Fibroids and bladder: Fibroid Symptoms and Diagnosis – Brigham and Women’s Hospital
Fibroid Symptoms and Diagnosis – Brigham and Women’s Hospital
Fibroids cause symptoms in 20 to 50 percent of women. The most common symptoms are heavy uterine bleeding, pelvic pressure, frequent urination, constipation, painful periods and painful intercourse, infertility, and pregnancy complications.
Normal menstrual periods typically last four to five days. Women with fibroids often have periods lasting longer than seven days that can be very heavy, requiring changing sanitary protection frequently (perhaps every hour). Bleeding between periods is not usually due to fibroids and should always be evaluated by a physician. Although abnormal bleeding can occur with any type of fibroid, women with submucous fibroids are more likely to experience abnormal bleeding.
Pelvic pressure results from an increase in size of the uterus or from a particular fibroid. Most women with fibroids have an enlarged uterus; in fact, doctors describe the size of a uterus with fibroids as they would a pregnant uterus, for example, as a 12 week-size fibroid uterus. It is not unusual for a uterus with fibroids to reach the size of a four to five month pregnancy. Women can experience pressure on the bowel and/or bladder due to fibroids. This can cause constipation, frequent urination and incontinence. In some rare cases, fibroids can press on the ureters (tubes which carry urine from the kidneys to the bladder), leading to kidney dysfunction.
Women with fibroids also may experience reproductive problems including recurrent miscarriage, infertility, premature labor, abnormal presentation of a fetus (such as a breech presentation), and complications during labor.
Many doctors believe these reproductive complications most often occur when fibroids change the shape of the uterine cavity. Thus fibroids on the inside the uterus (submucous fibroids) which distort the uterine lining should be removed.
In general, fibroids only need to be treated if they are causing symptoms or affecting a woman’s fertility or ability to carry a pregnancy. Treatment for uterine fibroids should be based on a woman’s medical history, surgical history and goals of therapy.
Fibroids can generally be felt by your doctor during a general gynecological examination, however diagnosis is made based on imaging tests such ultrasound, MRI (magnetic resonance imagery), and CT (computed tomography). Currently, ultrasound is the most common method used to diagnose uterine fibroids, but MRI may prove more useful because it can often distinguish fibroids from other growths in the uterus.
In patients experiencing menorrhagia (profuse and/or prolonged menstrual flow) or recurrent pregnancy losses, careful examination of the uterine cavity is important because the presence of a submucous fibroid can be missed on traditional ultrasound.
Hysterosalpingography, sonohysterography, and hysteroscopy are used to diagnose fibroids inside the uterus. Hysterosalpingography and sonohysterography use X-ray pictures and ultrasound pictures, respectively, to visualize the uterine cavity after fluid is injected into the uterus. Hysteroscopy allows your physician to look inside the uterine cavity by inserting a small camera on the end of a long tube (hysteroscope) into the uterus through the vagina and cervix.
Can Uterine Fibroids Cause Bladder Problems?
You’ve probably heard that uterine fibroids can cause heavy menstrual bleeding, abdominal pain and bloating, but did you know that there’s a link between fibroids and bladder problems?
Uterine fibroids are non-cancerous tumors that develop from smooth muscle cells and fibrous connective tissue. Also known as uterine myomas or leiomyomas, fibroids grow within and on the walls of the uterus. Fibroids are often confused with cysts. However, fibroids are solid tissue, while cysts are fluid-filled sacs.
Fibroids and Urinary Problems
Most women with uterine fibroids have an enlarged uterus. (i) In fact, a very large fibroid can expand the uterus to the size of a second-trimester pregnancy and press against the bladder, reducing its capacity for holding urine or blocking the outflow for urine to pass. (ii, iii)
The most common issue concerning fibroids and urinary problems is the need to urinate frequently. (iii) A woman may wake up several times during the night to empty her bladder and may occasionally experience an inability to urinate despite a full bladder. (iii)
In some cases, fibroids can cause urinary retention. (iv) This can happen when large fibroids press against a ureter. If a ureter becomes completely pinched off, surgery is needed quickly to prevent urine from flowing back, which may permanently damage the kidney on that particular side. It’s important for you to discuss fibroids and urinary problems with your doctor as soon as you notice any irregularities.
Fibroids and Pressure on the Bowels, Rectum and Abdomen
Uterine fibroids may also cause pressure on the bowels. This pressure can lead to feelings of bloating or constipation.
