelvic surgeries (like C-sections or hysterectomies), accidents, or falls may affect how blood flows through pelvic veins or how vein valves function. While your body is designed to heal, it ’s normal to heal with some imperfections like scars, which may increase the likelihood of pelvic congestion syndrome.
Hormonal factors. Hormones may also play a role — particularly estrogen, which can affect how your veins operate. Estrogen can make vein walls more relaxed and flexible, which may make them more likely to stretch and widen over time. When veins stay widened, the valves inside them may not close as well, allowing blood to flow backward and collect in the pelvis. Estrogen levels drop after menopause, which is one reason pelvic congestion syndrome becomes less common later in life.
Genetics. Some people are born with naturally weaker vein walls, which can make veins more prone to widening. A family history of varicose veins may increase the likelihood of developing pelvic congestion syndrome.
How movement can help pelvic congestion syndrome
When you’re dealing with chronic pelvic pain, it’s understandable to feel hesitant about exercising. But movement is medicine: gentle exercises are often an important part of managing symptoms.
Pelvic floor physical therapy and targeted exercises can help reduce muscle tension, improve circulation, and support pelvic stability.
It’s helpful to remember that your pelvic floor is a group of muscles and connective tissues that stretch from the pubic bone in the front to the tailbone in your back. These muscles support your bladder, uterus, and bowels and play an important role in bladder control, bowel movements, and sexual function.
"A healthy pelvic floor needs both flexibility and strength to function well," says Dr. Tipp. "When your pelvic floor muscles can both relax and contract effectively, they're better able to support your organs, manage pressure, and promote healthy circulation."
As you now know, blood begins to pool in your pelvic veins with pelvic congestion syndrome. The added pressure from enlarged veins can increase tension in surrounding pelvic muscles, which may contribute to pain.
Targeted exercises can help:
Retrain nerves to lower pain
Reduce muscle tension
Build strength and stability
Improve range of motion in your hips and lower back
Support healthy circulation
Movement can help ease pelvic discomfort and improve pelvic floor function.
Exercises for pelvic congestion syndrome
Want expert care? Check if you're covered for our free program →- Diaphragmatic breathing
- Hooklying Kegel exercise
- Open-book rotations
- Wall groin stretch with legs apart
- Standing side leg raise
- Mini squat
Practicing these exercises regularly can play an important role in managing pelvic congestion syndrome. Diaphragmatic breathing helps relax pelvic floor muscles and regulate your nervous system. Strengthening exercises — like Kegels, standing side leg raise, and mini squats — help improve pelvic stability and circulation. Dynamic stretches like open book rotations and groin stretches improve mobility and reduce tension in surrounding muscles. All of these movements can help support pelvic health and reduce symptoms over time.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Pelvic floor physical therapy is more than just kegel exercises. Various exercises tailored to your symptoms and needs are key to getting relief. Pelvic floor PT can relieve many different pelvic issues, such as pelvic pain, painful sex, and urinary incontinence.
Members of the Hinge Health pelvic health program experience an average 67% reduction in pelvic pain and 54% reduction in urinary incontinence within the first 12 weeks. Learn more*.
Treatments for pelvic congestion syndrome
Treatment for pelvic congestion syndrome depends on the type and severity of your symptoms. Your healthcare provider may recommend a combination of physical therapy and targeted exercises, pain medications, hormone therapy, or, in some cases, minimally invasive procedures to block affected veins. Lifestyle strategies — such as avoiding prolonged standing or sitting — may also help manage symptoms. Here’s a closer look at these options:
Try pelvic floor physical therapy and targeted exercises. Targeted exercises can help relax tight pelvic floor muscles and strengthen weak ones — both can contribute to symptoms. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a pelvic floor physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Stay active. Gentle activities such as walking, yoga, or stretching help improve circulation and reduce muscle tension in and around your pelvic area. Find your movement sweet spot, or the level of activity that feels like you’re challenging yourself without straining. Aim for consistent movement that feels manageable without worsening pain.
Change your positions often. Your next position is your best position — meaning the more you switch up how you sit or stand, the less stiffness and tension you’re likely to experience. Shifting between sitting, standing, and walking can help prevent muscle tightness and improve circulation throughout your body, including your pelvis.
Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) are generally considered safe to use for postpartum pain relief — including while breastfeeding — but always check with your provider.
Ask your doctor about hormone therapy. Some medications work by lowering estrogen levels or reducing how much veins widen, which may help relieve pain associated with pelvic congestion syndrome. These medications include birth control options, GnRH agonists, and progestins.
Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.
Ask your doctor about minimally invasive procedures. If symptoms persist despite simple treatments, your healthcare provider may recommend procedures that can help.
When to see a doctor
If your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have any concerning or unusual symptoms, including the following:
Foul-smelling vaginal discharge
Fever or chills (signs of infection)
Sharp or severe pain that does not improve with rest or medication
Difficulty urinating or passing bowel movements
Loss of bladder or bowel control
PT tip: Keep moving
Chronic pelvic pain can be challenging to deal with, but staying active can make a big difference. Gentle movement supports circulation, pelvic floor muscle function, and posture. “Doing gentle stretches, even if you feel a little uncomfortable, can help ease pelvic pain and pressure,” says Dr. Tipp. A pelvic floor physical therapist can also recommend exercises tailored to your symptoms to help provide relief.
How Hinge Health can help you
If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
A Guide for Patients. (n.d.). https://vascular.org/sites/default/files/2024-10/SVS_YVH_PelvicCongestionSyndrome.pdf
Dai, M., Bai, M., Chen, Y., Li, J., Wan, T., & Jiang, H. (2024). Application of Comprehensive Pelvic Floor Rehabilitation Therapy in Congestion Syndrome with Pelvic Oblique: A Case Report. Alternative Therapies in Health and Medicine, 30(10), 59–65. https://pubmed.ncbi.nlm.nih.gov/38401109/
Kamil Bałabuszek, M. Toborek, & Radosław Pietura. (2021). Comprehensive overview of the venous disorder known as pelvic congestion syndrome. Annals of Medicine, 54(1), 22–36. doi:10.1080/07853890.2021.2014556
Omer Saadat Cheema, & Singh, P. (2021, October 16). Pelvic Congestion Syndrome. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560790/
Rezaei-Kalantari, K., Fahrni, G., Rotzinger, D. C., & Qanadli, S. D. (2023). Insights into pelvic venous disorders. Frontiers in Cardiovascular Medicine, 10. doi:10.3389/fcvm.2023.1102063
Clark, M. R., & Taylor, A. C. (2023). Pelvic Venous Disorders: An Update in Terminology, Diagnosis, and Treatment. Seminars in Interventional Radiology, 40(04), 362–371. doi:10.1055/s-0043-1771041