Uterine fibroids, also known as leiomyomas, are common non-cancerous growths that develop within the muscular wall of the uterus. While these growths are most often associated with symptoms like heavy menstrual bleeding and pelvic pressure, they can affect surrounding areas of the body. Medical evidence confirms a recognized link between the presence of fibroids and pain perceived in the hip area, which is a pressure effect caused by the fibroid’s size and location within the pelvic cavity.
Understanding Uterine Fibroids
Fibroids are benign tumors composed of smooth muscle cells and fibrous connective tissue that originate in the myometrium, the middle layer of the uterine wall. They are classified based on their location, which dictates the type and severity of symptoms experienced. The three main types include submucosal, which grow into the uterine cavity; intramural, which are contained within the uterine wall; and subserosal, which develop on the outer surface of the uterus. The size and specific location of a fibroid determine whether it remains asymptomatic or causes symptoms. Subserosal fibroids are physically positioned to expand outward and press against structures outside of the uterus, making them the most relevant type for pressure-related symptoms like hip pain.
The Direct Link: How Fibroids Cause Hip Pain
Hip pain caused by uterine fibroids is primarily a consequence of the “mass effect,” where a large or strategically positioned fibroid physically occupies space and places pressure on adjacent anatomical structures. When a subserosal fibroid grows significantly on the posterior or lateral wall of the uterus, it can impinge directly upon nerves that traverse the pelvic area. This direct pressure can affect the lumbosacral nerve plexus, a network of nerves that supplies the lower limbs and pelvic girdle.
The sciatic nerve is a common target for this mass effect, as it runs through the pelvis before extending down the leg. When a large fibroid compresses this nerve, the resulting discomfort is often felt as pain radiating from the lower back or buttocks down the leg, a sensation known as sciatica. Furthermore, a large fibroid can press on the obturator nerve, which is responsible for sensation in the thigh and motor function in the hip muscles, contributing to referred pain in the groin and hip flexor region.
Fibroids can also induce a form of referred pain by causing chronic tension or strain on the muscles and ligaments surrounding the pelvis. A bulky uterus can alter a person’s posture and gait, placing strain on the sacroiliac joint or the hip flexor muscles, leading to pain perceived in the hip or lower back.
Other Pressure-Related Symptoms
The pressure exerted by growing fibroids frequently affects neighboring organs within the pelvic cavity. One of the most common pressure symptoms is a change in urinary function, such as frequency or urgency, which occurs when a fibroid presses against the bladder, reducing its capacity. Similarly, fibroids positioned toward the back of the uterus can press against the rectum or sigmoid colon. This compression can lead to symptoms of constipation, difficulty with bowel movements, or a persistent sensation of rectal fullness. The overall bulk of an enlarged uterus filled with fibroids can also result in a feeling of pelvic heaviness or abdominal bloating.
Management and Treatment Options
Treatment for fibroids causing significant pressure symptoms like hip pain is tailored to the severity of the symptoms, the size and location of the fibroids, and the individual’s desire for future fertility. Medical management often involves hormonal therapies designed to regulate the menstrual cycle and, in some cases, shrink the fibroids temporarily. Gonadotropin-releasing hormone (GnRH) agonists and antagonists can block the production of hormones that fuel fibroid growth, often used as a short-term measure before surgery.
Minimally invasive procedures offer options that aim to reduce the fibroid mass without major surgery. Uterine Fibroid Embolization (UFE) involves injecting particles into the arteries that supply the fibroid, cutting off its blood flow and causing it to shrink. Newer techniques, such as radiofrequency ablation, use heat energy to destroy the fibroid tissue.
For women who wish to preserve their uterus and maintain fertility, a myomectomy is a surgical procedure to remove the fibroids while leaving the uterus intact. Conversely, a hysterectomy, the complete removal of the uterus, remains the definitive treatment for severe symptoms when fertility retention is not desired.