Fibroids are non-cancerous growths that develop in or on the muscular walls of the uterus. Also known as uterine myomas or leiomyomas, fibroids are very common, affecting about 70-80% of women by age 50.
While fibroids are often asymptomatic, their location and size can cause symptoms like heavy menstrual bleeding, pelvic pain and pressure, and problems with pregnancy and fertility. One common symptom is increased urinary frequency and urgency, leading many women to wonder: can fibroids press on your bladder?
What Are Fibroids?
Fibroids are muscular tumors that grow in the wall of the uterus (womb). They are almost always non-cancerous (benign).
While the exact cause is unclear, fibroids seem to be influenced by:
– Hormones like estrogen and progesterone
– Genetics
– Natural growth factors
There are several types of uterine fibroids:
– **Intramural**: Within the muscular uterine wall. Most common type.
– **Submucosal**: Just under the lining of the uterine cavity.
– **Subserosal**: Projecting out from the uterus into the pelvis.
– **Pedunculated**: Connected to the uterus by a long stalk.
Fibroids can range dramatically in size – from microscopic to several inches across. They also vary in number, with women having just one fibroid up to several dozen.
Can Fibroids Cause Bladder Symptoms?
Yes, fibroids that grow close to or press on the bladder can cause a variety of urinary symptoms, such as:
– Frequent urination
– Urgent need to urinate
– Waking at night to urinate (nocturia)
– Incomplete bladder emptying
– Incontinence
This happens because the fibroids can physically compress the bladder, reducing its capacity to hold urine. Fibroids can also block the ureters, the tubes that carry urine from the kidneys to the bladder.
Fibroids That Impact the Bladder
The fibroids that most commonly press on the bladder are:
– **Subserosal fibroids** – These grow on the outer wall of the uterus and can press on nearby organs like the bladder. Large subserosal fibroids can fill the pelvis.
– **Intramural fibroids** – Even though these grow within the uterine wall, they can get large enough to put pressure on the bladder or urethra.
– **Cervical fibroids** – These grow in the cervix (lower part of the uterus) next to the bladder.
– **Pedunculated fibroids** – These grow on stalks projecting from the uterus. They have more room to move around the pelvis and press on the bladder.
Diagnosing Fibroids Causing Bladder Symptoms
If you have symptoms like increased urinary frequency, urgency, or incontinence along with pelvic pain or abnormal menstrual bleeding, you doctor will investigate whether fibroids may be the cause.
Diagnostic tests may include:
– **Pelvic exam** – Feeling for enlargement of uterus.
– **Ultrasound** – Uses soundwaves to create images of uterus and fibroids. Helps locate fibroids and identify if any are pressing on bladder. Considered the first-line imaging test.
– **MRI** – Provides detailed views of the uterus, fibroids, and surrounding structures like the bladder. Can confirm size and location of fibroids putting pressure on bladder.
– **Cystoscopy** – A camera on the end of a thin tube is inserted through urethra into bladder allowing doctor to visually assess any compression or blockage.
– **Urodynamics testing** – Measures bladder function and capacity by filling bladder with fluid. Helpful if there are concerns about bladder function.
– **Kidney tests** – May examine kidneys and ureters for signs of obstruction from fibroids. Includes kidney function blood tests or imaging like CT scan or IVU.
Treatments for Fibroid-Related Bladder Symptoms
If bothersome symptoms are present, the main treatments for fibroids pressing on the bladder are:
### Medications
– **NSAIDs** – To relieve pain and reduce inflammation. Ibuprofen or naproxen.
– **Low-dose contraceptive pills** – Help control heavy bleeding.
– **GnRH agonists** – Hormone blocking injections that temporarily shrink fibroids. Add-back therapy is needed to prevent menopausal side effects.
– **Antifibrinolytics** – Medication to slow heavy menstrual bleeding.
### Procedures
– **Uterine artery embolization** – Catheter delivers particles to block blood supply to fibroids causing them to shrink. Outpatient procedure with quicker recovery than surgery.
– **MRI-guided ultrasound surgery** – Noninvasive treatment that uses sound waves to destroy fibroids.
– **Myomectomy** – Fibroids are surgically removed through abdominal incision while leaving uterus intact. Can be done through laparoscopy with quicker recovery. Often allows retention of fertility.
– **Hysterectomy** – Surgical removal of uterus and fibroids. Permanent solution when fertility not desired. Can be done through vagina or abdomen.
Of note, small or mild fibroids often do not require treatment beyond over-the-counter pain medicine and increased fluid intake. Regular monitoring determines if intervention becomes necessary over time.
