Location of Uterine Fibroid Pain
Uterine fibroid pain is typically felt in the lower abdomen and pelvis, often described as pelvic pressure, fullness, or bloatedness, with acute complications causing sudden severe localized pain. 1
Chronic Pain Locations
Pelvic pain and pressure represent the cardinal symptoms of fibroids, manifesting as:
- Lower abdominal and pelvic discomfort with a sensation of bloatedness or fullness throughout the pelvic region 1
- Dysmenorrhea (menstrual cramping) occurring alongside heavy menstrual bleeding in the lower abdomen 1
- Generalized pelvic pressure affecting the entire lower abdomen and pelvis 1
The pain from chronic fibroids is typically diffuse rather than sharply localized, reflecting the bulk effect of the fibroid mass within the pelvis.
Acute Pain Presentations
When fibroids develop complications, the pain becomes more severe and localized:
- Sudden severe pain from acute infarction or hemorrhage in a degenerating fibroid, typically felt at the fibroid's location 2, 1, 3
- Acute localized pain from torsion of pedunculated fibroids, which can occur anywhere in the pelvis depending on fibroid location 2, 1
- Lower abdominal/pelvic pain from prolapse of a submucosal fibroid through the cervix 2, 1
Contrast-enhanced CT demonstrates 86% sensitivity for detecting diminished fibroid enhancement and 100% sensitivity for detecting ascites in fibroid complications, making it the gold standard for acute presentations 2, 1.
Pressure-Related Symptoms by Location
The specific location of pressure symptoms depends on which adjacent structures the fibroid compresses:
- Anterior lower abdomen: Urinary urgency and frequency result from bladder compression by anterior fibroids 1
- Lower back and posterior pelvis: Constipation and rectal pressure result from posterior fibroid compression on the rectum 1
- Lateral pelvic pain: Can occur with large fibroids extending laterally 4
Age-Specific Considerations
Fibroids become the second most common cause of acute pelvic pain in perimenopausal and postmenopausal women, representing a significantly more common cause than in younger women 2, 1. In postmenopausal women presenting with pelvic pain, maintain high suspicion for other gynecologic causes including ovarian cysts (the most common cause) and ovarian neoplasm 2, 1.
Clinical Pitfalls
Acute pain from fibroids warrants urgent imaging to exclude torsion, prolapse, or infarction/hemorrhage requiring intervention 1. When fibroids coexist with adenomyosis, pain patterns become more complex and diffuse, potentially leading to treatment failure 1. In cases of acute right-sided pelvic pain, always consider non-gynecologic causes such as appendicitis, which has 95% sensitivity on CT 5.