The most common pelvic congestion syndrome symptoms are a dull, heavy, dragging ache low in the pelvis that gets worse the longer you stand, and eases when you lie down. Many women also have pain during or after sex, a flare around their periods, and sometimes visible veins around the vulva or thighs. This guide explains each symptom, why it happens, and which other conditions can feel the same.
What the pain feels like
Pelvic congestion syndrome (PCS) happens when veins in the pelvis widen and blood pools in them instead of draining away. You can read the background in our guide to pelvic congestion syndrome.
Women describe the pain in similar ways:
- Dull and aching, rather than sharp or stabbing
- Heavy or dragging, as if something is pulling down inside
- Deep, low in the pelvis, rather than on the skin
- Long-lasting, usually present for six months or more before it is diagnosed
Sharp, sudden pain is not typical of PCS and should be checked promptly.
Where the pain is felt (pain location)
The ache is usually felt low in the pelvis, on one or both sides. It is often worse on the left. That is because the left ovarian vein is the one that most often has faulty valves.
The pain can also spread to:
- The lower back
- The hips and buttocks
- The upper, inner thighs
- The vulva, as a feeling of fullness or throbbing
Why it gets worse when you stand
A key clue is the pattern through the day. Many women feel fairly well in the morning. The ache then builds after standing, walking or sitting upright for hours, and is worst by the evening.
This happens because gravity pushes blood down into the widened veins when you are upright. When you lie down, especially with your hips raised, the veins drain and the pain usually eases. Lifting, straining and long days on your feet can also make it worse.
Pain during and after sex
Pain during sex is common in PCS. It is usually a deep pain felt inside, rather than pain at the entrance of the vagina. Many women also notice a deep, throbbing ache that lasts for hours after sex, sometimes into the next day.
This is thought to be because sexual arousal increases blood flow to the pelvis, which fills the already swollen veins. Our guide to pain during or after sex covers the many other causes too.
Symptoms linked to periods and hormones
Oestrogen relaxes vein walls, so symptoms often follow the menstrual cycle:
- The ache may flare in the days before and during a period
- Some women have heavier or more painful periods
- Symptoms often get worse during pregnancy
- Symptoms usually ease after menopause, when the ovaries become less active
Visible veins
Some women see the faulty pelvic veins “escape” to the surface. These varicose veins may appear on the:
- Vulva, as soft, bluish, lumpy veins on the labia
- Upper inner thigh
- Buttocks
- Back of the thigh, sometimes as unusual leg varicose veins
These are worth mentioning to your doctor even if they do not hurt. Read more about vulval varicose veins and leg veins that start in the pelvis.
Can it cause leg or back pain?
Yes, in some women. A dull ache in the lower back often comes with the pelvic ache. Aching, heaviness or throbbing in the thighs is also common, especially where varicose veins of pelvic origin are present.
These symptoms are not specific, though. Back and leg pain have many causes, from muscle strain to spine and nerve problems. On their own, they do not point to PCS.
Bladder, bowel and other symptoms
The swollen veins sit close to the bladder and bowel, and can irritate them. Possible symptoms include:
- Needing to pass urine urgently or often
- Bloating or bowel habits that look like irritable bowel syndrome
- Discomfort in the back passage
Living with long-term pain is tiring. Many women also report fatigue, poor sleep, low mood or anxiety. These are real effects of chronic pain, not signs that the pain is “in your head”.
Can the symptoms come and go?
Yes. Typical PCS pain changes from hour to hour and week to week. It is usually better in the morning, after rest, and in the days after a period. It is usually worse in the evening, after a long day standing, before a period and after sex.
Symptoms that point elsewhere
Many conditions cause chronic pelvic pain, and more than one can be present at the same time. Doctors will usually consider:
- Endometriosis and adenomyosis, which often cause very painful periods
- Fibroids or ovarian cysts
- Pelvic infection, especially with fever or unusual discharge
- Irritable bowel syndrome, where pain is closely tied to bowel habits
- Bladder pain syndrome, with pain as the bladder fills
- Pelvic floor muscle tension or nerve pain
Widened pelvic veins are also common in women with no pain at all, so a scan showing them does not prove they are the cause. Our guide to chronic pelvic pain explains the other causes. To understand where faulty veins come from, see what causes pelvic congestion syndrome.
How the symptoms are checked
There is no single symptom that confirms PCS. A doctor will ask about your pain pattern, periods, pregnancies and sex life, examine you, and usually arrange an ultrasound scan that looks at the veins as well as the womb and ovaries. It can help to bring a pain diary. See how it is diagnosed.
A Singapore vascular surgeon’s symptom guide gives another description of the typical pattern.
Keeping a symptom diary
Because PCS has no single tell-tale sign, the pattern of your symptoms is one of the most useful clues for your doctor. For two to four weeks, try noting:
- How bad the pain is each morning and evening, as a score out of ten
- How long you stood, walked or sat that day
- Where your period was in its cycle
- Whether you had sex, and how you felt during and afterwards
- Any bladder or bowel symptoms
- What helped, such as lying down, heat or painkillers
A short diary like this makes appointments quicker and helps separate vein-type pain from other causes.
When to see a doctor
See a doctor if you have had pelvic pain for several months, if the pain affects work, sex, exercise or sleep, or if you notice new varicose veins on your vulva, buttocks or thighs. Our pelvic symptom check can help you note down your symptoms before an appointment.
Get urgent medical help for sudden, severe pelvic or abdominal pain, heavy vaginal bleeding, pain with fever or vomiting, fainting, or pain or bleeding when you might be pregnant. In Singapore, call 995 in an emergency.
Frequently asked questions
Where is pelvic congestion syndrome pain felt?
Most women feel it low in the pelvis, on one or both sides. It is often worse on the left. The ache can spread to the lower back, hips, buttocks or the tops of the thighs.
Can pelvic congestion syndrome cause back pain?
It can. A dull ache in the lower back, often alongside the pelvic ache, is a common complaint. Back pain on its own has many other causes, such as muscle or spine problems, so it is not a reliable sign of pelvic vein trouble by itself.
Can pelvic congestion syndrome cause leg pain?
Yes, in some women. Refluxing pelvic veins can feed varicose veins in the upper inner thigh, the buttock or the back of the thigh, which can cause aching, heaviness or throbbing in the legs, especially after long periods of standing.
Can pelvic congestion syndrome come and go?
Yes. The ache tends to be mild in the morning and worse by evening, and it often flares before or during a period. It can get worse in pregnancy and usually eases after menopause. Many women have good and bad weeks.
How painful is pelvic congestion syndrome?
It varies a lot. Some women have a mild background ache, while others have pain that limits work, exercise, sex and sleep. Keeping a simple pain diary, with a score out of ten and what makes it better or worse, helps your doctor understand how it affects you.
Does pelvic congestion syndrome always cause pain?
No. Widened pelvic veins are often found on scans in women who have no pain at all. Doctors only call it pelvic congestion syndrome when the veins are linked to symptoms.
Sources and further reading
- Cleveland Clinic — Pelvic congestion syndrome
- CIRSE — Pelvic congestion syndrome (patient information)
- Society of Interventional Radiology — Pelvic venous disorders (patient information)
- RCOG Green-top Guideline No. 41: The initial management of chronic pelvic pain
- Radiopaedia — Pelvic congestion syndrome
This article is general information, not personal medical advice. Please speak to a doctor about your own symptoms. How we create our content.