When To See Your Doctor
You should make an appointment with your gynecologist or women’s health nurse practitioner if you have any of the following bladder symptoms:
– Frequent urination more than every 2 hours
– Sudden urges to urinate that are difficult to control
– Waking at night to urinate multiple times
– Trouble fully emptying your bladder
– Incontinence (leaking urine)
– Pain or burning with urination
Bring a list of all your symptoms, even if they don’t seem related. Mention the timeline of when symptoms started and any changes. Your medical provider can evaluate whether fibroids may be contributing to your bladder issues.
Some key questions your doctor may ask:
– When did you first notice bladder symptoms? Have they gotten worse?
– How often do you urinate during the day and at night?
– Do you ever leak urine? When does this occur?
– Is urination painful for you?
– Do you have trouble fully emptying your bladder?
– Do you have any pelvic pain, pressure, or abnormal uterine bleeding?
Tests to Diagnose Fibroid-Related Bladder Compression
If an enlarged uterus or fibroid-related bladder symptoms are suspected, your physician will likely order some tests to confirm diagnosis, including:
Pelvic Exam
Manual exam of uterus size, shape, tenderness. Determines if uterus is enlarged or irregularly shaped from fibroids.
Urinalysis
Checks for blood, infection, other abnormalities indicating bladder/urinary tract problems.
Ultrasound
Uses sound waves to create images of uterus and ovaries. Screens for uterine enlargement and presence of fibroids. Assesses fibroid location and proximity to bladder. Often done transvaginally.
Bladder Function Tests
Urodynamic tests measure bladder capacity, pressure, urinary flow rate. Help determine if fibroids interfere with bladder filling, emptying.
Cystoscopy
Scope inserted into urethra/bladder. Checks for compression of bladder, obstruction of ureter openings by fibroids.
MRI
Detailed pictures of uterus, fibroids, ovaries, and surrounding structures including bladder. Confirms size, position, and compression of bladder.
Relieving Bladder Symptoms from Fibroids Without Surgery
For less severe cases, the following conservative and medical treatments may relieve bladder symptoms without surgery:
– Avoid bladder irritants like caffeine, alcohol, citrus, carbonated drinks
– Increase water intake to dilute urine
– Reduce fluid intake before bedtime
– Urinate frequently to avoid bladder stretching
– Take warm baths to soothe bladder
– Try OTC meds for pain/inflammation like ibuprofen
– Maintain healthy weight and exercise regularly
– Consider prescription medicine to reduce heavy bleeding
– Try hormone-blocking injections like GnRH agonists to shrink fibroids
Your doctor can determine if a trial of conservative treatments may be appropriate based on your test results and severity of symptoms.
When Surgery May Be Recommended
If conservative treatments fail to adequately improve bothersome bladder symptoms, your doctor may suggest surgical options to remove or debulk the fibroids.
Surgery may be recommended if you have:
– Large fibroids placing direct pressure on bladder
– Persistent urinary frequency/urgency interfering with sleep and daily activities
– Recurrent bladder infections likely due to fibroid obstruction
– Hydronephrosis (kidney swelling) from ureter obstruction by fibroids
– Significant incontinence not relieved by medication or conservative measures
– Fibroids causing recurrent pregnancy loss or infertility
Talk to your doctor about the options like myomectomy, uterine artery embolization, or hysterectomy based on your age, fertility wishes, symptom severity, and goals.
Preparing for Fibroid Surgery to Relieve Bladder Symptoms
If your doctor advises surgery for fibroids affecting your bladder, here are some tips to prepare:
– Follow all instructions for fasting, bowel prep before procedure
– Arrange a ride home from the hospital or clinic
– Stock up on soft foods, toiletries, supplies for recovery period
– Set up care assistance or home services if needed after discharge
– Discuss medication plan for pain, vomiting, infection risk
– Ask for written post-op instructions about activity limits, incision care
– Have extra pads handy for vaginal bleeding after gynecologic surgery
– Take at least 1-2 weeks off work; rest as much as possible
– Avoid lifting over 5-10 pounds or strenuous activity for 4-6 weeks
– Make follow-up appointment to check recovery progress
Proper preparation can help you have the safest and smoothest recovery from fibroid surgery. Be sure to discuss all your questions with your medical team.
