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During pregnancy, women’s bodies change in a number of different ways. It’s not just a matter of your belly getting larger as the baby grows bigger. Two changes that you might not know about are the massive increase in blood volume during pregnancy, and changes to the pelvis (including bone structure) as the pregnancy progresses. One side effect of these developments is that the veins inside the pelvis can be put under extra pressure, and a condition called Pelvic Vein Incompetence, or Pelvic Congestion Syndrome (PCS) can result. If you notice that you have varicose veins in your legs developing during pregnancy, the faulty valves may not actually be in the legs at all; rather, they may be inside the pelvis, caused by the above two factors.

Varicose Veins and PCS

Varicose veins are veins that are swollen and bulging, due to a backflow of blood within the vein. Usually this happens because there is a weakening or collapse of one of the small valves within the vein, which leads to blood pooling and causing swelling. Varicose veins are not necessarily dangerous, but they can cause pain and other side effects.

When these varicose veins form in the pelvis, this is called Pelvic Congestion Syndrome. The symptoms of PCS are a chronic ache or pain in the pelvis, which often gets worse with prolonged standing or sitting, menstruation, and sexual intercourse. Some research indicates that “13 to 40 per cent of women in the UK who have chronic pelvic pain suffer from PCS”, but many of these women are not receiving adequate treatment. In some cases, they are not receiving any treatment at all.

What Are the Risk Factors and Treatments?

To some extent, there is a genetic factor involved in whether you may develop PCS. However, during pregnancy it is more likely to develop, and may then flare up again in subsequent pregnancies Dr. Schaffir, an OB/GYN from The Ohio State University Wexner Medical Center, notes that “when women are pregnant, the extra blood volume and pressure that naturally comes with carrying a baby make the blood vessels in the pelvis dilate, he explains—and sometimes they break down, making your vessels even bigger”.

There is some controversy, however, in that there are many women with PCS who have never been pregnant, and many who have chronic pain but no pressure or discomfort. Others have pressure and discomfort, but no chronic pain. The only thing that seems to be common in all cases is the enlargement of these pelvic veins.

Usually PCS is diagnosed by way of an ultrasound, and then a treatment plan is determined. Diagnosis can sometimes be complicated, as the first sign of any issues may actually be varicose veins in the legs, not in the pelvis.

Eddie Chaloner, an expert working with varicose veins, notes that “ultrasound scanning has now shown us that up to 20% of women coming to see a doctor with varicose veins in the legs, do not have a problem with the leg valves at all – rather that the bulging leg veins are in fact filled by faulty valves from within the pelvis.

To a certain extent that is not surprising – the female pelvis has a lot more organs in it than the male one and pregnancy causes significant anatomical and physiological changes in the female pelvis which have long lasting effects. Women with pelvic vein problems causing veins in the legs have often had trouble with veins during pregnancy – either in the legs or in the vulva. Under normal circumstances, when the pregnancy is over, the vulvar veins recede and often completely disappear. The leg veins often persist.”

The exact treatment followed will depend on exactly what symptoms the woman is experiencing. If she is feeling a lot of pain or discomfort around the time of her period, she may be given medication that reduces or stops menstruation.

In some cases, these approaches don’t help, and a vein embolisation may be needed. This is when a catheter is used to seal off the veins that are causing pain. If the pelvic pain has stopped after the pregnancy, the varicose veins in the legs may still need to be treated in this way, or with other approaches that are specific to normal varicose vein treatment.

In the vast majority of cases, PCS can be alleviated with treatment. So if you are experiencing this, try not to worry; it will either resolve when the pregnancy is over, or you will be able to get treatment to alleviate the pain.

Brought to you by our friend, Jose Calvo.