Fibroids may press against the rectum and cause a sense of rectal fullness, difficulty having a bowel movement, and/or pain with bowel movements. (iii) Sometimes, fibroids may lead to the development of hemorrhoids. (iii)
Women with large fibroids may experience a sense of heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague sense of discomfort rather than a sharp pain. Sometimes, an enlarged uterus can make it hard to lie face down, bend over, or exercise without discomfort. (iii)
Other Complications of Uterine Fibroids
In addition to fibroids and bladder problems, as well as unusual sensations of pressure, uterine tumors can cause other issues, including:
Pedunculated fibroids are attached to the uterus by a stem and may twist and can result in pain, nausea or fever. (v) Fibroids that grow rapidly, or start breaking down, may also cause pain. (v)
Lower back pain
In rare circumstances, fibroids may press against the muscles and nerves of the lower back. (iii) A large fibroid growing towards the rear of the uterus is more likely to cause back pain than a small intramural fibroid. (iii)
Uncomfortable or painful sexual intercourse
Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue, so be sure to discuss it with your doctor.
If fibroids are the only cause of infertility, many women are able to become pregnant after they are treated. (v)
Large fibroids that reach the size of a cantaloupe may lead to a rare association with blood clots in the lung, which can be deadly. (vi)
While doctors are still unclear about the causes of uterine fibroids, women can experience a variety of symptoms and medical complications.
Treatment will depend on many factors, including your age, the severity of the bleeding, and whether you want to have children. Common medical treatment options include the use of birth control pills, hormone injections, a hormone-releasing intra-uterine device, and surgical or non-surgical procedures.
When considering surgical or non-surgical procedures, talk with your doctor about the risks and benefits of each procedure. A more conservative option is uterine fibroid embolization or UFE, a minimally invasive procedure. It safe and effectively shrinks uterine fibroid tumors and offers relief from many of the unpleasant symptoms that come with them. It doesn’t require open surgery and is performed in an outpatient setting, so patients can go home the same day.
Download our free information sheet, Understanding Uterine Fibroid Embolization, or call 844-UFE-CARE (833-2273) to schedule an appointment with a vascular specialist.
i Brigham and Women’s Hospital. (n.d.). _About Uterine Fibroids._Retrieved June 15, 2018, from http://www.fibroids.net/fibroids.html
ii Harvard Health Publishing. (2008, July). _What to do about fibroids – Harvard Health._Retrieved June 19, 2018, from https://www.health.harvard. edu/womens-health/what_to_do_about_fibroids
iii UCSF National Center of Excellence in Women’s Health. (2017, April 25). _Fibroid Symptoms. Retrieved_June 20, 2018, from http://coe.ucsf.edu/coe/fibroid/symptoms.html
iv Institute for Quality and Efficiency in Health Care. (2017, November 16). _Uterine fibroids: Overview._Retrieved June 19, 2018, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072719/
v American College of Obstetricians and Gynecologists. (2011, May). _Women’s Health Care Physicians._Retrieved June 17, 2018, from https://www.acog.org/Patients/FAQs/Uterine-Fibroids
vi Bradley, J. G., MD. (2011, June 22). _Uterine Fibroids._Retrieved June 15, 2018, from http://www.obgyn.net/laparoscopy/uterine-fibroids
Uterine fibroids: symptoms and treatment
Uterine fibroids are benign tumors that develop in the uterus. Knots range in size from a pea to a melon. They are also called leiomyomas or fibromyomas.
Uterine fibroids are very common and occur in approximately 20-50% of all women. Most often detected in women aged 30 to 40 years, many have a hereditary character. Fibroids can grow during the reproductive period, but in some cases remain at the same level for many years. Fibroids stop growing after menopause.
NB! If the nodes continue to increase after menopause, you should definitely consult your doctor!
Fibroids usually do not cause any symptoms and do not require treatment. But if symptoms occur, you should seek medical attention.
- Bleeding Heavy or prolonged menstrual bleeding is the most common symptom. Women have to change sanitary pads almost every hour, they are forced to stay at home on the most abundant day of menstruation. As a result, anemia develops, which can cause fatigue, dizziness, headache, and reduced performance.
NB! If your periods become more abundant than before, you should definitely consult a doctor.
- T basic discomfort. Women with large nodules may feel heaviness or pressure in the lower abdomen or pelvis. This is often described by patients as pelvic discomfort rather than acute pain. Sometimes unpleasant sensations are aggravated in the prone position, with the torso tilted.
- Pelvic pain. A less common symptom is sharp and severe pain. There is a degeneration of the myomatous node, i.e. violation of its blood supply. Usually the pain is localized in a certain place. Chronic pelvic pain may occur. This type of pain is usually less intense but persistent and limited to a specific area.
- Bladder problems. The most common urinary tract symptom is frequent urination. A woman may wake up several times during the night to empty her bladder. Sometimes women cannot urinate despite having a full bladder.
- Pain in the lower back. Occurs when fibroids are localized on the back of the uterus and pressed against the muscles and nerves of the lower back, which causes pain.
