Many women experience back pain at some point in their lives. For some, this back pain may be caused by uterine fibroids. Fibroids are noncancerous growths that develop in or on the muscular wall of the uterus. Many women have fibroids, but often experience no symptoms. However, for some women, fibroids can cause symptoms like heavy menstrual bleeding, pelvic pain and pressure, and back pain.
What are the causes of back pain?
Back pain can have many different causes. Some common causes include:
- Muscle or ligament strain
- Bulging or ruptured discs
- Arthritis
- Skeletal irregularities, like scoliosis
- Osteoporosis
- Pregnancy
Back pain can also sometimes be caused by problems with organs, even if the pain is felt in the back. This is called referred pain. Fibroids are one condition that can sometimes cause referred back pain.
How do fibroids cause back pain?
Uterine fibroids are benign tumors that grow in the wall of the uterus. They are extremely common, affecting about 70% of women by age 50. Fibroids can range greatly in size from microscopic to quite large.
There are a few ways that fibroids may cause back pain:
- Large fibroids can press on nerves in the pelvis and lower back, causing pain signals to be sent.
- Some fibroids grow outward on stalks. These may press against the spine and surrounding muscles.
- Fibroids can make the uterus enlarged and heavier, putting strain on ligaments and muscles that support it.
- Fibroids may cause heavier periods with more clotting and cramping, leading to back pain.
The back pain may range from mild to severe. It may be acute or chronic. The specific location, severity, and nature of the pain can help determine if fibroids are the likely cause.
What types of back pain do fibroids cause?
There are a few main types of back pain that fibroids may contribute to:
- Lower Back Pain – Pressure and heaviness from an enlarged uterus can strain the lower back muscles and ligaments.
- Sacral Back Pain – Fibroids pressing on sacral nerves can cause sacral back pain.
- Sciatic Pain – Impingement of the sciatic nerve, which runs from the lower back through the buttocks and down the legs.
- Middle Back Pain – Less common, but larger fibroids can sometimes press on the spine and ribs.
The pain may be localized to one side or the other if a fibroid is asymmetrically positioned. Severe cases can cause compression of the nerves and numbness or weakness of the legs.
When to see a doctor
Mild or intermittent back pain is common and usually not a concern. However, you should make an appointment with your doctor if you experience:
- Severe or worsening back pain
- Back pain along with abdominal bloating or pelvic pain
- Back pain with vaginal bleeding between periods
- Back pain that does not improve with rest or over-the-counter pain medication
- Loss of bowel or bladder control
- Numbness, tingling, or weakness in the legs
These can indicate a more serious problem like nerve compression. Prompt medical evaluation is recommended.
How are fibroids related to back pain diagnosed?
If you suspect your back pain may be related to fibroids, the first step is to get an accurate diagnosis. Your doctor will likely begin with a pelvic exam to feel for any enlargement of the uterus. They may also do a neurological exam of the lower body to assess nerve function.
Some common diagnostic tests used include:
- Ultrasound – Uses sound waves to create images of the uterus and ovaries. Can identify fibroids and their locations.
- MRI – Provides detailed images of the pelvic organs and can confirm fibroid presence and size.
- CT scan – Provides images of the back and spine. Can detect causes of back pain other than fibroids.
- X-ray – Can identify spinal abnormalities or bone issues contributing to back pain.
- Blood tests – Help rule out other conditions like endometriosis or infection.
Your doctor will review your test results along with your full medical history and symptoms to make a diagnosis. If fibroids appear to be the cause of your back pain, treatment options can be discussed.
What are the treatment options for back pain from fibroids?
The treatment options for back pain from fibroids depend on the severity of your symptoms and your plans for future pregnancy. Some options include:
- Pain medication – Over-the-counter anti-inflammatories like ibuprofen can help relieve mild back pain. Stronger prescription medications or muscle relaxants may be prescribed for more severe pain.
