A Comprehensive Look at Pelvic Venous Disorders
A clinical roadmap designed to enhance your ability to screen, assess, and comprehensively treat your clients with pelvic venous disorders (PeVD), a notoriously under-recognized and misdiagnosed cause of chronic pelvic pain.
Pelvic venous disorders (PeVD) are the second leading cause of chronic pelvic pain after endometriosis. Once PeVD is identified, it is actually a very treatable condition! But you have to know what you are looking for.
You won’t find much information about it in your textbooks from graduate school.
Continuing education about PeVD still dances around the issue, offering outdated information, minimal actionable advice, and older terminology like “Pelvic Congestion Syndrome.”
Patients are frequently under-treated and dismissed, or over-treated with full blown hysterectomies that don’t resolve the venous issue.
I created this course to fill the gap in knowledge because when we know better, we do better.
One of the biggest risk factors for the development of PeVD is pregnancy. Who better to screen for and identify this often misdiagnosed condition than you — a pelvic health provider?
PeVD treatment demands a comprehensive plan of care in collaboration with other medical providers.
Your plan of care must include:
high quality patient education
assessing and treating the entire body system with evidence-based techniques
understanding proper diagnostic test selection
referring out for appropriate surgical interventions when necessary
In this course, you will gain access to a video library complete with special test demonstrations and evidence-based treatments to help identify and treat compensatory patterns found in the thorax and pelvis. It is important to understand how to treat the compensations your client has developed over time in response to their venous issues and chronic pain.
People with PeVD struggle to maximize their venous return. This is not solely due to their presence of venous abnormalities. The compensatory patterns of movement they develop over time as a result of their pain and lifestyle also play a huge role in poor venous return for these clients.
For someone with PeVD, their venous return is influenced by many factors including:
limitations in rib cage and pelvic mobility
reduced diaphragmatic excursion
limited neuromuscular control of the diaphragm and pelvic floor
And more
As a pelvic PT you cannot fix someone’s anatomical venous abnormalities. But you can fix compensatory strategies. Your guided instruction will help them optimize their venous return and minimize their symptoms. Plus, you’ll know exactly when to refer out and who to talk to so your client gets the collaborative care they need for the best outcome.
By Enrolling in this Course, You Will:
Learn to differentiate between venous pain and musculoskeletal pain.
Understand how anatomical abnormalities of venous obstruction and venous reflux (“RIGI”) manifest across genders and how this presentation changes in the presence of compensatory strategies.
Identify the four main clinical presentations of PeVD.
Understand how to cluster subjective and objective exam findings to guide skilled intervention.
Identify the significance of optimal diaphragmatic function and understand its systemic effect on venous return.
Identify four strategies needed to maximize venous return and the exercises to help clients accomplish this.
Understand when to refer out for imaging and collaborate with other healthcare providers to provide the most comprehensive plan of care for the patient.
Bonus Content Includes:
Diagnostic imaging and case studies with Dr. Kathleen Gibson, Vascular MD and President of the American Vein and Lymphatic Society
S-V-P Classification System review with Dr. Kathleen Gibson, Vascular MD and President of AVLS
Video demonstrations of exercise progressions
Product recommendations
Reference list with 50+ sources
Lifetime access to course content (+ any updates forever!)
So, what are you waiting for? Come join me and level up your practice TODAY. Get the tools you need to diagnose and treat PeVD like the seasoned clinician you are!
My health journey began in 2008 with symptoms that puzzled doctors until 2023 when I was diagnosed with a pelvic venous disorder (PeVD). I battled stomach bloating, dizziness, fatigue, and excruciating pelvic pain, visiting many specialists with no clear answers… Nobody expected vascular issues in younger non-pregnant women.
After 2 years of increasing pain and a fried nervous system, I asked my PCP for a CT scan which showed vascular compressions and varicose veins in my pelvis. I reached out to a vascular surgeon and soon after confirmed with ultrasound the presence of PeVD. I had my “plumbing fixed”, but I was surprised the pain persisted…That's when I began seeing Julie.