- Rectal pressure. Fibroids may press against the rectum and cause a feeling of fullness, difficulty with bowel movements, and pain during bowel movements. Sometimes uterine fibroids can lead to the development of hemorrhoids.
- Discomfort or pain during intercourse. Pain occurs only in certain positions or during certain periods of the menstrual cycle.
Diagnosis of uterine fibroids:
Usually, uterine fibroids are discovered during a routine pelvic exam, which allows the doctor to determine the size and shape of the uterus. If it is enlarged, has an irregular shape, a bumpy surface, uterine myoma can be suspected. Or, you may notice new symptoms appear and tell your doctor.
After a gynecological examination, there are several ways to confirm the diagnosis. The main method is ultrasound of the pelvic organs. Other methods are more specialized and are performed only when necessary. Below is a brief description of each study.
Ultrasound is a safe and reliable way to detect fibroids. As a rule, a transabdominal and transvaginal examination is used. In the first case, in the presence of a full bladder, the sensor is placed on the patient’s stomach, in the second case, with an empty bladder, a special vaginal sensor is used and the uterus and ovaries are examined.
Go to the page “Ultrasound in gynecology”
Magnetic resonance imaging (MRI) – gives a detailed picture of the number, size and exact location of fibroids. Not all women with fibroids require an MRI.
Hysteroscopy – a procedure for examining the uterine cavity, which allows you to identify nodes growing into the cavity (submucosal, or submucosal fibroids). The study is performed on an outpatient or inpatient basis.
When is surgery needed?
What is fibroids?
Myoma has many names – fibromyoma, leiomyoma or uterine fibroid, and is the most common tumor of the pelvic organs in women. Although fibroids are 100% benign tumors, they can cause a lot of trouble if they are not properly treated.
The uterus consists of several layers. The thickest uterus, which consists exclusively of muscle tissue, and is called “myometrium” . This is what we are talking about in the context of myomas – the tumor begins to develop from the muscles of the uterus. The muscular layer is the middle layer between the mucosa, “growing” inwards, into the uterine cavity – the endometrium and the outer one – growing “outwards”, towards the bladder and colon.
Why do fibroids appear?
A typical situation for any tumors – no one can say unequivocally why a fibroid appeared. In the same way, it is impossible to explain why in one woman a centimeter-sized tumor remains asymptomatic in the uterus all her life, and in the second it grows so much in six months that it necessitates surgery. Most often, this is associated with a genetic predisposition, with external factors – such as stress, alcohol and nicotine.
Although it is impossible to name the causes of the problem, the fact remains that fibroids are hormone-dependent tumors . It is estrogens and progesterones that influence the growth of the neoplasm. Therefore, most often, fibroids are a problem for women of reproductive age – a period when hormones are actively and successfully produced. This also explains the hormone replacement therapy – for example, after menopause, can provoke the growth of a small fibroid that has been “silent” for a long time.
What are the possible symptoms?
Before describing the symptoms, (first you need to understand how different fibroids can be.
If the fibroids grow towards the uterine cavity, then they call it “submucosal” or “submucosal” . cause symptoms in total: severe menstrual pain and heavy bleeding , and as a result – anemia, weakness. If the fibroid is large, it “occupies” the territory where the embryo potentially wants to attach, deforms the endometrium: submucosal fibroid can be the cause infertility, problems with pregnancy . An important symptomatic difference between polyps and myomas: in the case of the first, the patient complains of spotting bleeding, and in the case of submucosal fibroids, of heavy menstrual bleeding.
Another variant of fibroids – the one that grows “out” – subserous . Symptoms include a feeling of pressure, a constantly full bladder, frequent urination, constipation, chronic aching pelvic or even lumbar pain. If the fibroid is small, then there may not be any symptoms.
There is another type of fibroids that develop in the muscular layer of the uterus – intramural . Such a node can also bleed and cause miscarriage or infertility. But, as a rule, this education does not cause complaints and does not interfere with life. This type is the most common.
There is also a fibroid “on a leg”. There is a danger that the leg will twist – the blood supply to the fibroid will stop, the fibroid cells will begin to die, which can cause unbearable pain. This is a direct indication for urgent surgery! With a different location of the fibroids, it can be “squeezed out” outward, directly into the cavity of the cervix or even into the vagina – then they talk about the so-called “nascent myoma” . This situation is also very painful: the cervix opens, and later bloody discharge from the genital tract appears.
How is myoma diagnosed?
If the fibroid is large, it can be felt and palpated during a gynecological examination. But, in the case, for example, with a submucosal node growing inward, alas, this is impossible. That is why, the gold standard for diagnosing myomas is ultrasonography .
On ultrasound, the fibroid looks like this: dark, the edges are very clearly visible, the shape is round, it has a light shadow called the “comet tail”. How the patient will be treated depends on the result of the ultrasound. It is necessary to understand the size of the tumor, where and how deep in the tissues of the uterus it is located.
