Why do I feel heavy “down there”?

Q:

I’m 46, and for the past few months I’ve felt uncomfortable heaviness and pain in my pelvis. It tends to be worse when I stand up or sit down, but when I lie down the pain generally subsides. I’ve also noticed what look like varicose veins in my pelvic area. What could be causing this and how can I make the pain stop?

A:

What you’re describing sounds like pelvic congestion syndrome (PCS), a very common cause of pelvic pain experienced by about one-third of all women at some point. The condition occurs when veins in the pelvis, thighs, buttocks or vaginal area weaken, reducing the ability of the valves in those veins to close properly. As result, too much blood flows into the area, leading to varicose veins and the pressure and pain you’re experiencing. And standing or sitting for long stretches of time speeds blood flow to this area, which explains why you tend to feel worse at these times. In fact, health-care providers often miss PCS because lying down for a pelvic exam eases the pressure.

Although we physicians aren’t exactly sure what causes this condition, hormonal imbalances, weight gain and past pregnancies—all of which can weaken the veins—are the most likely culprits.

I recommend making an appointment with your ob-gyn, who can order an ultrasound or a CT scan to rule out other causes of your pain, like fibroids or endometriosis. If she does confirm that PCS is the cause of your discomfort, taking over-the-counter pain relievers like ibuprofen can help ease the pain. Also smart: supplementing with up to 250 mg of gotu kola daily—the herb has been shown to strengthen the connective tissue surrounding weakened veins to better regulate blood flow.