From the start, Julie addressed mobility of my entire core and pelvis and identified lifestyle factors reinforcing my pain and symptoms. Julie taught me exercises and techniques to tackle specific pains on my own if they flared up, helping me develop awareness and control.
My pain decreased significantly, and I regained mobility and confidence. In just a few months of working with Julie, I was back on my feet, enjoying time with friends and even performing in theater again!
Julie's holistic approach to body awareness has made all the difference in my recovery. Working on my ribcage, diaphragm, and pelvis has helped me feel stronger and breathe better as my pain and blood flow improve. I can even think about yard work and singing again! Julie’s work finally brought hope and relief I desperately needed and helped me reclaim my life with the tools for long-term success.
C.F., Patient
Hi, I’m Dr. Julie Baron, your course instructor and creator of A Comprehensive Look at Pelvic Venous Disorders. I suffered from PeVD myself, and decided to transform my painful experience into an opportunity for more providers to better understand and more quickly capture PeVD.
If I’m being honest with myself, my PeVD symptoms began during my second pregnancy, with a low grade ache and heaviness in my pelvic floor.
It is so easy to rationalize a dull pain that ebbs and flows with your cycle, or a pain you push aside with the distractions of life, work, and parenting.
My abdominal and pelvic pain grew in intensity over the next four years, culminating in a classic PeVD presentation of post-coital pain, urinary urgency, and a debilitating ache in my pelvis and abdomen that prevented me from sitting, standing, or exercising beyond ten minutes.
And yet, nobody could tell me what was causing my pain.
Little did I know, I was a walking textbook case of PeVD.
All of my amazing healthcare providers missed my diagnosis, but I don’t blame them; they truly didn’t know any better. No one had ever taught them about PeVD. By just looking at me, they weren’t able to see the renal vein obstruction, refluxing gonadal veins, or the varicose veins running around my ovary and across my uterus.
But had they recognized those classic signs of PeVD; had they been aware of the evidence-based treatments for it; had they known just enough to refer me to a vascular specialist–my story would have been so different. I could have gotten my diagnostic imaging, diagnosis and treatment years earlier.
As a result, it has become my mission to educate as many providers as I can — anyone willing to listen — about PeVD. It’s my quest, as my kids say. 😀
My journey with PeVD spans over a decade, marked by misdiagnoses and debilitating symptoms. Despite my persistent efforts to seek answers, I encountered dismissive responses from multiple doctors, leaving me feeling frustrated and unheard. Beginning after the birth of my son in 2011, my symptoms gradually worsened, evolving into severe abdominal pain, pressure, and swelling.
Over the years, medical investigations yielded inconclusive results until 2022, when a vascular surgeon identified the anatomical basis for my condition. Following embolization surgery, I experienced temporary relief, but symptoms resurfaced months later, impacting my daily life and forcing me to quit my job. Despite further consultations, including with a vascular surgeon and a pelvic floor therapist, my symptoms persisted. My first experience with pelvic floor PT was hard because everything they had me do brought on so much pain and discomfort. It was basically frog pose, piriformis stretching, cupping, fascial massage and Kegels. I was still in so much pain from pressure in my abdomen.
It wasn't until I found Drs. Gibson and Julie Baron, who approached my case with compassion and expertise, that I began to see progress. Through a combination of medical interventions and tailored physical therapy, I gained valuable tools to manage my symptoms and reclaim my life. Their collaborative care has been instrumental in restoring hope and functionality, highlighting the importance of a supportive healthcare team in navigating complex medical conditions like PEVD.
C.L., Patient
When we know better, we do better:
For the person who can no longer run around the park with their kids
For the person who just wants to have sex with their partner again, without an increase in pelvic floor ache afterward
For the 29 year old who was told, “maybe your symptoms will go away in menopause.”
For the person who was told they have “pelvic congestion syndrome” and then discharged from care because “there isn’t much we can do for that.”
For the person struggling with infertility due to their low sperm count
For the person with vulvar varicosities that never resolved after baby arrived
For the 33 year old who was told to have a hysterectomy and oophorectomy to resolve their pelvic pain, though they wanted more children
Once you see how easy it is to identify and treat PeVD, I know you’ll join me in shouting from the rooftops about it.
