Uterine Fibroids: Exploring Symptoms, Treatment Options

• By Dr. Neena Singh Kumar

Uterine Fibroids: Exploring Symptoms, Treatment Options, and Post-Operative Care

Uterine fibroids are common growths of the uterus. They often appear during the years when people usually want to get pregnant and give birth. Uterine fibroids are not cancerous. They are also called leiomyomas or myomas. Fibroids vary in number and size. You can have a single or more than one fibroid. Some are too small to see with the eyes. Others grow to the size of a grapefruit, or large enough to fill the pelvis and sometimes even the whole abdominal cavity. Fibroids grow at various sites in the uterus:

On the outer surface are called subserosal fibroids.

Intramural fibroids are in the wall of the uterus.

Towards the cavity are called submucosal fibroids.

Symptoms

They may produce no symptoms and are discovered accidentally during routine pelvic or ultrasound examinations.

Symptoms are influenced by location, size and the number of fibroids:

Heavy menstrual bleeding or painful period (mostly in submucous fibroids)

Longer or more frequent periods

Pelvic pressure or pelvic pain

Frequent urination or trouble passing urine

Pain in the lower abdomen and back

Pain during sex

Symptoms of anaemia due to chronic excessive bleeding

Inability to conceive

See your gynaecologist if you have any of the above symptoms, and they will guide you about the treatment required.

However, the diagnosis of uterine fibroids is not synonymous with the indication to operate. Fibroids which give rise to symptoms and/or complicated myomas may need surgical treatment.

The surgical removal of fibroids is called Myomectomy. A myomectomy can be done by open technique or by minimally invasive technique (laparoscopic/robotic). In the past, open abdominal myomectomy was the most common management technique for fibroids; with its associated physical and psychological trauma, it is no longer an acceptable choice of surgery for any patient.

Laparoscopic/robotic myomectomy is the treatment of choice in symptomatic patients. Laparoscopic and robotic myomectomy is performed under general anaesthesia and involves inserting a needle in the abdomen and filling it up with carbon dioxide to bloat it up. A telescope is inserted through a 10 mm incision inside the abdomen, and the whole pelvis is visualised. The position and number of fibroids are defined. The fibroid is removed from the uterus, and using special equipment, the bigger fibroids are broken into smaller pieces and removed. The uterine capsule is stitched up to ensure that the patient retains fertility. Blood loss is minimal.

The patient is allowed a liquid diet within 24 hours and a full diet by the second day. The patient is back home in 2448 hours. The patient has very little pain postoperatively as compared to open surgery. It leaves behind a 1 cm scar as compared to a 4 6 inches scar of open surgery. Laparoscopic/robotic myomectomy is a gold standard in the treatment of uterine fibroids.

Robotic myomectomy even scores over laparoscopic myomectomy, with the ease of suturing the uterine capsule because of the greater range of motion than the human hand with seven degrees of freedom.

Advantages of minimally invasive surgery for Uterine Fibroids

1. Require only a tiny nick in the skin.
2. Shorter hospital stay.
3. Less blood loss
4. All fibroids are treated at once; only one sitting may be necessary.
5. Financially, emotional and physical harmony over other procedures.

Postoperative care

1. Antibiotics are administered perioperatively and postoperatively.
2. According to the risks in surgery (bleeding, trauma, suture, vaginal incision), the patient can be discharged 2448 hours after surgery.
3. Mild analgesics are usually sufficient to control postsurgical pain.