A Text-book of Diseases of Women

by Charles B. Penrose

The blood that escapes from the fibroid uterus may be fluid or clotted, or it may be partly decomposed from the retention of clots.

A profuse secretion from the utricular glands often occurs between the uterine hemorrhages. This secretion is usually thin and watery in character, and may be so profuse as to require the continuous wearing of a napkin. In some unusual cases there is no marked hemorrhage, but a continuous abundant watery discharge.

Pain is a more or less constant accompaniment of fibroid tumors. It varies a great deal in character and position. It is often referred to the sacrum and to the top of the head or the occiput. Pain of this character is due to the accompanying metritis and endometritis. That it is uterine in origin is shown by the fact of its complete and permanent disappearance from the day that hysterectomy is performed.

The pain is always increased at the menstrual periods, and may at first be present only at these times. It afterwards becomes continuous.

In the case of a submucous or a polypoid fibroid there may be present the pain of uterine contractions, referred to the center of the lower abdomen, and resembling labor-pains.

The pain from pressure is sometimes intense. It occurs in large tumors and in those of pelvic growth, like the intra-ligamentous fibroids. Sciatic or crural neuralgia may be thus developed.

In all these cases there is a feeling of weight and dragging in the pelvis which is most marked in the erect position, and which is caused by the weight of the tumor and of the enlarged uterus.

The symptoms of pressure are very marked in the case of intra-ligamentous tumors. The capacity of the bladder may be so diminished that there may be continuous incontinence of urine; or the bladder and the urethra may be so distorted, from traction and pressure, that urine is voided with great difficulty, and it is sometimes impossible to introduce the catheter. I have seen a woman with a fibroid the size of the adult head who could urinate only when upon her hands and knees.

Pressure upon the pelvic nerves may, as has already been mentioned, produce great pain, and in some cases paralysis. Women are sometimes affected with sudden complete paralysis of one or both legs from the pressure of a fibroid. I have performed hysterectomy upon a woman who had on several occasions fallen helpless in the street from paralysis of the left leg caused by the pressure of a small intra-ligamentous fibroid tumor. All the pressure-symptoms are exaggerated at the menstrual period, on account of the swelling of the tumor that occurs at this time.

Pressure upon the rectum is often very marked, and may cause constipation and hemorrhoids. Pressure upon the ureters causes dilatation, hydronephrosis, and uremia. This is a not infrequent cause of death, both in the untreated case and after operation for the relief of fibroids.