Dr. Roach: Case of enlarged pelvic veins are not a cause for concern

I have seen a vascular surgeon and a urogynocologist to ask about this condition, and if I need “treatment” for it. Both were rather vague, saying if I’m not experiencing pain, I should just get it imaged every year. Is that sound advice? Can the veins twist and cause blockage? Can they cause a blood clot? I can’t really get any info on it.

ANSWER: Although advanced imaging like CT and MRI scans have led physicians to be able to make more precise diagnoses than before, there is an issue of what to do with “incidental” findings.

Many people have written to me about small tumors (which are far more common than we thought), but enlarged pelvic veins are another example of an incidental finding.

Some women do have a condition called “pelvic congestion syndrome,” which is a cause of pelvic pain that is worsened by prolonged standing, or by sexual activity. This condition is found in women in the reproductive age group, especially those who have had multiple children, but is not found in menopausal women. Since you aren’t in the age group and don’t have symptoms, you clearly don’t have pelvic congestion syndrome.

Dilated veins in the legs are simply called varicose veins, and they are often due to loss in function of the valves in our legs as we age. Pelvic vein enlargement is the same thing: Veins get bigger as we age.

There are cases of blood clots in the pelvic veins, but it is not clear whether a person like you is at increased risk. I don’t see the need to repeat the imaging studies.

DEAR DR. ROACH: Why do multivitamins invariably provide some ingredients with more than 100%, and some with less than 100%, of daily requirement? Why aren’t all ingredients 100%?

ANSWER: 100% of the RDA is intended to provide the nutrient requirements for about 98% of the population. Most people will get what they need from food. Many North Americans feel that more vitamins are better, or take a vitamin pill as an insurance policy against an inadequate diet. Both of these have been reasonable hypotheses, but many studies have been done, and have not shown any convincing benefit of taking vitamins in absence of a clear medical reason for deficiency.

Vitamin manufacturers put in large amounts mostly for marketing: People are more likely to buy the pill that has 1,000% of B12, for example, since it must be better than the one with 500%. In fact, your body will simply excrete more B12 if you take more, so the supplement with 1,000% of a water-soluble vitamin like B12 is not any better for you.

However, a few nutrients in multivitamins are dangerous at high levels: Vitamin A has a high risk of causing birth defects at high doses, and beta carotene promotes lung cancer growth in smokers, as two examples. Responsible vitamin manufacturers don’t put in doses of vitamins that will be toxic if taken as directed.