Uterine fibroids are non-cancerous growths, also known as leiomyomas, that develop within or on the uterus. These muscular tumors vary widely in size and number, often significantly increasing the overall size of the uterus. When present, fibroids can physically interfere with the normal function of the urinary system, confirming they can cause bladder issues. This often results in uncomfortable and disruptive urinary symptoms for many women.
How Fibroids Physically Affect Bladder Function
The primary way fibroids impact the bladder is through the mass effect. As fibroids grow, they increase the total volume of the uterus, causing it to press against surrounding pelvic organs. Since the bladder sits directly in front of the uterus, it is particularly susceptible to this external pressure.
The location of the fibroid is often more significant than its size in determining symptom severity. Fibroids developing on the anterior wall of the uterus are most likely to press directly into the bladder space. This constant compression reduces the bladder’s functional capacity, meaning it holds less urine before signaling the need to empty.
Fibroids that grow outward from the outer surface of the uterus, known as subserosal fibroids, can also cause significant pressure if positioned toward the front of the pelvis. Very large fibroids can press on the ureters, the tubes carrying urine from the kidneys to the bladder. This pressure can obstruct urine flow, potentially leading to hydronephrosis and impaired kidney function.
Common Urinary Symptoms Linked to Fibroids
The physical compression of the bladder by an enlarged uterus translates into several distinct urinary symptoms. Increased urinary frequency, requiring more trips to the bathroom throughout the day, is one of the most common complaints. This occurs because the fibroid’s pressure reduces the space available for urine storage, causing the bladder to signal fullness sooner than normal.
This frequent need to urinate often extends into the night, a condition called nocturia, which disrupts sleep patterns. Patients also report urinary urgency, the sudden, compelling need to pass urine that is difficult to defer. The persistent pressure on the bladder wall can irritate the muscle, causing it to contract prematurely.
The mechanical pressure can also interfere with the complete emptying of the bladder, leading to incomplete voiding or urinary retention. In some instances, this pressure contributes to urinary incontinence, such as urge or stress incontinence, where urine leaks due to increased abdominal pressure. Accurate diagnosis is important as these symptoms are often similar to those caused by conditions like a urinary tract infection.
Diagnosing the Connection
Confirming that fibroids cause urinary symptoms requires ruling out other common causes, such as infection, diabetes, or an overactive bladder. Diagnosis begins with a thorough patient history and a pelvic examination, where a provider may feel an enlarged uterus. A urinalysis is a standard initial test to check for signs of a urinary tract infection or blood in the urine.
Imaging studies confirm the presence, size, and location of the fibroids and their relationship to the bladder. Pelvic ultrasound, performed transabdominally or transvaginally, is a common non-invasive tool used to visualize the uterus and fibroids. Magnetic Resonance Imaging (MRI) offers more detailed images, helping to precisely map the anatomical relationship between the fibroid mass and the urinary organs.
Specialized Bladder Function Tests
Specialized tests may be necessary for a deeper understanding of bladder function. A post-void residual measurement assesses how much urine remains in the bladder immediately after the patient attempts to empty it, confirming incomplete bladder emptying. Urodynamic testing involves filling the bladder with sterile water to measure pressure and flow, providing objective data on bladder capacity and muscle function.
Treatment Options for Symptom Relief
The most effective way to relieve fibroid-related bladder symptoms is to directly address the fibroids, which are the source of the mechanical pressure. Treatment options range from medical management to minimally invasive procedures and surgery. The choice depends on factors like symptom severity, patient age, and the desire to preserve fertility.
Medical and Minimally Invasive Treatments
Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) agonists, can temporarily shrink fibroids, offering short-term relief. These are often used as a bridge to other treatments because fibroids typically regrow once the medication is stopped. Minimally invasive options reduce the size of the tumors without major surgery.
Uterine Fibroid Embolization (UFE) is one such procedure, where an interventional radiologist blocks the blood supply to the fibroids, causing them to shrink and soften. This reduction in mass effectively alleviates the pressure on the bladder.
Surgical Options
Surgical options include myomectomy, the surgical removal of the fibroids while leaving the uterus intact. This is a viable option for those who wish to maintain future fertility. Complete removal of the uterus, known as a hysterectomy, is generally reserved for women with severe symptoms who no longer wish to become pregnant, offering a definitive solution.