Physiotherapy consultation

Comprehensive care for the Patient with pelvic venous insufficiency

Female patients (and male patients) with pelvic venous insufficiency require interdisciplinary care. Lower pelvic pain, a feeling of heaviness, venous-related dyspareunia, painful and prolonged periods, urinary frequency, pelvic instability, or post-exertional heaviness of the lower limbs — these are symptoms that usually cannot be resolved with a single procedure. That is why at the Phlebology Clinic, we guide the Patient through the entire treatment process. We are a precursor of such an approach to venous disease therapy in Poland.

(1) Diagnostic stage: phlebological consultation, comprehensive and expert Doppler ultrasound of the veins, if necessary, extended diagnostics (MRV – magnetic resonance venography or CTV: computed tomography venography), gynecological assessment, and physiotherapy consultation.

(2) Pre-procedure stage: preparation of the pelvic floor muscles, learning proper breathing, optimization of body posture and movement patterns.

(3) Peri-procedural stage: in Patients with pelvic venous insufficiency, both female and male, who have a scheduled venous embolization in our Vascular Laboratory, physiotherapy accompanies the treatment process and supports the recovery period.

(4) Post-procedural stage: consolidating and maintaining the effects of phlebological treatment, preventing recurrence of venous disease, a gradual return to physical and daily activity.

Takie podejście holistyczne i interdyscyplinarne pozwala uniknąć sytuacji, w której Pacjent „wędruje” między gabinetami bez spójnego planu leczenia. W Klinice Flebologii flebolog, radiolog interwencyjny, chirurg naczyniowy, proktolog czy fizjoterapeuta uroginekologiczny wymieniają się informacjami o Pacjencie i wspólnie decydują o kolejnych krokach terapii.

What does a physiotherapy consultation include?

Urogynecological physiotherapy – why is it so important?

Urogynecological physiotherapy is a specialized branch of physiotherapy that deals with the function of the pelvic floor and the organs of the lesser pelvis. In female patients with pelvic venous insufficiency, pelvic floor muscle tension disorders—both excessive tension (hypertonia) and weakness (hypotonia)—can exacerbate symptoms of venous congestion, hinder venous outflow from the pelvis and abdominal cavity, and sustain painful symptoms.

During a urogynecological consultation, the physiotherapist:

• assesses the tension, strength, and coordination of the pelvic floor muscles – externally, and, upon informed consent and clinical indications, also via internal examination (per vaginam or per rectum);
• checks muscle reflexes, sensation, and sphincter function;
• analyzes scars and their impact on tissue mobility as well as venous and lymphatic drainage;
• assesses the connection between symptoms and the menstrual cycle, sexual intercourse, urination, and bowel movements;
• teaches conscious work with the pelvic floor muscles — activation, relaxation, and coordination with breathing.

Urogynecological consultation is particularly indicated for patients with pelvic pain, dyspareunia, urinary incontinence, urgency, constipation, pelvic organ prolapse, as well as for women after childbirth and gynecological surgeries.

Urogynecological physiotherapy is not just a women's domain. Men too—especially after urological procedures, those with chronic pelvic pain, or those with pelvic floor dysfunctions—can and should benefit from it.

Hypopressives: How LPF helps your veins!

Low Pressure Fitness (LPF), known in Poland as hypopressives, is a training method that combines specific postural positions, controlled breathing, and the so-called diaphragmatic aspiration – a maneuver that lowers pressure within the abdominal cavity and pelvis. For patients with pelvic venous insufficiency and symptoms of pelvic floor overload, it is one of the most rational activity proposals for stimulating venous drainage.

LPF – how does it work for your veins?

In a properly functioning circulatory system, blood from the pelvis and lower limbs returns to the heart thanks to the muscle and joint pumps, pressure fluctuations in the abdominal cavity and chest, and efficiently working venous valves. In pelvic venous insufficiency, these mechanisms are disrupted—blood stagnates in the venous branches and plexuses of the pelvis, causing volume overload, frequent pain, a feeling of heaviness, and symptoms of pelvic congestion syndrome.

Hypopressives reverse this unfavorable mechanism. Lowering intra-abdominal pressure during LPF exercises:

• facilitates venous drainage from the pelvis and lower limbs;
• relieves the walls of the veins and pelvic venous plexuses;
• reduces pressure on the pelvic floor muscles;
• improves the tonic activity of the deep core muscles;
• supports the proper mobility and function of the diaphragm.

For patients after treatment for pelvic venous insufficiency (pelvic vein embolization), LPF is particularly valuable—it helps maintain the effects of the procedure and reduces the risk of recurring symptoms resulting from venous blood stasis.

How to prepare for a physiotherapeutic consultation?

Good preparation for your visit shortens the time needed for the medical interview and allows the physiotherapist to focus immediately on the most important elements of the examination. Below is a practical checklist that works well in our daily practice:

1. Bring your medical documentation. Results of Doppler ultrasound, MRI, or CT scans of the pelvis, reports from phlebological and gynecological procedures, and discharge summaries after childbirth or surgeries. Relevant laboratory test results (e.g., hormonal levels, D-dimers, or complete blood count) are also useful.

2. Wear comfortable clothing. Leggings or shorts and a top or blouse that allows for an easy assessment of diaphragmatic breathing and posture. Avoid tight belts, bodysuits, or stiff compression underwear immediately before the appointment.

3. Prepare a list of medications and supplements. Write down the names, dosages, and frequency of intake. Include hormonal contraception, hormone replacement therapy, anticoagulants, phlebotropic preparations, and supplements.

4. Reflect on your symptoms. When did the symptoms first appear? What exacerbates them, and what brings relief? Are they strictly related to your menstrual cycle, physical activity, or body position? How do they affect your daily life, work, sleep, and sexual activity? It is worth writing these observations down (this helps to precisely describe the problem in a stressful situation during the appointment).

5. Write down your questions. The first visit is the perfect time to ask about everything that concerns you. Having your questions prepared in advance ensures they won't "slip your mind" during the conversation with the specialist.

6. Do not arrive with a full bladder. Before a urogynecological examination, we recommend emptying your bladder immediately before the visit—unless the physiotherapist specifically instructs otherwise.

7. Skip heavy cosmetics on your abdomen and back that day. Lotions and oils make manual work more difficult and hinder a reliable assessment of scars and subcutaneous tissue.

8. Plan your time after the visit. After the consultation, it is worth having 20–30 minutes of downtime—sometimes you receive exercises to test while they are "fresh" in your mind, or you may simply want to review the recommendations in peace.

When do we use physiotherapy in the phlebological treatment process?

At the Phlebology Clinic, physiotherapeutic and urogynecological consultations accompany the treatment of venous disease at three stages:

Before the procedure: preparing the body for venous embolization, sclerotherapy of veins in the intimate areas, or procedures on the veins of the lower limbs. We work on breathing, pelvic floor muscle tension, and posture to ensure the Patient enters the procedure in optimal condition.

In the perioperative period: For patients with pelvic venous insufficiency undergoing embolization at the Vascular Laboratory of the Phlebology Clinic, physiotherapy supports convalescence and shortens recovery time.

After completion of surgical treatment: this ensures the consolidation of positive post-treatment effects (especially for women with endometriosis), minimizes the risk of recurrence, and accelerates the return to sports and daily activities. This stage is sometimes overlooked—yet it is precisely what determines the long-term success of the therapy.