- Hormonal birth control – Can help regulate menstrual cycles and reduce heavy bleeding and cramping that may contribute to back pain.
- Fibroid embolization – Blocks blood flow to shrink the fibroids while leaving the uterus intact.
- MRI-guided ultrasound surgery – Uses focused ultrasound waves to heat and destroy fibroid tissue without incisions.
- Myomectomy – Surgically removes just the fibroids while preserving uterus function and ability to get pregnant.
- Hysterectomy – Surgical removal of the entire uterus. Prevents fibroid recurrence but ends ability to bear children.
Your gynecologist can explain these options in more detail to help determine which is right for your individual situation.
Conclusion
Uterine fibroids are a common cause of back pain in women. Pain results from the direct pressure of fibroids on the spine, nerves, and surrounding structures. Large or rapidly growing fibroids are more likely to cause symptoms. Back pain from fibroids may be acute or chronic and range from mild to severe. An enlarged uterus full of fibroids can also contribute to back strain and pain from the excess weight.
If you have persistent or worsening back pain along with other uterine symptoms, see your doctor for an evaluation. Pelvic imaging tests like ultrasound and MRI can confirm if fibroids are present and possibly causing pain. Various treatment options are available to help provide relief from fibroid-related back pain.
Fibroid Back Pain FAQs
Can small fibroids cause back pain?
Small fibroids are less likely to cause back pain, but it is still possible. Even small fibroids can potentially press on pelvic nerves and lead to referred lower back pain. Small fibroids may also contribute to heavier menstrual bleeding, which can cause cramping and backache.
Does the location of the fibroid affect back pain?
Yes, fibroid location plays a role in whether it causes back pain. Fibroids near the back of the uterus and those with larger stalks are most likely to press directly on the spine, sacrum, and surrounding nerves. Broad ligament fibroids between the uterus and pelvic wall can also sometimes contribute to back pain.
Should I see an orthopedist or gynecologist for fibroid back pain?
It is best to see a gynecologist first if you suspect your back pain may be related to fibroids. They can examine your pelvic area, order uterine imaging tests, and diagnose any fibroids present. If no gynecologic cause is found, your doctor may then refer you to an orthopedist for evaluation of musculoskeletal causes of back pain.
Can back pain be a sign of fibroid degeneration?
Yes, acute severe back pain can occasionally be a symptom of fibroid degeneration. Fibroid degeneration occurs when a fibroid outgrows its blood supply. The lack of oxygen causes it to suddenly die off or degenerate. This can cause intense localized pain.
What exercises help relieve back pain from fibroids?
Low-impact exercises like swimming, walking, or yoga can help stretch and strengthen the back to help alleviate fibroid-related back pain. Pilates, physical therapy exercises, and chiropractic adjustments may also provide relief. Avoid heavy lifting and high-impact activities that may worsen pain.
Detailed Overview of Fibroid Back Pain
Causes and Mechanisms
Fibroids are benign muscular tumors that grow from the smooth muscle layers of the uterus. They are extremely common, with an estimated 70-80% of women developing them by age 50. However, only about 25% of women with fibroids have any symptoms. For those women who do have symptoms, back pain is relatively uncommon but can occur through several mechanisms:
- Fibroids can compress nerves in the pelvis and lower back, causing referred pain signals to be transmitted to the brain.
- Pedunculated subserosal fibroids grow on stalks on the outer surface of the uterus. These can press directly into the lumbar spine and sacrum.
- A uterus enlarged with a high fibroid burden puts outward pressure on pelvic ligaments and muscles supporting it.
- Excessive menstrual bleeding from fibroids causes increased cramping during periods, which can radiate into the lower back.
- Rapid growth or degeneration of fibroids causes swelling and inflammation that may irritate pelvic nerves.
In summary, the root cause is the physical compression and disruption of nerves and supportive structures in the pelvis. The back pain is referred from the nerves in the pelvis to the nerves that supply the lower back.
