Some people with POTS also have pelvic venous insufficiency (PVI), which is a condition where the veins in the pelvis are unable to properly move blood back up to the heart, leading to blood pooling in the pelvis.

Symptoms of PVI

Heaviness or pressure in pelvis worsened with prolonged standing, sitting, or exercise
Swelling in legs or feet
Aching or throbbing in legs
More severe or prolonged pain during menstruation
Chronic pelvic pain
Dyspareunia
Constipation or bloating
Pain in lower back or hips
Problems with fertility
Varicose veins in pelvis or legs
Increased urinary frequency, urgency, or discomfort

Pelvic venous insufficiency (PVI) can sneak under the radar in some people with POTS. We don’t know if PVI causes POTS symptoms in these individuals, or if it stems from an underlying condition such as Ehlers-Danlos syndrome (EDS).

How is PVI Diagnosed?

PVI is diagnosed through imaging such as a pelvic ultrasound or MRV, often by an interventional radiologist or gynecologist.

What is the Treatment for PVI?

Treatment can include compression, medication, surgery, or vein embolization, which has become the standard treatment for it.

Recent Research: Impact of Treatment on Quality of Life in Those with POTS

Recent studies among people with POTS who have undergone iliac vein stenting for pelvic venous disease (PeVD; a broader term that encompasses conditions affecting the pelvic veins, including PVI) have shown improvement in quality of life across several domains.

It’s not yet clear if treating PVI will improve POTS in every case and there isn’t yet a good way to predict who will benefit. More studies are underway, and this area of research could look very different in upcoming years.

Thadani et al. (2025). Iliac vein stenting improves quality of life in patients with postural orthostatic tachycardia syndrome. JACC; Almuwaqqat et al. (2024). Iliac vein stenting and quality of life in patients with postural orthostatic tachycardia syndrome (POTS). JACC; PMID: 36292025; PMID: 38469013; PMID: 32757696

Disclaimer: This blog post is for informational purposes only and shall not be construed as behavioral health or medical advice. It is not intended or implied to supplement or replace treatment, advice, and/or diagnosis from your own qualified healthcare provider.

Pelvic Venous Insufficiency (PVI) Seen in Some Individuals with POTS