How Fibroids Leave Their Mark: Fibroid Removal and Scarring Risk

For women who struggle with symptoms of uterine fibroids—pelvic pain, heavy menstrual bleeding, painful periods, and/or frequent urination— a variety of surgical treatments offer potential relief. Of course, virtually any kind of surgery carries some risk for post-operative complications. Scarring is one issue of significant concern to many women who are looking at fibroid removal procedures. And unsightly visible scars aren’t the only scars to warrant concern: internal scars, called adhesions, present their own set of symptoms, which – in extreme cases – can be more problematic than those that motivated the surgery in the first place.

They may not be a painful consequence, but abdominal scars can be unsightly. However, for women facing a fibroid removal surgery who are haunted by visions of a friend’s post-C-section tummy, there’s some good news: long-term, visible scarring is rare with most fibroid removal procedures. Dr. Donald Galen, MD and former Surgical Director at the Reproductive Science Center of the San Francisco Bay Area, explains, “severe scarring from elective surgery is very uncommon.”

In part, the infrequency of major scarring is due to the size of incisions that most methods entail. The external incisions required for laparoscopic surgeries are typically small, ranging from 5-12mm (i.e. less than 1/2 inch) in length. Hysterectomies may require longer abdominal incisions, since they, by definition, involve complete or partial removal of the uterus. Still, the approximate length of incisions varies by method. Some hysterectomies can be performed using minimally-invasive surgical techniques. “The benefits of minimally-invasive surgery for hysterectomy are that only two to three 0.5-1 inch incisions are necessary, [which enables] rapid healing and minimal visible scarring,” says Dr. Galen.

What can patients do to inhibit the formation of abdominal scarring after surgery? Not much, unfortunately. According to Dr. Galen, “Many methods, such as topical steroids, massage, [and] Mederma, have been…used to try and minimize external scarring. These [topical treatments] may help minimize scar formation, however, the more important ingredients seem to be the patient’s own genetic makeup and race, as well as the type and size of sutures used for closure.”

Internal scars, called adhesions, are another potential consequence of fibroid removal surgeries, and ones that can pose a risk to the patient’s health. Abdominal adhesions can result in pelvic pain, cramping, bowel obstructions, and even infertility.1

Adhesions form when the body’s attempt to heal internal incisions goes awry. During the healing process, a layer of new scar tissue forms over damaged tissue. If this new tissue attaches to other organs or locations within the abdomen, it is called an “adhesion”.
Logic dictates that, the greater the number of incisions, the higher the risk for developing adhesions after surgery. For this reason, different fibroid removal procedures present different levels of risk in terms of adhesion formation. A laparoscopic myomectomy, for example, requires a surgeon must make one or more incisions in the uterus; the incisions create the circumstances for adhesions to form.2 Dr. Galen describes the typical case, saying, “when myomectomy is performed… there are usually considerable post-op adhesions that form from the incisional sites on the exterior of the uterus to other abdominal structures such as bowel, anterior abdominal wall, and bladder.”

Less invasive options for fibroid removal, like the Acessa procedure (radiofrequency volumetric thermal ablation or “RFVTA”), present little risk of adhesions: the Acessa procedure utilizes heat from a probe to destroy fibroids, thereby avoiding the need for uterine incisions and the potential for subsequent internal scarring.
Women diagnosed with uterine fibroids should consult with a physician to determine the best course of treatment. While minimal scarring and adhesion risk is obviously preferential, different surgical fibroid treatments are appropriate in different cases. The number, location, and size of fibroids, along with other factors, will ultimately determine which method(s) of treatment is medically advised.

Sources:

  1. “Abdominal Adhesions”, MedicineNet.com, http://www.medicinenet.com/script/main/art.asp?articlekey=143560. Retrieved September 23, 2014.
  2. Macer, James A. For uterine-sparing fibroid treatment, consider laparoscopic ultrasound-guided radiofrequency ablation. OBG Management, Nov. 2013:Vol.25(11).
  3. Endoscopic Surgery for Gynaecologists, page 31, edited by Chris Sutton and Michael Diamond, Published by W.B. Saunders Co. Ltd, Philadelphia, PA, 1993
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Why are Fibroids a concern?

Uterine fibroids grow on the inside or outside of a woman’s uterus, and can also be present on the uterine wall. Many women understandably want to know: Are fibroids dangerous, or do they just potentially cause painful problems?

The Prevalence of Fibroids

Doctors sometimes refer to uterine fibroids as fibroid tumors, but do not become confused or alarmed and assume that fibroids are cancerous. They are rarely cancerous, and many women do not even know they have them. Physicians are uncertain as to the exact causes of uterine fibroids, but many believe they are somehow related to the production of female hormones. This may be why women are commonly diagnosed with fibroids in their 30s and 40s when their hormones oftentimes begin to change in preparation for menopause.