Recovering After Fibroid Removal Surgery
Recovery time after surgery for fibroids pressing on your bladder depends on:
– Type of procedure – Laparoscopic myomectomy usually faster than open abdominal myomectomy or hysterectomy
– Size and number of fibroids removed – More or larger fibroids mean longer recovery
– Individual healing ability – Age, medications, comorbidities impact healing
– Activity level after surgery – Overexertion slows recovery
For less invasive procedures like laparoscopic or hysteroscopic myomectomy, recovery may take:
– 1-2 weeks of pelvic rest
– 2-4 weeks until lifting restrictions lifted
– 4-6 weeks until back to normal activity
For major surgery like abdominal hysterectomy:
– 4-6 weeks of pelvic rest
– No heavy lifting for 6 weeks
– 6-8 weeks until most patients feel back to baseline
Call your doctor if you experience fever, bleeding, pain not relieved by medication, or other issues during your post-op recovery. Avoid sexual intercourse, douching, and insertion of anything in the vagina until your doctor gives the go-ahead. Expect some temporary bladder discomfort, leaking, urgency as your bladder returns to normal function over the healing period.
Outlook After Removing Fibroids Causing Bladder Symptoms
The prognosis is generally good after surgery to take out fibroids pressing on the bladder. Patients often report:
– Decreased urinary frequency and urgency
– Fewer episodes of incontinence
– Improved bladder control
– Better ability to fully empty bladder
– Reduced waking at night to urinate
– Resolution of bladder or ureter obstruction
– Relief of pelvic pain and pressure
However, fibroids can sometimes grow back after myomectomy. Hysterectomy may be an option if you are done having children and desire permanent relief.
Stay in close follow-up with your gynecologist and report any return of bladder symptoms after surgery. Further monitoring or repeat imaging tests may be needed to check for fibroid regrowth or other conditions like endometriosis or prolapse contributing to symptoms.
When to See Your Doctor Again After Surgery
After surgery for fibroids, call your doctor if you experience:
– Fever over 100.4F
– Heavy vaginal bleeding soaking over 1 pad per hour
– Increasing abdominal swelling or pain
– Pus or foul-smelling drainage from incisions
– Persistent nausea, vomiting, inability to eat or drink
– Chest pain or trouble breathing
– Leg pain, redness, swelling, or warmth
– No bowel movement 2-3 days after surgery
Also follow up if urinary symptoms like increased frequency, urgency, or incontinence recur. Further evaluation may be needed to determine if additional fibroids are causing bladder compression or if other pelvic conditions are contributing to symptoms.
Most women feel significantly better within 4-6 weeks after surgery for fibroids pressing on the bladder. But do not hesitate to call your healthcare provider if any concerning post-op symptoms arise.
Can Fibroids Come Back After Removal?
Unfortunately, new fibroids can sometimes grow after surgical treatment. The likelihood depends on:
– **Type of procedure** – Recurrence is least likely after hysterectomy since the uterus is removed. Myomectomy has a higher recurrence rate.
– **Number of fibroids** – The more fibroids at time of treatment, the greater the chance new ones will develop.
– **Age** – Risk increases as women get closer to menopause when estrogen levels normally decline.
– **Genetics** – Family history impacts fibroid development. African American women have higher rates of recurrence.
– **Childbearing** – Pregnancy after myomectomy can stimulate new fibroid growth.
Within 5 years after myomectomy, studies show recurrence rates are:
– Around 10-25% after removing 1-2 fibroids
– Up to 40-50% when 3 or more fibroids originally present
New fibroids after surgery often respond well to repeat procedures or hormone blocking medications if symptoms warrant future treatment.
Preventing Fibroids
While fibroids may recur after surgical removal, there are some steps you can take to lower your overall risk:
– Maintain a healthy weight through diet and exercise
– Limit alcohol intake
– Consider taking vitamin D supplements
– Avoid eating too much red meat
– Manage stress levels
– Use hormone-based contraceptives sparingly
– Consider pregnancy by age 30 if desired
– Breastfeed each child if possible
– Quit smoking
– Discuss gene testing if strong family history
Implementing healthy lifestyle habits can help optimize hormone balance and potentially prevent new fibroids from developing.
Conclusion
Fibroids located near the bladder are a common cause of urinary symptoms like frequency, urgency, and incontinence. Intramural, subserosal, cervical, and pedunculated fibroids most often press on the bladder triggering these issues.
If you have fibroid-related bladder symptoms, your doctor can order tests like pelvic ultrasound, urodynamic studies, and cystoscopy to confirm compression of bladder structures. Conservative treatments like increased fluids, medications, and hormone injections may help initially.
However, bothersome bladder symptoms often require surgical removal of the fibroids putting pressure on the bladder. After surgery for fibroids, most women experience significant relief from bladder frequency, urgency, and incontinence. Stay in close follow-up care, as new fibroids can sometimes develop and again cause urinary symptoms.