Chronic pelvic pain
Chronic pelvic pain is pain in the lower abdomen lasting more than six months. It is a common problem with many possible causes and has a major impact on quality of life. One of these causes, often under-diagnosed, is pelvic varicose veins.
Possible causes
- Gynaecological: endometriosis, adenomyosis, pelvic inflammatory disease, adhesions.
- Venous: pelvic varicose veins and pelvic congestion syndrome, sometimes associated with venous compressions such as May-Thurner or Nutcracker syndrome.
- Urological and digestive: interstitial cystitis, irritable bowel syndrome.
- Musculoskeletal: pelvic floor tension, myofascial pain syndrome.
- Neurological: entrapment of pelvic nerves.
Several causes often coexist, so investigation must be systematic and carried out as a team.
Symptoms suggesting a venous origin
- A dull ache or pelvic heaviness that worsens at the end of the day, after standing for long periods or after sexual intercourse.
- Relief when lying down.
- Painful or heavy periods.
- Varicose veins in the vulva, perineum, buttocks or inner thigh.
- Leg varicose veins with an unusual distribution or that recur after treatment.
Pelvic varicose veins are one of my areas of special focus: you can read how I investigate and treat them in pelvic congestion and compression syndromes. In men, the equivalent is varicocele, which can also cause chronic pain.
A multidisciplinary approach
GynaecologyUsually carries out the first assessment and rules out gynaecological causes.
Vascular surgeryDiagnosis and treatment of pelvic varicose veins and venous compressions.
UrologyAssessment of urinary symptoms and, sometimes, of nerves and ureters.
Pelvic floor physiotherapyTreats the muscle tension that maintains and amplifies pain.
PsychologyChronic pain affects personal, relationship and working life; addressing this improves outcomes.
Pain clinicMedication management and ultrasound-guided nerve blocks.
At Clínica Rotger we work in coordination with these specialists to assess each case comprehensively.
How pelvic venous disorders are classified
Since 2021 there has been a specific international classification, SVP (Symptoms, Varices and Pathophysiology), which helps describe each patient precisely and compare results between centres. It distinguishes the origin of the symptoms (pelvis, legs or kidney), where the varicose veins are and the mechanism causing them: reflux, obstruction or both.
Videos on this topic (in Spanish)
References
- Meissner MH, Khilnani NM, Labropoulos N, et al. The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: a report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. J Vasc Surg Venous Lymphat Disord. 2021;9(3):568-584.
- Daniels JP, Champaneria R, Shah L, Gupta JK, Birch J, Moss JG. Effectiveness of embolization or sclerotherapy of pelvic veins for reducing chronic pelvic pain: a systematic review. J Vasc Interv Radiol. 2016;27(10):1478-1486.
Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.
Would you like an assessment?
Consultation with duplex ultrasound at Clínica Rotger, in the centre of Palma.
Do you live outside Mallorca?
Send me your test results: I review them in advance and we hold a first video consultation. If treatment is needed, we coordinate the whole process.
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