More people need to know about this often debilitating and very TREATABLE condition!
A Comprehensive Look at Pelvic Venous Disorders leaves no stone unturned.
In this self-paced online course, you’ll earn 3.75 CEU’s throughout the following modules:
-
Course intro with information on how to access your CEUs and download your slide deck.
-
Before we can fully appreciate how far we have come in our understanding of the pathophysiology of PeVD, we need to know where things began. This module will cover a brief history of pelvic venous disorders and the reasons why it remains under-diagnosed and mistreated.
-
This module discusses the historically imprecise terminology that continues to be used to describe what we now know as Pelvic Venous Disorders (PeVD). This section will discuss familiar nomenclature like “Pelvic Congestion Syndrome,” “Nutcracker Syndrome” and “May Thurner Syndrome” and why our evolution away from these terms is beneficial for both patient and provider.
-
PeVD is defined as a wide spectrum of venous symptoms that occur as a result of venous reflux, venous obstruction, or a combination of both. We will discuss the different types of venous reflux and obstruction pathways, and the ways in which they can exist concomitantly with each other.
-
How will PeVD present in our patients? How can we differentiate venous pain from musculoskeletal pain? In this module you will learn how venous pain presents, discuss the common clinical findings of PeVD, and learn what can exacerbate or alleviate those symptoms.
-
A patient’s symptom presentation will be determined by whether their body has created compensatory strategies to relieve venous pressure. In this module you will learn the different venous compensations that may occur to accommodate anatomical abnormalities such as renal obstruction, iliac obstruction, gonadal reflux, and internal iliac vein reflux.
-
This module will use a variety of gender affirming language to describe four broad clinical presentations and how they manifest across people.
-
This module reviews what to listen for when taking a thorough medical history. We walk through what constitutes a good functional movement screen; examine the thorax, abdomen, and pelvis; and culminate with a review of internal/external pelvic exam findings (dependent on your scope of practice).
-
The respiratory diaphragm is best known for being the primary muscle of respiration and an important modulator of intra-abdominal pressure (IAP). But it also plays a role in cardiac function, lymphatic function, and acts as a sump pump when it is coordinated with the muscles of the pelvic floor. This is particularly important for those with pelvic venous disorders, where venous return has been compromised.
-
The ability to maximize venous return will be directly influenced by a person’s ability to achieve and/or move through a zone of apposition (ZOA), 360 degrees of thoracic expansion, pelvic neutrality, and a coordinated sump pump action (composed of the pelvic floor musculature and respiratory diaphragm).
We review special tests that can offer information on the state of a person’s ZOA, thoracic expansion, pelvic position, and position of the pelvic floor musculature within the greater system.
-
Once you’ve identified PeVD, where do you start with treatment?
Patient education on the use of compressive garments and restorative positioning for symptom management and improved venous return is incredibly important.
Guiding your patients toward appropriate referrals and diagnostic imaging will likely be necessary. Guidance may or may not start with a vascular doctor/interventional radiologist. As the provider, it is important to get to know the vascular providers you will refer out to, as there is no accreditation process to treat PeVD.
-
What actionable advice can you provide for patients to start managing symptoms ASAP?
In this module we will work through five techniques that can be offered in your first few visits with a client. The restorative positions, breathing cues, back body expansion and positions of inversion can offer patients with PeVD some good relief from their symptoms throughout the day.
-
Move past initial HEP into more advanced strategies.
The goals of this module’s exercise progressions are to help maximize venous return and allow the patient to begin to access fluid, reciprocal movement patterns. This can be done by achieving a zone of apposition, which will reflect coordinated diaphragmatic excursion in a well-positioned ribcage over the pelvis.
-
This module will review the post-operative guidelines offered to patients after they undergo embolization, sclerotherapy, and stenting.
-
Wrap-up your newfound knowledge of how to identify and treat PeVD!
PLUS three bonus modules containing videos regarding imaging and case studies from Dr. Kathleen Gibson, Vascular MD and President of the American Vein and Lymphatic Society.