Sonohysterography can be done to make the picture clearer – this will help to distinguish myoma from, for example, a polyp (see the article “Polyps”).
With an accuracy of 90-95% on ultrasound, you can see suspicious fibroids. For example, the one that itself began to “die off” – the tissues disintegrate, cavities with liquid appear inside, the contour changes. In this case, it is vital to make sure that it is not a malignant tumor. Therefore, after the ultrasound, the patient is sent for fidelity to magnetic resonance.
Taking aspirate – that is, fluid from the uterine cavity for analysis – makes no sense. With this analysis, the myometrium cannot be checked.
How to treat fibroids?
L Fibroids should only be treated if there are symptoms or if the fibroids are too large If not, ultrasound should be done every six months to control fibroid size. A small fibroid is not a hindrance to either pregnancy or gestation.
There are several options for therapy. The first is hormonal treatment. Works partially. The fibroid grows under the influence of hormones, and if the drug blocks their production or effect on the tumor, then this is a way to shrink it, weaken its blood circulation and save the patient from symptomatic bleeding. It is this action of hormonal drugs that is often used before surgery to make it easier to remove the tumor, but, alas, drugs work only in 35-40 percent of cases. It happens that the tumor does not respond to drugs at all or may even begin to grow.
Today there are two types of drugs that are trying to treat fibroids. The first ( analogue of gonadotropin- releasing hormones, for example, buserylin acetate acts at the level of the brain and radically changes the hormonal background . The drug causes artificial menopause with all the ensuing consequences – osteoporosis, sweating, overweight, and so on. Therefore, it is recommended before surgery no more than 2-3 courses of the drug
Second – ulipristal acetate is a newer and less aggressive drug, it acts exclusively on fibroids, hormones continue to calmly affect the body, and there are no symptoms of menopause. It is this drug that specialists prescribe today. The medicine can be taken in courses.
However, the drug has contraindications. First, according to the new recommendations, it should not be prescribed to patients with liver problems: it is necessary to take liver tests before prescribing it . And secondly, do not forget that the second remedy frees the patient from symptoms exactly as long as she takes the drug, and after its withdrawal, the fibroids will again safely increase in size and again become the cause of complaints.
One more thing: if surgery is needed, then is more suitable for the first group of medicines , because ulipristal acetate softens the fibroids too much, complicating surgery.
Doctors sometimes suggest an intrauterine device as a treatment. Yes, it can reduce symptoms, but over time, bleeding and pain may return. The spiral affects the endometrium more than the fibroids.
The main method of treatment is surgery
If the patient is close to menopause and does not plan pregnancy, and the fibroids are large enough, or if there are several of them, in these cases it is suggested to remove the entire uterus. Doctors say that for a woman of reproductive age who does not want to have more children, only the ovaries matter (for the production of hormones and maintaining a normal hormonal background). They, if there is no pathology, are left, but the correct removal of the uterus will not affect health in any way.
The second option is to remove fibroids only, which is usually the preferred method for those planning a pregnancy. And here is the main question in the type of operation:
- Hysteroresectoscopy , when under the visual control of the camera, the fibroids are removed from the inside of the uterine cavity, without incisions on the abdomen (read more in the article “Polyps”). The doctor is likely to choose this method if the fibroid is submucosal, small (say, up to 2-3 cm).
- Laparoscopy, in which, under general anesthesia, 3-4 incisions are made in the patient’s abdomen, no more than 10 mm in diameter, through which a camera and instruments are inserted into the cavity;
- Laparotomy is an open operation with an incision in the anterior abdominal wall. This method is best if the fibroid is really large (greater than 6-7 cm) or is located in an “unfortunate”, poorly visualized location.
Which of the three methods the gynecologist will choose – the question of the place where the fibroid is located, its size and, of course, the doctor’s practice in one method or another – the most important part of the operation is suturing to successfully restore the integrity of the uterus.
Another treatment option is uterine artery embolization . The bottom line is that the fibroid blood flow is blocked by a special substance that is launched into the uterine artery through a thin catheter inserted through the groin. This is a minimally invasive procedure that does not require general anesthesia, and is not treated by gynecologists, but by invasive radiologists. When the nutrition of the fibroid is blocked, it begins to die on its own. But, if the fibroid is large, then such a “half-dead” tumor can become infected and cause severe pain. Moreover, embolization to date is not recommended for women planning a pregnancy.
What to expect after treatment?
If fibroids are treated with medications only, you need to understand that this is a temporary therapy, and as soon as the patient stops taking medications, the fibroids will grow again and will again give symptoms .
In the case of surgical treatment, a fundamental difference exists for women planning a pregnancy.