Summer's Pain: The Diagnosis

As readers of the blog may remember, I was complaining during the summer of pain in the low abdominal region and in my lower back. Over time, I noticed that these two sumptoms almost always occurred together. I started searching the online medical sites for answers, conditions, that could cause pain in both areas at the same time.

The options did not look good. Various cancers of the reproductive or urinary tract system popped up, but I was relieved to see that I did not have any of the other symptoms usually associated with these diseases. Other than the actual pain, not much else was going on. I had no nausea or vomiting, no loss of appetite, no unexplained weight loss, no weakness, etc. So, rather than get totally freaked out about the possibilities, as I think many of us do when we start trying to self-diagnose, I went to my doctor.

I told him about the persistent pain and also that I’d noticed a firmness (not muscular, sadly) in the lower abdominal region that didn’t seem normal. He palpated my belly and agreed. He recommended an ultrasound to see what was going on. As I walked out of his office, I asked, “Should I be worried?” and he reassuringly told me there was no need to be.

I was scheduled for the ultrasound. I had never had one before and was alarmed at the instructions I received before going. Apparently, getting a clear picture of the bladder is important. The way this is achieved is by making sure the patient has a full bladder. The way this is achieved is by having the patient drink a whole lot of water and not urinate, even when the tech is rubbing the ultrasound wand over the area. My specific directions were to completely void the bladder 90 minutes before my appointment and then, over the course of the next 30 minutes, drink 48 ounces of water.

Think about that. The standard recommendation for daily water consumption is eight 8 ounce glasses, over the course of an entire day. I drink a lot of water - I live in the desert, after all - but for this I was supposed to drink six of those glasses in half an hour! And the worst part? I was not allowed to urinate before my appointment, which was another half hour after drinking all that water. Let me sum up by saying this was an uncomfortable experience! Thank goodness my husband was able to drive me to the appointment as I think dealing with the slightest traffic problem might have resulted in an accident INSIDE the car.

During the ultrasound, the tech mentioned that many of the female patients she saw had fibroids. I knew nothing about fibroids, nor did she indicate that she thought I had one, but I, of course, looked it up when I got home. The Mayo Clinic webpage on uterine fibroids listed symptoms such as heavy menstrual bleeding, longer periods, pressure or pain in the pelvic area (Bingo!), frequent urination and difficulty emptying the bladder, constipation, leg pains, and backache (Bingo!). This symptom list did not include a bunch of things that were way off (like the ones listed for cancer) but did include the pain I was experiencing. It sounded like a possibility.

Therefore I was not surprised when I got the note from my doctor a week later confirming that I did have a uterine fibroid. By then I’d done quite a lot of research online and the diagnosis spurred me on to further research, now focused on treatment. At 10 centimeters in diameter (about 4 inches), it was not surprising this sucker was causing some pain! The question now was what to do about it.

The traditional treatments include surgery, drugs, or “watchful waiting.” While there are surgical procedures to remove just the fibroid (myomectomy), many doctors recommend removal of the entire uterus (hysterectomy) as new fibroids often grow after only a mymectomy. Surgery is an absolute last resort option for me. Been there, done that on my foot (for plantar fasciitis) and seriously regretted it. The drug option basically forces the body into early menopause. I don’t do well with medications, often having the uncommon side effects, so this also didn’t interest me. Finally, there is “watchful waiting,” usually an option if the woman is near menopause. The drop in estrogen levels after menopause often result in the fibroid shrinking and sometimes going away entirely on its own.

I’ll come back to that last one in a moment, but I did want to mention there are a few other, newer, treatment options such as MRI-guided focused ultrasound to break up the fibroid and several other procedures (one laparoscopic and one injected particles) intended to cut the blood supply off to the fibroid. The FUS is the least invasive option, other than drugs or watchful waiting, while the last two have other risks that I wasn’t interested in facing.

In any case, something had already caught my eye: menopause, whether natural or drug-induced, often results in the shrinkage of fibroids because of the reduction in hormones. Okay, so that must mean the hormones are part of the problem, right? That is exactly what my research indicated and that will be the subject of my next post.