If you have been living with chronic pelvic heaviness, unexplained varicose veins around your thighs, or deep discomfort that worsens after standing, you may be dealing with pelvic venous insufficiency. Often described as “varicose veins in the pelvis,” this vascular condition may be treated in Singapore with a procedure called pelvic vein embolisation.
an Introduction
Pelvic vein embolisation is a minimally invasive, image-guided procedure that addresses pelvic venous disorder (PeVD), a condition previously referred to as pelvic congestion syndrome. If you experience chronic pelvic heaviness, discomfort that flares during prolonged standing, or pain during and after intercourse, these symptoms can significantly affect daily life.
This procedure targets the underlying vascular cause of symptoms rather than masking them with medication alone.
Many patients with the symptoms of the condition may not require a procedure or operation at all and can have their symptoms managed well with targeted supportive treatments. These include
Venotonic medication
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Is based on delivering a unique set of sound waves that stimulate the metabolism, enhance blood circulation and accelerate the healing process within the pelvis. After treatment, damaged cells gradually regenerate and damaged tissues eventually heal. These non-invasive outpatient procedures have been shown to be effective as adjunctive treatment for chronic pelvic pain, enhance repair and function of the pelvic floor and improve mild urinary incontinence that is often associated in women with Pelvic Venous Disorder (PeVD) or Pelvic Congestion Syndrome (PCS) after multiple pregnancies. The therapy typically involves 6-9 sessions once a week and is offered via our clinical vascular surgery partners at the Harley Street Heart and Vascular Centre at Gleneagles Hospital by trained ESWT nurses, where Dr Ram is the Senior Vascular Surgeon.
Not everyone with pelvic pain will require embolisation.
Candidacy depends on a careful evaluation of your symptoms, their duration, and a confirmed vascular cause.
Symptom patterns that suggest a pelvic venous origin include:
Many gynaecological and urological conditions share overlapping symptoms with PeVD. Endometriosis, uterine fibroids, ovarian cysts, interstitial cystitis, and musculoskeletal pelvic floor dysfunction can all produce chronic pelvic discomfort. Before embolisation is considered, these conditions must be assessed and either excluded or identified as co-existing factors.
Dr Sriram Narayanan, who leads The Venus Clinic team, emphasises a comprehensive evaluation that addresses both the medical and psychosocial dimensions of pelvic venous disorder. His approach includes pelvic floor assessments alongside vascular imaging to ensure the full clinical picture is understood before any procedural decision is made.
These are procedures done to correct the abnormal blood flow and reduce the pooled blood volume in the deep veins of the pelvis. Different procedure options are required depending on the precise location of the problem in the pelvic veins, whether further pregnancies are planned and what the symptoms are. This emphasises the importance of an accurate diagnosis as well as symptom assessment. These procedures may need to be combined in patients where the veins at multiple sites are involved.
| Ovarian vein embolisation | When the source of problem are the veins draining the ovary, they can be treated with special platinum coils using a key-hole technique. The procedure may be a day-surgery procedure or may need an overnight stay and usually requires a short general anaesthetic. It is performed under X-ray control and guided by special ultrasound catheters that can view the veins from inside the vessel (Intra vascular ultrasound). |
| Sclerotherapy and glue embolisation | These are used to close or block off the diseased deep veins in the pelvis. A drug, called a sclerosant is injected into the target veins under X-ray and Ultrasound guidance to cause closure of these veins and decrease the venous blood volume in the pelvis. Sclerotherapy is also often used when there are varicose veins in the groin or private areas around the vagina. Sometimes, this may be combined with the use of medical glue to further reduce the diseased blood volume. |
| Iliac vein stenting | This may be required when blockages in the large veins draining the legs and the pelvis cause venous hypertension and congestion in the veins around the uterus, vagina and in the pelvis. A metallic tube (called a stent, similar to but much larger than a heart stent) is placed within the blocked vein to relieve the blockage and allow the blood in the veins to flow normally. The procedure needs an overnight stay and usually a short general anaesthetic. It is performed under X-ray control and guided by special ultrasound catheters that can view the veins from inside the vessel (Intra vascular ultrasound). |
Women with a single pregnancy, post-menopausal women (in some cases), women who have undergone multiple IVF cycles, women with a family history of varicose veins.
