Uterine fibroids, also known as leiomyomas, are common non-cancerous growths that develop in the muscular wall of the uterus. A prolapse refers to the displacement of an organ or tissue from its normal position. When a fibroid is described as prolapsed, it means the tumor has moved out of the uterine cavity and is protruding through the cervix. This event transforms a typically manageable gynecological condition into one that requires immediate medical attention.
Defining the Condition and Immediate Symptoms
A prolapsed fibroid starts as a submucosal fibroid, originating beneath the inner lining of the uterus. These fibroids often grow on a stalk, or pedicle, connecting them to the uterine wall, making them pedunculated. As the uterus contracts, attempting to expel the mass, it pushes the fibroid downward. This expulsive force stretches the stalk, moving the fibroid through the cervix and into the vaginal canal.
The primary symptom is acute, intense pelvic pain or cramping, resulting from strong uterine contractions and the mechanical stretching of the pedicle. Patients frequently experience heavy or prolonged menstrual bleeding (menorrhagia) and spotting between periods. The most telling symptom is often the sensation of a foreign mass physically protruding from the vaginal opening.
The fibroid’s movement into the vagina can also lead to a watery or foul-smelling vaginal discharge. This discharge is often a sign of irritation or possible degeneration of the exposed tissue. While submucosal fibroids cause heavy bleeding inside the uterus, the prolapsed state introduces new, physically disruptive symptoms.
Assessing the Danger
While the fibroid itself remains a benign tumor, its prolapsed position introduces time-sensitive risks that elevate the condition to a state of urgency. The most immediate danger is acute hemorrhage, which is severe, sudden bleeding from the site where the fibroid’s stalk attaches to the uterus. This blood loss can be profuse and rapid, potentially leading to severe anemia or even hemorrhagic shock if not quickly controlled. In such cases, blood transfusions and emergency procedures may become necessary to stabilize the patient.
Another major complication is infection and subsequent tissue necrosis, or tissue death. When the fibroid is pushed through the cervix, the stretching and compression of its stalk can compromise its blood supply. The exposed tissue of the fibroid, now sitting in the vaginal environment, is prone to bacterial colonization and infection. Necrosis occurs when the blood flow is cut off entirely, causing the tissue to die, which can then lead to a serious uterine infection known as sepsis.
A serious risk is fibroid torsion, which involves the twisting of the pedicle. A prolapsed fibroid’s stalk can twist, leading to sudden, sharp, and intense abdominal pain. This twisting immediately cuts off the blood supply, accelerating tissue death and increasing the risk of infection and inflammation. Symptoms such as a high fever, chills, or a noticeably foul-smelling discharge accompanying the mass require immediate medical evaluation due to the risk of a systemic infection.
Diagnosis and Management Options
The first step in diagnosing a prolapsed fibroid involves a pelvic examination, where the physician visually confirms the presence of a mass protruding through the cervical opening. During this examination, the doctor attempts to determine the fibroid’s size, mobility, and point of attachment. This initial visual and physical assessment is often sufficient to make a presumptive diagnosis.
To confirm the diagnosis and plan for management, imaging studies are employed, most commonly a transvaginal ultrasound. The ultrasound provides detailed images of the uterus, allowing the physician to identify the origin of the fibroid’s stalk and ensure no other uterine masses are present. In some instances, a hysteroscopy may be performed, involving the insertion of a thin, lighted telescope through the cervix to visually inspect the uterine cavity and the fibroid’s attachment point.
The standard treatment for a prolapsed submucosal fibroid is surgical removal, typically performed through a procedure called a vaginal myomectomy. Because the fibroid is already accessible within the vagina, the surgeon can remove the mass by cutting the pedicle at its base. This approach is minimally invasive, resolves the prolapse, and removes the source of the acute symptoms and risks.
If the fibroid is extremely large or if there are complications like uncontrolled bleeding or signs of sepsis, medical intervention may need to be escalated. While vaginal myomectomy is the preferred method to preserve the uterus, an emergency hysterectomy (removal of the entire uterus) may be required as a life-saving measure. After the fibroid is successfully removed, the symptoms of heavy bleeding and pain generally resolve.