Uterine fibroids are non-cancerous growths that develop from the muscle tissue of the uterus. These tumors are extremely common, affecting up to 77% of women during their reproductive years, though many remain unaware they have them. Feeling a mass or a distinct firmness in the abdomen is a frequently reported symptom. This typically indicates the fibroid has grown to a significant size or is positioned to push against the abdominal wall.
Factors That Make Fibroids Palpable
The ability to feel a fibroid depends almost entirely on its physical location and overall size. Fibroids that grow outward, away from the center of the uterus and into the abdominal cavity, are the most likely to become palpable. These are called subserosal fibroids, as they are situated beneath the outermost layer of the uterus.
When a subserosal fibroid continues to grow, it can create a noticeable bulge that pushes against surrounding organs and the abdominal wall. Some of these growths develop a stalk, becoming pedunculated fibroids, which hang from the uterus. Both subserosal and large pedunculated fibroids cause abdominal distension or a firm mass that can be felt.
Intramural fibroids, which grow within the muscular wall, are the most common type but are less likely to be felt externally unless they are very large. Fibroids often begin causing significant pressure symptoms when they reach approximately 5 centimeters or more in diameter. In severe cases, the uterus can become so enlarged from multiple fibroids that it resembles a full-term pregnancy, causing a noticeable increase in stomach size.
Associated Pressure and Secondary Symptoms
When fibroids grow large enough to be felt, the accompanying pressure often leads to symptoms related to organ compression. The feeling of a mass is frequently accompanied by a chronic sensation of pelvic heaviness or a dull, persistent ache in the lower abdomen or back. This discomfort is caused by the enlarged uterus and its growths.
The expansive growth of fibroids can push directly on neighboring structures, most notably the bladder, which sits immediately in front of the uterus. This pressure can significantly reduce the bladder’s capacity, resulting in the need for frequent urination throughout the day and night. Similarly, if the fibroid is positioned toward the back, it can press on the rectum, leading to issues like constipation or difficulty with bowel movements.
Heavy menstrual bleeding is also a common symptom. Fibroids, particularly those that grow near the uterine lining, can interfere with the uterus’s ability to contract effectively to stop blood flow. This can lead to prolonged periods, excessive blood loss, and the passage of large clots, which may eventually cause anemia and fatigue.
Medical Confirmation and Evaluation
If you suspect you have a mass in your abdomen, the first step is usually a pelvic examination. A healthcare provider can manually palpate your abdomen and pelvis to detect firm, irregular changes in the shape or size of the uterus. While this initial assessment suggests the presence of fibroids, imaging tests are needed for confirmation.
The primary diagnostic tool used to confirm and map fibroids is ultrasound, which uses sound waves to image the pelvic organs. An ultrasound can be performed transabdominally (on the skin surface) and transvaginally (inserted into the vagina). This allows accurate measurement of the size, number, and precise location of the fibroids.
For cases where the ultrasound is inconclusive or when planning a procedure, a Magnetic Resonance Imaging (MRI) scan may be ordered. MRI provides superior soft-tissue contrast, offering a more detailed, three-dimensional picture of the fibroids and surrounding tissues. It is valuable for pre-surgical planning, such as before a myomectomy or Uterine Fibroid Embolization, as it helps identify the exact blood supply and precise location of each growth.
Options for Treatment and Management
The approach to managing fibroids depends on the severity of symptoms, the fibroid’s size and location, and personal goals, such as future fertility plans. For fibroids that are small and cause minimal or no symptoms, a strategy of watchful waiting is often recommended, involving regular monitoring with a healthcare provider.
For symptomatic relief, particularly for heavy bleeding, medication can be the first line of management. This includes hormonal therapies such as birth control pills or progestins, which help control menstrual flow. GnRH agonists or antagonists can also temporarily reduce fibroid volume by creating a low-estrogen environment. These medications can often provide short-term relief or shrink fibroids before a planned procedure.
Minimally invasive procedures offer options that preserve the uterus. Uterine Fibroid Embolization (UFE) involves injecting small particles to block blood flow to the fibroids, causing them to shrink. Surgical removal of the fibroids, known as a myomectomy, is the preferred option for individuals who wish to retain their uterus, offering relief from bulk and pressure symptoms. Hysterectomy, the surgical removal of the entire uterus, is considered the definitive treatment for severe cases when no future pregnancies are desired.