Uterine fibroids are common non-cancerous growths that develop within the uterus. While many fibroids remain without symptoms, some can grow in specific locations, leading to various issues. A prolapsed fibroid is a type of fibroid that has shifted from its typical position inside the uterus, extending downwards through the cervix and into the vaginal canal.
Understanding a Prolapsed Fibroid
Uterine fibroids are benign growths of muscle and fibrous tissue in the uterus. They vary in size and location; some grow from a stalk, known as a peduncle. Pedunculated fibroids on the inner lining are called submucosal fibroids, which can be pushed out of the uterus.
Uterine contractions, occurring during the menstrual cycle, can gradually elongate the stalk of a pedunculated submucosal fibroid. This allows the fibroid to extend through the cervical canal and into the vagina. Most women with a prolapsed uterine fibroid experience symptoms due to its presence, including pressure, vaginal bleeding, or general discomfort. Some individuals may also report feeling a mass protruding into the vaginal area.
Potential Risks and Complications
A prolapsed fibroid, while not typically life-threatening, can lead to several complications. One concern is the potential for infection and tissue necrosis. When a fibroid prolapses, its blood supply can become compromised, leading to tissue degeneration. This compromised tissue then becomes susceptible to infection, which can manifest with symptoms like foul-smelling vaginal discharge, fever, and increased pain.
Severe or prolonged vaginal bleeding is another frequent complication. Heavy or irregular menstrual bleeding is a common symptom of fibroids, and a prolapsed fibroid can exacerbate this, leading to significant blood loss. This excessive bleeding can result in anemia, causing fatigue and weakness, and may require medical intervention. In some instances, continuous severe bleeding may even require emergency procedures.
The presence of a prolapsed fibroid often causes considerable pain and discomfort. Individuals may experience severe abdominal pain, pelvic pressure, or cramping. This discomfort arises from the fibroid’s position, its potential to become inflamed, or the body’s attempts to expel it. The size and location of the fibroid contribute to the intensity of these symptoms.
A large prolapsed fibroid can also exert pressure on nearby pelvic organs, leading to urinary and bowel issues. Pressure on the bladder might cause frequent urination or difficulty completely emptying the bladder. Similarly, pressure on the rectum can lead to constipation. The physical presence of a prolapsed fibroid in the vaginal canal can also interfere with sexual activity, causing pain or discomfort during intercourse.
Diagnosis and Management
Diagnosing a prolapsed fibroid begins with a pelvic examination, where a healthcare professional may observe or feel the mass protruding through the cervix into the vagina. Imaging techniques are then used to confirm the diagnosis and assess the fibroid’s characteristics. An ultrasound, either transvaginal or abdominal, is the initial and most cost-effective step, providing images of the uterus and fibroid. For more detailed information regarding the fibroid’s size, location, and its connection to the uterus, a pelvic MRI may be used.
Management of a prolapsed fibroid primarily involves surgical removal to alleviate symptoms and prevent further complications. Vaginal myomectomy is a common and minimally invasive procedure for removing prolapsed submucosal fibroids accessible through the vagina. This procedure involves detaching and removing the fibroid, often with minimal blood loss. In cases where the fibroid is entirely within the uterine cavity but accessible via the cervix, a hysteroscopic myomectomy may be performed using a thin scope inserted through the vagina.
While surgical removal is the definitive treatment, medications might be used to manage symptoms in some cases, such as iron supplements for anemia caused by heavy bleeding or hormonal therapies to temporarily reduce bleeding. However, these medications do not remove the fibroid itself. A “watch and wait” approach is not recommended for symptomatic prolapsed fibroids due to the risk of complications like infection and severe bleeding. Given the potential for discomfort and health issues, it is important to consult a healthcare provider if symptoms suggestive of a prolapsed fibroid arise. Timely diagnosis and appropriate management are important for improving quality of life and preventing complications.