Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the muscular wall of the uterus. Up to 77% of women will develop them by age 50, although many never experience symptoms. When fibroids become symptomatic, one of the most common concerns is the frequent need to urinate, which is directly attributed to the physical presence of the fibroids. This symptom often includes both urinary urgency and frequency.
How Fibroid Location Causes Bladder Pressure
The uterus sits in the pelvis, positioned closely behind the bladder, meaning any growth on the front of the uterus can directly impact urinary function. Fibroids that grow on the anterior wall of the uterus, particularly subserosal fibroids that protrude outward, are most often the cause of bladder pressure. As these growths expand, they physically press against the bladder, a soft, collapsible organ. This external compression reduces the bladder’s capacity to hold urine, sending signals to the brain that it is full sooner than it actually is.
This restriction leads to urinary frequency, meaning the individual needs to use the bathroom more often throughout the day. The pressure can also cause a sudden, intense feeling of needing to urinate, known as urinary urgency. For some, this effect is particularly noticeable at night, a condition called nocturia, which interrupts sleep. In more severe cases, fibroid pressure can also contribute to incontinence or difficulty fully emptying the bladder.
Other Common Symptoms of Fibroids
Fibroids often present with a range of symptoms unrelated to the bladder. The most frequently reported symptom is heavy or prolonged menstrual bleeding, which can lead to significant blood loss and cause anemia. Menstrual periods may last longer than seven days, and the blood flow can be heavy enough to require frequent changes of sanitary products.
Many people with fibroids also experience chronic pelvic pressure or a dull ache in the lower abdomen. Large fibroids can cause abdominal swelling or bloating. Similar to how they press on the bladder, fibroids can also push on the rectum, leading to issues like constipation or difficulty with bowel movements. Other symptoms include pain during sexual intercourse and lower back or leg pain if the growths press on nerves.
Diagnosis and Treatment Options
If fibroids are suspected as the cause of frequent urination or other symptoms, diagnosis typically begins with a pelvic exam. The doctor may be able to feel an enlarged or irregularly shaped uterus during this assessment. The most common initial imaging tool used to confirm the presence of fibroids is transvaginal or transabdominal ultrasound.
An ultrasound uses sound waves to create detailed pictures of the uterus, allowing the provider to determine the number, size, and location of the fibroids. Magnetic resonance imaging (MRI) may be used to provide greater detail, which is helpful for planning treatment. Management depends on the severity of symptoms, the size and location of the fibroids, and whether the patient wishes to preserve fertility.
For mild symptoms, a doctor may recommend watchful waiting, where the fibroids are monitored. Medical management often involves hormonal therapies, such as birth control pills or hormone-blocking drugs, which help control heavy bleeding and may temporarily shrink the fibroids. When symptoms are severe, procedural options are considered, including uterine artery embolization (UFE), which shrinks the fibroids by blocking their blood supply. Surgical treatments range from a myomectomy, which removes the fibroids while leaving the uterus intact, to a hysterectomy, which is the complete removal of the uterus.