What If It’s Not IBS or Anxiety? A Vascular Surgeon Explains with Dr. Robert Hacker (Ep 178)

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Jan 8, 2026

Dr. Robert Hacker, a double board-certified vascular surgeon, sheds light on often-misdiagnosed conditions like MALS and Nutcracker Syndrome. He discusses how many chronic symptoms in women are attributed to IBS or anxiety, when they might actually stem from vascular issues. The conversation uncovers the intricate connections between vascular compression, EDS, and POTS. Dr. Hacker emphasizes the importance of proper imaging and advocacy in treatment, while sharing innovative surgical approaches and practical tips for managing symptoms.

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INSIGHT

Vascular Compression Explains Many ‘Mystery’ Symptoms

Many patients with pelvic symptoms improve after treating venous compressions like May-Thurner and nutcracker.
These vascular problems often explain years of GI, pelvic, and POTS-like symptoms that previous tests missed.

INSIGHT

MALS Often Hides On Standard Scans

MALS causes a characteristic mid-back pain and is best detected by breathing-phase ultrasound.
It is underdiagnosed because standard scans often miss the dynamic compression.

INSIGHT

Nutcracker Creates Wide Downstream Effects

Nutcracker compresses the left renal vein under the SMA and causes kidney and GI-related symptoms via collateral flow.
Collateral drainage into gonadal veins and spine can produce pelvic congestion and headaches.

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What if your chronic pain, bloating, or fatigue wasn’t in your head, but in your blood vessels? In this episode, Dr. Linda Bluestein sits down with vascular surgeon Dr. Robert Hacker, who’s on the front lines of diagnosing and treating complex conditions like MALS (Median Arcuate Ligament Syndrome), Nutcracker Syndrome, May-Thurner Syndrome, and pelvic venous congestion syndrome, conditions that disproportionately affect women and often go undiagnosed for years.

Together, they dive into the frustrating diagnostic delays, the overlap between vascular compression and syndromes like POTS (Postural Orthostatic Tachycardia Syndrome) and EDS (Ehlers-Danlos Syndrome), and how new surgical approaches are offering hope. Whether you're navigating chronic pelvic pain, unexplained GI symptoms, or fainting episodes, this conversation breaks down the misunderstood links between your veins, nerves, and connective tissue—and what to do about them.

Takeaways:

MALS isn’t rare, it’s rarely diagnosed. Dr. Hacker explains the symptoms and scans to look for when your gut symptoms don’t match the tests.

Why so many women are misdiagnosed with IBS or anxiety. Pelvic venous congestion, Nutcracker Syndrome, and May-Thurner often mimic more common conditions—but require totally different treatments.

The surprising connection between vascular compression and POTS. It’s not just nerves, your veins might be compressing in ways that worsen dysautonomia.

Surgery isn’t a silver bullet, but it can be life-changing. Dr. Hacker shares what makes a good surgical candidate and how his team helps patients navigate workup and recovery.

When your connective tissue works against your vascular system. Hypermobility and EDS can make vascular compression more likely and more complicated to treat.

Find the episode transcript here.

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