When to Be Concerned

Although many women do not have problems with uterine fibroids, there are some complications that can occur. The potential dangers of fibroids include intense pain in the pelvic area, coupled with heavy menstrual bleeding. Heavy menstrual bleeding can be particularly dangerous if you are already at risk for anemia. Other issues, such as pain during bowel movements, frequent urination and bloating are also symptoms that could be caused by uterine fibroids. Although the dangers of fibroids are obvious for a person who is at a higher than normal risk of experiencing anemia, the other symptoms mentioned can cause disruption to the overall quality of life for any woman.

Prescription Medicines to Treat Fibroids

If you have been diagnosed with uterine fibroids, a doctor may prescribe pharmaceutical interventions for pain relief and/or to shrink the size of existing fibroids. Additionally, medicine may be prescribed to compensate for symptoms of anemia. However, these solutions are temporary, and many women prefer treating the actual cause of the problem, the fibroids, rather than just attending to the symptoms.

An Easy Way to Treat Fibroids

Fortunately, women now have the welcome opportunity to pursue an outpatient procedure that uses the FDA-cleared Acessa System to treat symptomatic uterine fibroids. Using a laparoscope, a physician treats all of a patient’s detectable fibroids, so the chances of reoccurring problems are quite low. This minimally-invasive procedure also allows women to return back to work in only four to five days, especially if they take the prescribed anti-inflammatory medication after the procedure.

If you’ve been diagnosed with uterine fibroids, it’s important to keep in mind that the condition is very common among women who are still having their menstrual cycles. Luckily, the Acessa System offers an appealing way to treat this problematic condition in a way that makes sense for women who want to be proactive about their health.

Sources:

  1. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-symptoms
  2. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-topic-overview
  3. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-medications
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Is fibroid treatment elective?

Hearing a diagnosis of fibroids might feel overwhelming, but it doesn’t have to be. Fibroids are far more common than you might think, and there are exciting new treatment options available for women who suffer from the effects of uterine fibroids.

What are Fibroids?

Fibroids are firm, generally benign, tumors that grow inside of, and on the surface of, the uterus. Also known as uterine fibromas, leiomyomas or myomas, these compact masses are made of fibrous connective tissue and smooth muscle cells. Approximately 70%-80% of women will develop fibroid tumors during her reproductive years, but the impact this will have on her overall health varies from woman to woman.

The exact cause of fibroids is not known, though current theory is that they develop due to a combination of an aberrant muscle cells and the presence of estrogen; the two join together to produce a tumor. Most fibroids, up to 99 percent of all detected fibroids, are not cancerous and will never become cancerous. But they can still cause health problems if they are not treated.

Fibroids range in size from that of a pea to tumors large enough to be felt by the patient and her physician; about the size of a soft ball or grapefruit. In the case of tumors large enough to be a source of pain or other symptoms, fibroid treatment is the best option for remedying the uncomfortable situation. Where the fibroids are tiny enough not to cause health problems, they are unlikely even to be detected and treatment may be unnecessary.

What Happens if Larger Fibroids are Left Untreated?

Uterine fibroids that grow large enough to be detected can cause a wide range of troublesome symptoms, including lower back pain, abnormally heavy or long periods, bleeding between periods, pain or frequent urination due to the tumor pressing on pelvic organs or the bladder, or pain during sexual intercourse. If left untreated, the increased blood loss due to heavy periods and between-period bleeding can lead to anemia, which can have serious consequences. In those cases, it is wise to consult your physician as to the best fibroid treatment for you.

Fibroid Treatment Options

There are several options for treatment. The mildest and least invasive is simple painkillers, which are commonly used in cases where the tumors are tiny and causing few complications. The most radical and invasive fibroid treatment is a hysterectomy, which is major abdominal surgery to remove the uterus carrying with it all the risks that entails. Hormone therapies are also available, such as estrogen reduction and anti-progestin therapies, though these tend to come with unpleasant side effects.

One fibroid therapy, called radiofrequency ablation, uses an FDA-cleared small array needle device to target and shrink fibroids without damaging the surrounding tissue. This is an outpatient procedure with a four- to five-day recovery time and minimally invasive. Many patients achieve successful results with radiofrequency ablation and are back to living their normal daily lives without the discomfort of uterine fibroids.

Sources:

  1. http://acessaprocedure.com/acessa-procedure.php
  2. http://umm.edu/health/medical/ency/articles/uterine-fibroids
  3. http://www.uchospitals.edu/online-library/content=P00560
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