Character and Location of Pain
The character and location of back pain can provide clues as to whether fibroids may be contributing to it:
- Lower Back Pain – Dull aching pain in the lumbar region most typical. Can extend into the buttocks and upper thighs.
- Sacral Back Pain – More localized pain over the sacrum and tailbone region if compressing those nerves.
- Sciatic Pain – Sharp or shooting pain radiating from lower back down through hips and back of legs.
- Middle Back Pain – Uncommon, but possible if very large fibroids are present.
- Flank Pain – Fibroids on the outer surface of the uterus can irritate parietal nerves.
The pain may be more pronounced on one side if a fibroid is asymmetrically positioned. Moving positions does not tend to relieve fibroid back pain.
Associated Symptoms
Back pain from fibroids rarely occurs in isolation. Other possible associated symptoms include:
- Heavy, prolonged menstrual periods
- Pelvic pain and pressure
- Leg pain or numbness
- Pain during intercourse
- Urinary frequency or incontinence
- Abdominal bloating or fullness
- Constipation
- Fatigue
Sudden onset of severe pain could indicate a fibroid undergoing degeneration. This occurs when its blood supply is inadequate and begins to die off rapidly. Associated fever could indicate infection.
Diagnostic Evaluation
If back pain is suspected to be from fibroids, the patient will undergo a complete gynecological evaluation. This includes a medical history, physical exam, pelvic exam, and imaging studies such as:
- Pelvic ultrasound – Uses sound waves to evaluate uterus, ovaries, and nearby structures. Can identify shape, number, size, and position of any fibroids present.
- MRI – Provides detailed cross-sectional images of the pelvis. Confirms fibroid characteristics and relationship to nerves and spine.
- CT scan – Better visualizes lumbar spine. Helps identify any non-gynecologic causes of back pain.
- X-ray – Images bony structures. Can detect spine injuries, arthritis, or bone cancer as pain causes.
Blood tests check for conditions like anemia and infection. With a clear diagnosis, appropriate management of fibroid back pain can proceed.
Treatment Approaches
Treatment of back pain from uterine fibroids involves both relieving current symptoms and reducing the size or removing fibroids to prevent recurrence. Options include:
- Pain medications – Anti-inflammatories and heating pads help relieve acute muscular back pain from cramping and strain.
- Hormonal treatments – Oral contraceptives regulate menstrual bleeding. GnRH agonists temporarily shrink fibroids.
- Uterine artery embolization – Catheter procedure blocks fibroid blood supply causing them to shrink.
- MRI-guided ultrasound surgery – Non-invasive ablation of fibroid tissue using focused ultrasonic heating.
- Myomectomy – Surgical removal of just the fibroid tumors while sparing the uterus.
- Hysterectomy – Removal of the entire uterus. Definitively stops fibroid symptoms but impacts fertility.
Mild cases may be managed medically with periodic monitoring. More severe, chronic, or progressive cases generally warrant surgery. The risks and benefits of each approach must be carefully weighed.
Prevention
Unfortunately, there are no well-proven ways to prevent uterine fibroids. Factors that are suspected to reduce risk include:
- Maintaining a healthy body weight
- Exercise
- Avoiding early first menstrual period
- Giving birth
- Using oral contraceptives
However, fibroids develop from many influences including genetics and chance cellular mutations. Eating a balanced diet, staying active, and avoiding tobacco products may help maximize general health.
References
- Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med. 2015;372(17):1646-1655. doi:10.1056/NEJMcp1411029
- Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-1095. doi:10.1097/01.AOG.0000285997.38553.4b
- Zhao W, Wang L, Luo X, Xu H. Uterine fibroids: pathogenesis and interactions with endometrium and myometrium. Int J Clin Exp Pathol. 2015;8(10):13042-13054.
- Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health. 2012;12:6. doi:10.1186/1472-6874-12-6
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7. doi: 10.1067/mob.2003.99