Uterine fibroids are very common non-cancerous tumors that can develop within and on the uterus. They can cause a host of unpleasant symptoms which can range from mild to debilitating and are most often associated with heavy menstrual bleeding. Sometimes, in rare cases, fibroids can cause strange problems and end up in atypical locations such as in the case of a prolapsed fibroid.
The 3 Categories Of Fibroids
Three different types of fibroids can grow in and around the uterus and they are put in categories according to where they are growing.
- Intramural Fibroids
- Intramural fibroids are the most common type of fibroid and can cause painful symptoms including very heavy and prolonged menstrual bleeding and are also associated with infertility. They are embedded within the muscular wall of the uterus, and are also categorized depending on their location:
- Anterior intramural fibroids are found on the front portion of the uterus;
- Posterior intramural fibroids are found on the back portion of the uterus;
- Fundal intramural fibroids are found on the top portion of the uterus.
- Subserosal Fibroids
- Subserosal fibroids are found growing along the outer surface of the uterus and do not disturb the lining of the uterus so they normally do not cause heavy bleeding. Because of their location and if they grow large enough to exert pressure on nearby organs or structures, they can cause strange symptoms. Lower back or leg pain, pain during intercourse, and bowel/bladder issues can all be symptoms of subserosal fibroids.
- Submucosal Fibroids
- Submucosal fibroids can grow in clusters and cause deformities in the uterine wall. They can also become quite large and are known to cause very heavy bleeding that can lead to anemia. Studies have indicated that submucosal fibroids greatly contribute to fertility issues.
Fibroids can grow embedded within the uterus (sessile fibroids) or they can grow from a small stem-like structure called a peduncle (pedunculated). There is currently no known cause that makes a fibroid grow from a peduncle rather than grow on the uterus directly. Pedunculated fibroids can grow from the outer or inner surface of the uterus.
Complications Caused By Pedunculated Fibroids
Pedunculated fibroid torsion – When fibroids grow on a peduncle, sometimes they can cause serious problems such as becoming suddenly twisted. This can be in response to a sudden movement that causes the fibroid to rotate on its stalk which suddenly cuts off the blood that is flowing to the fibroid.
This condition is rare, occurring in less than .025% of patients, and is difficult to identify or predict based on imaging scans. It is often initially misdiagnosed as another condition such as appendicitis when facilitating an emergency room visit.
The symptoms of fibroid torsion can include:
- Sudden sharp and intense pain in the abdomen;
- Moderate to severe menstrual-type cramps;
- Prolonged bleeding during menstruation.
A Case Study of Pedunculated Fibroid Torsion
A recently published study recounted the case of a 58-year-old woman who went to the emergency room with severe lower abdominal pain that had been getting worse by the hour and was accompanied by nausea, vomiting, and diarrhea.
She had been to another urgent care facility the evening before and after a CT scan, she was released with the diagnosis of a degenerating fibroid. (natural and gradual breakdown of a fibroid that is dying and shrinking)
While at the ER, another CT scan was performed and then they performed a transvaginal ultrasound assisted by Power Doppler (an internal scan that uses sound waves to more accurately depict internal vascular architecture). The medical team could see some blood flow within the stalk but because they were unable to see the blood flowing beyond the mass, they began to suspect pedunculated fibroid torsion.
During surgery, they confirmed their suspicions and removed a leiomyoma (fibroid) that was about 3 ½ “ in diameter on a twisted stalk. Situations involving pedunculated leiomyoma torsion are considered emergencies and require swift medical intervention.
Prolapsed Uterine Fibroid
Another complication that can arise with pedunculated fibroids is when they drop or shift (prolapse) into a location or position where they do not belong. Submucosal fibroids represent only a tiny portion of fibroids that are treated in women but they can cause a serious condition called a prolapsed fibroid.
What Causes A Prolapsed Uterine Fibroid?
