Why do so many women with chronic pelvic pain get told "this is just motherhood" or "it'll get better when you go through menopause"? What if the heaviness, the aching, the constant discomfort isn't something you have to live with?

In this episode, I sit down with Dr. Julie Baron, a pelvic floor physical therapist and director of Pelvic Health and Performance Center in Bellevue, Washington. Dr. Baron blew our minds at ISSWSH this year with her groundbreaking lecture on pelvic venous disorders a condition that's massively underdiagnosed and often dismissed as "just in your head."

Dr. Baron shares her own lived experience with pelvic venous disease. For years, she couldn't sit or stand for more than 10 minutes without needing to lie down. She saw urologists, gynecologists, GI docs, colorectal specialists, and pelvic PTs and everyone told her she was normal. She was working as a pelvic floor PT herself, helping other people with pelvic pain while feeling like a fraud because she couldn't solve her own.

She finally diagnosed herself, pushed her way into getting the imaging no one wanted to order, and finally felt validated after the report came back showing renal vein obstruction, iliac obstruction, gonadal vein reflux, and 12-millimeter varicose veins across her uterus. After gonadal vein embolization and sclerotherapy, her life changed completely.

We discuss the classic presentation of pelvic venous disorderschronic non-cyclical ache or heaviness that gets worse throughout the day, urinary urgency, postcoital pain, and varicose veins. We talk about why pregnancy is one of the biggest risk factors and how hypermobility disorders, MCAS, and POTS all connect. Dr. Baron explains the imaging process and why a normal ultrasound doesn't always mean you're fine.

She also explains the five functions of the pelvic floor and how pelvic venous disease impacts everything from bladder support to sexual function. We get into the sump pump concept, why belly breathing can actually make things worse for this patient population, and how compression shorts can be life-changing. Dr. Baron shares her protocol for helping patients optimize venous return through breathing, positioning, and nervous system regulation.

If you're experiencing chronic pelvic pain and feel like you're being dismissed or told it's normal, talk to your provider about pelvic venous disease. While it's frustrating, don't stop advocating for yourself even if you're told everything is normal. You know your body, and if something feels off, keep pushing for answers.

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Episode Mentioned:

Dr. Alexis Cutchins

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