Women with a single pregnancy, post-menopausal women (in some cases), women who have undergone multiple IVF cycles, women with a family history of varicose veins.
Women with a single pregnancy, post-menopausal women (in some cases), women who have undergone multiple IVF cycles, women with a family history of varicose veins.
Women with a single pregnancy, post-menopausal women (in some cases), women who have undergone multiple IVF cycles, women with a family history of varicose veins.
Care discussions consider your symptoms, neurological function, and personal treatment goals in a structured and supportive setting.
Your experienced urology specialist in Singapore employs established protocols, careful patient selection, and precise technique to minimise complication risks. Pre-treatment evaluation identifies risk factors, allowing appropriate precautions and patient counselling about realistic expectations.
*Individual results and timelines may vary.*
Improve venous tone, support circulation at the tissue level, and have anti-inflammatory effects that may help reduce venous distension and associated pain. The evidence base, while growing, remains limited.
Aims to reduce the dilating and wall-weakening effects of female sex hormones on pelvic venous walls — one of several factors that contribute to venous reflux and distension in pelvic venous disorder.
Addresses musculoskeletal contributors to chronic pelvic pain that frequently co-exist with pelvic venous disorder. While it does not directly treat venous reflux, it is a recognised part of a broader, multimodal approach to managing pelvic pain.
Reduce the overall pressure load on your pelvic veins.
They drain venous blood away from the uterus, ovaries, and surrounding pelvic structures back toward the heart. Inside these veins, small one-way valves prevent blood from flowing backwards. When these valves become incompetent (meaning they no longer close properly), blood begins to flow in the wrong direction. This is called retrograde flow, or reflux.
Blood accumulates in the ovarian veins and their pelvic tributaries, causing them to dilate and become engorged. This creates sustained venous hypertension (raised blood pressure within the pelvic veins). Over time, this increased pressure leads to the chronic aching, heaviness, and fullness that characterise PeVD.
A vascular surgeon navigates a catheter (a thin, flexible tube) into the incompetent veins and deploys embolic agents, such as metallic coils or sclerosant solutions, to close them. Once sealed, these veins can no longer carry refluxing blood. The body then naturally redirects venous drainage through healthy, competent pathways.
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Not everyone with pelvic pain will require embolisation.
Candidacy depends on a careful evaluation of your symptoms, their duration, and a confirmed vascular cause.
Symptom patterns that suggest a pelvic venous origin include:
To understand how this procedure helps, it is useful to first understand what occurs at the vascular level.
They drain venous blood away from the uterus, ovaries, and surrounding pelvic structures back toward the heart.
Inside these veins, small one-way valves prevent blood from flowing backwards. When these valves become incompetent (meaning they no longer close properly), blood begins to flow in the wrong direction. This is called retrograde flow, or reflux.
Blood accumulates in the ovarian veins and their pelvic tributaries, causing them to dilate and become engorged.
This creates sustained venous hypertension (raised blood pressure within the pelvic veins). Over time, this increased pressure leads to the chronic aching, heaviness, and fullness that characterise PeVD.
A vascular surgeon navigates a catheter (a thin, flexible tube) into the incompetent veins and deploys embolic agents, such as metallic coils or sclerosant solutions, to close them.
Once sealed, these veins can no longer carry refluxing blood. The body then naturally redirects venous drainage through healthy, competent pathways.
If you would like to discuss your symptoms with Dr Ram, you may reach out through our contact page.
Senior Vascular and Endovascular Surgeon
The Venus Clinic is led by Dr Sriram Narayanan (Dr Ram), a Senior Vascular and Endovascular Surgeon with over two decades of clinical experience in vascular surgery in the United Kingdom and Singapore.
Dr Ram was among the first surgeons in Singapore to develop vein stenting, intravascular ultrasound (IVUS), and duplex ultrasound assessment protocols for Pelvic Congestion Syndrome. He has published extensively on vascular disease and has served as a faculty member and trainer at international vascular and vein conferences, including training programmes in the UK and Asia focused on pelvic duplex ultrasound for PCS.
If you would like to discuss your symptoms or enquire about a consultation, please contact us by phone, WhatsApp, or email. You may also complete the enquiry form on our Contact page. A GP referral is not required to make an initial enquiry.
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Led by Dr Sriram Narayanan
Director , Senior Consultant Vascular & Endovascular Surgeon
