Fibroids & Bladder Issues: Why You’re Always Running to the Bathroom

Fibroids & Bladder Issues: Why You’re Always Running to the Bathroom

If you feel like you always need to pee—or you’re waking up multiple times a night to use the bathroom—uterine fibroids could be part of the reason. These common, noncancerous growths in the uterus can press on the bladder and urethra, causing frequent urination, urgency, nighttime trips, and sometimes incomplete emptying. Understanding why this happens, how to tell fibroid-related bladder symptoms from other causes, and what treatments actually help can get you back in control.

How Fibroids Trigger Bladder Symptoms

The uterus sits directly above the bladder. When fibroids enlarge the uterus or grow on the front (anterior) wall, they can physically compress the bladder. That “mass effect” reduces bladder capacity and irritates the bladder wall, leading to:

  • Urinary frequency: needing to go more than 8 times in 24 hours
  • Urgency: a sudden, hard-to-delay urge
  • Nocturia: waking to urinate one or more times per night
  • Feeling of incomplete emptying or weak stream
  • Occasional leakage if urgency is severe

Not all fibroids cause bladder issues. Subserosal fibroids that bulge outward from the uterus—especially on the anterior side—are most likely to press on the bladder. Large intramural fibroids (within the uterine wall) can also create bulk symptoms. Submucosal fibroids (protruding into the uterine cavity) typically cause heavy bleeding more than bladder pressure.

In rare cases, very large fibroids can obstruct urine flow from pressure on the urethra, contributing to retention and recurrent urinary tract infections (UTIs) due to incomplete emptying. The National Institutes of Health and the American College of Obstetricians and Gynecologists (ACOG) note that fibroids are extremely common—by age 50, most women have them—and that symptoms vary by size, number, and location (NIH/NICHD; ACOG).

Is It Fibroids—or Something Else?

Urinary frequency and urgency aren’t unique to fibroids. Other possibilities include:

  • Urinary tract infection (burning, fever, foul-smelling urine)
  • Overactive bladder (bladder muscle overactivity)
  • Pregnancy
  • High fluid intake or bladder irritants (caffeine, alcohol, carbonated drinks, artificial sweeteners)
  • Diuretics and other medications
  • Diabetes or uncontrolled blood sugars
  • Pelvic floor dysfunction or pelvic organ prolapse

A urinalysis and brief evaluation can help distinguish among these causes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides helpful definitions and self-care tips for overactive bladder and urgency/frequency.

When to Call a Clinician

Seek prompt care if you have:

  • Inability to urinate or severe difficulty starting your stream
  • Burning, fever, back/flank pain, or blood in urine
  • Severe pelvic pain or pressure
  • Heavy menstrual bleeding causing dizziness, fatigue, or shortness of breath

These symptoms may indicate infection, obstruction, significant anemia, or other conditions that require urgent evaluation.

How Fibroid-Related Bladder Issues Are Diagnosed

Your clinician may recommend:

  • Medical history and pelvic exam
  • Urinalysis and urine culture to rule out infection
  • Pregnancy test if relevant
  • Pelvic ultrasound (transvaginal and/or transabdominal) to map fibroid size and location
  • MRI if imaging needs further detail
  • Post-void residual measurement (ultrasound) if incomplete emptying is suspected

These steps help confirm whether fibroid bulk is the likely cause of bladder symptoms and guide treatment choices that match your goals (symptom relief, uterine preservation, future fertility).

What You Can Do Now to Ease Urinary Symptoms

Lifestyle changes won’t shrink fibroids, but they can reduce bladder irritability and improve emptying:

  • Time your fluids: drink consistently during the day; cut back 2–3 hours before bedtime
  • Identify and limit bladder irritants: caffeine, alcohol, carbonated drinks, spicy/acidic foods, artificial sweeteners
  • Bladder training: scheduled voids (e.g., every 2–3 hours) and gradually lengthen intervals as tolerated
  • Double voiding: after you urinate, wait a moment and try again to help empty more completely
  • Manage constipation: a full rectum can worsen bladder pressure—prioritize fiber, hydration, and regular bowel habits
  • Pelvic floor physical therapy: can reduce urgency and improve control, especially if overactive bladder coexists

If symptoms persist or worsen, medical or procedural treatments that address the fibroids themselves may be needed.

