Uterine fibroids (leiomyomas or myomas) are non-cancerous growths that develop from the smooth muscle tissue of the uterus wall. These growths are extremely common, affecting many women during their childbearing years, though most never experience symptoms. While most fibroids are small and go unnoticed, they can sometimes be felt through the stomach. The ability to feel a distinct mass depends heavily on the fibroid’s size and position.
The Conditions for Feeling a Fibroid (Palpability)
A fibroid must achieve a significant size and favorable location to be manually detectable through the abdominal wall. Since the uterus resides deep within the pelvis, only growths large enough to extend substantially above the pelvic bone can be felt. Generally, a fibroid must be the size of a large orange or grapefruit, or sometimes larger, to create a noticeable mass.
Location is an equally important factor, differentiating between fibroid types. Subserosal fibroids, which grow on the outer surface of the uterus, are the most likely type to become palpable. As they grow outward, they push into the abdominal cavity, making them accessible to external touch. A variation, the pedunculated fibroid, is attached to the uterus by a stalk and may also be felt if the fibroid is large.
Fibroids located within the muscular wall (intramural) or those bulging into the uterine cavity (submucosal) are rarely felt externally. Intramural fibroids are enclosed by the uterine muscle, and submucosal fibroids grow inward, meaning neither type typically causes a detectable lump on the outside of the stomach. However, multiple intramural fibroids can enlarge the entire uterus, where the overall size is felt as a general firmness or fullness in the lower abdomen.
Common Physical Sensations Caused by Fibroids
Many women who suspect they can feel a fibroid are actually experiencing intense sensations of pressure or fullness caused by the growths. This feeling, often called pelvic pressure, is a common symptom of large or numerous fibroids. The sheer bulk of an enlarged uterus containing multiple fibroids can cause a constant sensation of heaviness in the lower abdomen.
Fibroids can press on adjacent organs, resulting in distinct physical discomfort. When a fibroid grows toward the front, it may press on the bladder, leading to frequent urination or incomplete emptying. Conversely, if a fibroid is positioned toward the back, it can put pressure on the colon or rectum, resulting in constipation or difficulty with bowel movements.
Abdominal swelling or bloating is another frequent sensation that can be mistaken for feeling a distinct mass. Large fibroids can visibly distend the stomach area, sometimes making a person appear pregnant due to the volume they occupy. This distension results from the enlarged uterus itself, rather than a single, easily identifiable lump.
Clinical Confirmation and Diagnosis
Because self-detection is unreliable, medical professionals use specific methods to confirm the presence, size, and location of fibroids. The process often begins with a manual pelvic exam, where a physician feels the uterus for irregular changes in shape or size. This initial step provides an indication of uterine enlargement or an obvious mass.
The most common and standard tool for confirming a diagnosis is an ultrasound, which uses sound waves to create images of the uterus. An ultrasound can be performed transabdominally (over the stomach) or transvaginally. This imaging allows the doctor to accurately map and measure the size, number, and location of the fibroids, distinguishing them from other potential causes of a mass or pelvic symptoms.
For more complex cases, or when detailed information is needed for surgical planning, a Magnetic Resonance Imaging (MRI) scan may be utilized. The MRI provides a comprehensive view with greater detail, helping to determine the precise location of fibroids within the uterine wall and their relationship to nearby structures. Other specialized tests, like a hysteroscopy or hysterosonography, may be used if the main concern is heavy bleeding or issues with fertility. These procedures offer a closer look at the inside of the uterine cavity.