Every month the uterus begins using contractions to shed its lining as part of the normal menstrual cycle. Sometimes during these contractions, an ill-positioned submucosal fibroid growing from a stalk can get pushed out into the cervix or the vaginal canal.
Pedunculated fibroids that are being pushed into the cervix or prolapse into the vagina can cause severe abdominal pain, vaginal bleeding/discharge, or no symptoms at all. Some women report feeling something protruding into their vaginal area with accompanying bleeding which sends them to the emergency room.
Three Case Studies Involving Prolapsed Uterine Fibroids
Case Study #1 told of a 47-year-old woman with a history of abnormal vaginal bleeding and frequent urination that had been going on for years. She came to the urgent care complaining of pain and bleeding (most likely prolapsed uterine fibroid discharge)
Upon examination they found a bleeding dark purple mass prolapsing from her uterus into her cervical canal and vagina. A total laparoscopic hysterectomy was done as well as a transvaginal removal of the prolapsed fibroid.
Case Study #2 involved a 25-year-old woman who became pregnant about a year after she was diagnosed with 4 uterine fibroids. At 10 weeks pregnant a CT scan revealed her fibroids had become larger but her pregnancy went along with no issues as well as her vaginal delivery. Just after delivery, she was vaginally examined for retention of fetal membranes and there was no indication of anything out of the ordinary.
About a month later, she was having difficulty urinating and was found to have a 10cm uterine fibroid that had prolapsed into her vagina. Doctors treated her for 2 days with broad-spectrum antibiotics and then removed the prolapsed fibroid vaginally under general anesthesia. This is the first known case of a prolapsed fibroid in a woman who had recently given birth vaginally.
The study concluded that pregnant women who have a history or diagnosis of uterine fibroids that are located low on the uterus should be carefully observed after delivery. Diagnosing and eliminating a vaginally prolapsed uterine fibroid early could prevent a dangerous obstruction or infection.
Case Study #3 was written about a 36-year-old woman who had never had children who had suffered for years from heavy bleeding and was also suffering from anemia. She had a history of her periods lasting as long as 6 months and had undergone a related blood transfusion just months earlier in another hospital.
She was admitted with the normal blood pressure but was pale and tachycardic. During a vaginal exam, a large tightly impacted prolapsed fibroid measuring 10cm X 11cm was found. Four different techniques were attempted to dislodge and remove the fibroid but failed.
Finally, out of other viable options, they manually morcellated (cut it into smaller pieces) the fibroid and removed it piecemeal causing the patient to lose about a liter of blood. They removed the large fibroid that weighed a little over a pound and fortunately, the patient’s recovery was uneventful.
Is There a Non-Surgical Treatment for Prolapsed Uterine Fibroids?
Uterine Fibroid Embolization (UFE) may be an effective treatment to prevent pedunculated uterine fibroids from reaching the point of prolapse. Even though there is a very low risk of pedunculated fibroid torsion or the occurrence of a prolapsed uterine fibroid, if diagnosed with pedunculated fibroids seeking treatment before problems occur may be prudent.
UFE does not involve surgery and patients are discharged the same day to go home with just a bandaid. During the 45-minute outpatient procedure, the blood supply to all the fibroids is cut off and they begin to shrink and die.
UFE is highly effective in reducing/eliminating all types and sizes of fibroids as long as they are attached to the uterus. Studies have confirmed that after performing a uterine fibroid embolization both the fibroids and their stalks (peduncles) were reduced in diameter.
With only about a week of downtime for recovery, non-surgical UFE offers a safe and more desirable treatment option to address all types of uterine fibroids including those that can lead to a prolapsed fibroid.
If you have been diagnosed with uterine fibroids and are experiencing symptoms associated with fibroids, contact the Atlanta Fibroid Center today to set up a consultation. We have been treating fibroids with UFE for over 27 years and have brought relief from life-interrupting symptoms to thousands of women.
There is no need to suffer or worry for one more day when help is just one click away. Contact us today and find out more about UFE, the Atlanta Fibroid Center, and how we can help you be fibroid-free!