Treatment Options That Can Help

Medications

  • NSAIDs (e.g., ibuprofen) for pelvic pain. They don’t shrink fibroids but can ease discomfort.
  • Hormonal contraception (pills, patch, ring, depot medroxyprogesterone) and the levonorgestrel-releasing IUD reduce heavy bleeding. They may not significantly impact bladder pressure if bulk is the main issue (ACOG).
  • Tranexamic acid for heavy periods during menses (does not shrink fibroids).
  • GnRH agonists and antagonists to shrink fibroids temporarily. Examples include leuprolide acetate (a GnRH agonist) used short-term to reduce fibroid size and improve anemia, and oral GnRH antagonists combined with estrogen/progestin “add-back” therapy, such as elagolix combination (FDA-approved for heavy menstrual bleeding due to fibroids) and relugolix combination (also FDA-approved for fibroid-related bleeding). Shrinkage can reduce pressure-related bladder symptoms for many patients, but side effects (hot flashes, bone density loss) limit long-term use. These are often used to bridge to surgery or as a time-limited therapy (FDA; ACOG).
  • Overactive bladder medications (antimuscarinics or beta-3 agonists) may be considered if bladder overactivity coexists, but they won’t resolve mass effect from fibroids.

Procedures

  • Uterine artery embolization (UAE/UFE): An interventional radiology procedure that blocks blood flow to fibroids, shrinking them typically over months and improving bulk symptoms like urinary frequency and pressure. Most patients go home the same day; cramping and low-grade fever (“post-embolization syndrome”) are common short-term effects. Fertility after UFE remains an area to discuss with your clinician (ACOG; MedlinePlus).
  • Myomectomy: Surgical removal of fibroids with preservation of the uterus. Approaches include hysteroscopic (for submucosal fibroids), laparoscopic/robotic, or open surgery depending on size and location. Myomectomy can significantly relieve pressure symptoms if anterior or large fibroids are removed. Fibroids can recur over time.
  • Hysterectomy: Definitive removal of the uterus, which cures fibroid-related symptoms and eliminates recurrence. It is appropriate for those who do not desire future pregnancy.
  • MRI-guided focused ultrasound (MRgFUS) and radiofrequency ablation (laparoscopic or transcervical) are uterus-sparing options for select patients that reduce fibroid volume and bulk symptoms; availability and candidacy vary, and long-term fertility data are evolving (ACOG; MedlinePlus).

Choosing the Right Path

Your decision depends on symptom severity, fibroid size/location, your age and health, plans for pregnancy, and personal preferences. A collaborative discussion with a gynecologist—and, when appropriate, an interventional radiologist or pelvic floor specialist—can tailor a plan that addresses both fibroids and bladder symptoms. Many people find meaningful relief once bulk is reduced or removed.

This article is for general education and is not a substitute for personalized medical advice. If bladder symptoms are disrupting your life, schedule an evaluation—effective options are available.

Trusted Sources

  • NIH/NICHD: Uterine Fibroids – Overview, symptoms, and treatment options: https://www.nichd.nih.gov/health/topics/uterine/conditioninfo
  • ACOG: Uterine Fibroids FAQ – Diagnosis and treatment choices: https://www.acog.org/womens-health/faqs/uterine-fibroids
  • NIDDK: Overactive Bladder – Urgency/frequency overview and self-care: https://www.niddk.nih.gov/health-information/urologic-diseases/overactive-bladder
  • MedlinePlus (NIH/NLM): Uterine Artery Embolization: https://medlineplus.gov/ency/article/007308.htm and Uterine Fibroids: https://medlineplus.gov/uterinefibroids.html
  • FDA: Approved medicines for fibroid-related heavy menstrual bleeding – Elagolix combination (ORIAHNN) approval summary: https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-drug-combination-treat-heavy-menstrual-bleeding-fibroids and Relugolix combination (MYFEMBREE): https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-relugolix-combination-therapy-management-heavy-menstrual-bleeding-associated-uterine

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