Pelvic Congestion Syndrome

By Dr. Aimee Anagnostos, PT, DPT on 1/16/2023


Let’s talk about the “Who, What, and Where” of Pelvic Congestion.

Who is affected by Pelvic Congestion Syndrome (PCS)?

Pre-menopausal women who have had multiple births are more likely to be diagnosed with pelvic congestion. It is common in women of reproductive age. Risk factors may include obesity, pregnancy, sedentary lifestyle, constipation, prostatitis, surgeries, and excessive estrogen.

What is pelvic congestion?

It is defined as the pelvic venous insufficiency is due to the incompetency of the internal iliac vein, the ovarian vein, or both (1). This would mean the veins that normally drain the lower extremities and pelvis are losing the ability to circulate fluid back to the heart, causing blockage and, well, congestion. One can think of a traffic jam in the pelvic veins building up traffic in the pelvic and lower extremities. This can cause sensations of swelling, heaviness, warmth, itching. The source of venous insufficiency is unclear, but it is widely accepted that the cause is multifactorial. Hormones, valve dysfunction, and venous obstruction can be contributing factors that prevent fluid from moving back to the heart.

Where is pelvic congestion common?

The internal iliac vein, ovarian vein, or both are common sites of occlusion preventing proper flow. Studies show that people present with more left side congestion. Ultrasound is the first line of imaging studies to confirm the diagnosis of PCS. Ultrasound can view any obstruction, pelvic anatomy, uterine size, and dilation of veins. Increased vein diameter is associated with venous insufficiency. Although Ultrasound is the first line of imaging, venography is the gold standard. Venography can measure the exact vein diameter, and a 5-10mm diameter is closely associated with venous insufficiency and failure to pump blood proximally.

How does pelvic physical therapy help with PCS?

A thorough external examination of the low back, pelvic, hips, and posture is vital prior to making conclusions about treatment. An internal exam may be warranted to evaluate vulvar varicosities and pelvic floor muscle tone/ presence of trigger points/ adhesions.. We can work with you in discussing pelvic compression garments, performing lymphatic drainage, positioning and posture modifications to reduce symptom severity.

Please reach out to us here at the Pelvic Health Physical Therapy Center in Madison, NJ to set up an evaluation & assessment! Feel free to call us 908-443-9880 or email us at

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