Ehlers Danlos and Pelvic Congestion Syndrome

By Jennifer Richards, LMT 2026

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome (PCS) is a chronic condition caused by dilated, poorly functioning veins in the pelvis, similar to varicose veins that occur in the legs.

Normally, veins contain one-way valves that keep blood flowing upward toward the heart. When those valves weaken or fail, blood can pool in the pelvic veins, causing pressure and inflammation.

This leads to chronic pelvic pain and vascular congestion.

Why PCS Can Occur in People with Ehlers–Danlos Syndrome

People with Ehlers-Danlos Syndrome have weaker connective tissue, including the collagen that supports blood vessels and vein walls.

This can lead to:

• Venous laxity (veins stretch more easily)

• Valve dysfunction

• Poor vascular tone

• Blood pooling

Because the veins become overly stretchy, they may enlarge and twist, creating pelvic varicosities.

Many hypermobile patients also experience autonomic dysfunction, such as Postural Orthostatic Tachycardia Syndrome, which can worsen blood pooling in the lower body.

Common Symptoms

Symptoms often worsen after standing for long periods or at the end of the day.

Typical symptoms include:

Chronic pelvic pain

Dull, aching pain in the pelvis Pain worse after standing or sitting long periods

Pressure or heaviness

Feeling of pelvic fullness

Pain during or after intercourse

Lower back or hip pain

Visible varicose veins

Buttocks Upper thighs Vulva or vaginal area

Urinary or bowel pressure

Many people with EDS report that symptoms fluctuate with:

• Hormonal changes

• Menstrual cycle

• Pregnancy

• Long periods of upright posture

Why It Is Often Missed

PCS is frequently underdiagnosed, especially in hypermobile patients.

Reasons include:

• Symptoms overlap with endometriosis

• Symptoms resemble IBS or bladder disorders

• Pain is often dismissed as “normal pelvic pain”

Diagnosis may involve:

Pelvic ultrasound Doppler imaging MRI or CT Venography (gold standard)

Treatment Options

Treatment depends on symptom severity.

Conservative management

Often first approach:

• Compression garments

• Pelvic floor physical therapy

• Avoid prolonged standing

• Anti-inflammatory support

• Hormonal therapy in some cases

Medical procedures

If symptoms are severe:

• Pelvic vein embolization

• Sclerotherapy

• Rarely surgical vein ligation

Embolization is currently one of the most common treatments.

Massage Therapy Considerations

Because you are a massage therapist specializing in hypermobility, these points are important for your clients.

Massage can help secondary symptoms, but cannot treat the vascular problem itself.

Helpful approaches may include:

Lymphatic drainage

Supports fluid movement

Gentle abdominal work

Avoid deep pressure over pelvic veins

Myofascial release

Address compensatory muscle tension

Hip and lumbar work

Reduce referred pain patterns

Important precautions

Avoid:

• Deep abdominal pressure

• Aggressive psoas work

• Intense heat over the pelvis

• Excessive intra-abdominal pressure

Clients with PCS may also experience:

• POTS-related dizziness when standing up after massage

• Increased pelvic pressure when prone too long

Position changes should be slow and supported.

Evidence and Support

Information about vascular involvement in EDS can be found through:

• The Ehlers-Danlos Society

• Vascular and autonomic complications documented in connective-tissue disorders

Studies show increased rates of venous insufficiency and pelvic varicosities in connective-tissue disorders due to collagen weakness.

Quick Summary

EDS can increase risk of pelvic congestion because:

• Connective tissue is weaker

• Veins stretch more easily

• Valves fail more easily

• Blood pools in the pelvis

This can lead to chronic pelvic pain, pressure, and vascular symptoms.

Disclaimer

This article is for educational purposes only and is not intended to diagnose or treat medical conditions. Individuals experiencing pelvic pain or suspected pelvic congestion syndrome should consult a qualified healthcare professional for evaluation and appropriate care. Massage therapists should practice within their scope of practice and modify techniques as needed for clients with connective tissue disorders such as Ehlers–Danlos Syndrome.