Causes of Uterine Fibroid
Other names for these tumors include fibromyomas, fibromas, myofibromas, and myomas (“Center For Uterine Fibroid”, Tues, 19 Sep 2006).
The reality is that researches are still going on to know the real causes.
- Hormonal (affected by estrogen and progesterone levels)
- Genetic (runs in families)
(“womenshealth.gov”, May 13, 2008).
The risk for developing leiomyomas is lower in women who are smokers and in women who have given birth. Although the high estrogen levels in oral contraceptive pills have led some clinicians to advise women with leiomyomas to avoid using them, there is good epidemiologic evidence to suggest that oral contraceptive use decreases the risk of leiomyomas (“Center For Uterine Fibroid”, Tues, 19 Sep 2006).
However, with careful pathologic inspection of the uterus, the overall prevalence of leiomyomas increases to over 70%, because leiomyomas can be present but asymptomatic in many women.
- Pelvic pain or pressure: this symptom may appear as a result of the bulk or weight of the fibroids pressing on other structures in the pelvic area.
- Pain in the back of legs: this uterine fibroid symptom appears as the fibroids press on nerves that extend to the pelvis and legs.
- Pressure on the bladder: this uterine fibroid symptom can cause frequent urination, urinary incontinence, or urine retention.
- Lower back pain: a feeling of pressure or fullness in the lower abdomen.
- An abnormally enlarged abdomen: this may be mistaken for weight gain or pregnancy.
- Pain during sexual intercourse
- Imaging studies such as ultrasonography (commonest confirmation method), MRI (magnetic resonance imagery, most useful confirmation method as it can often distinguish leiomyomas from other intramural lesions), and CT (computed tomography) may be useful in confirming the diagnosis. Hysterosalpingography, sonohysterography, and hysteroscopy can all supply information and aid in a more definitive diagnosis of fibroids.
- More invasive procedures such as laparoscopy can also aid in definitive diagnosis (“Center For Uterine Fibroid”, Tues, 19 Sep 2006).
Treatment depends on several factors, including:
- General health
- Severity of symptoms
- Type of fibroids
- Whether or not pregnant
- Desire to bear children in the future (“MedlinePlus”, 7 Nov 2011).
Surgical treatments for fibroids
When women wish to preserve childbearing potential, a myomectomy (a surgical procedure in which individual fibroid(s) are removed) may be performed. Most myomectomies are performed through an abdominal incision in a procedure called laparoscopic myomectomy or rarely through the vagina in a procedure called hysteroscopic myomectomy. In general, myomectomy diminishes menorrhagia (prolonged and/or profuse menstrual flow) in roughly 80% of patients presenting with this symptom.
Pre-Operative Nursing Management
The surgeon, nurse and other members of the health team explain to the patient and family the surgery to be carried out. The therapeutic effects of surgery as well as complications of the surgery are explained to the patient and family. They are encouraged to ask questions to allay anxiety and fear. The questions asked are answered tactfully or referred to the appropriate person.
Diversional therapy is provided for patient by encouraging patient to watch television, listen to radio, or converse with other patients who have successfully undergone similar surgeries.
Spiritual leader may be called upon to talk to patient depending on patient’s religion. The patient is asked to sign the consent form as a legal document after she has understood the surgery.
Depending on the surgery type to be done, either myomectomy or hysterectomy, the patient is counseled.
If the patient is to undergo total abdominal hysterectomy, she is counseled that she will not be able to give birth again. The patient is told however that she will be able to resume normal sexual activities after recovery from the surgery.
Laboratory investigations such as haemoglobin level estimation, blood grouping and cross matching and urine microscopy is carried out to rule out any urinary tract infection.
Correction of fluid and electrolyte imbalance, transfusion to correct anaemia, bowel preparation, breathing and coughing exercises and insertion of tubes as may be required; (Ryles tube, urethral catheter and flatus tube) are all done.
Patient is asked to empty the bowels early in the morning, on the day of surgery. The abdomen is carefully shaved from the xiphisternum to the mid-thigh including the perineal regions. The skin is washed with soap and water, rinsed and dried. It is then disinfected, kept dry and covered with sterile towel. Vaginal douching is done if vaginal hysterectomy is to be done.
The patient is given nothing per os for about 6 to 8 hours prior to surgery. Dentures, rings, necklaces, hair pins, if present are removed, labeled and kept in the ward’s safety locker.
Immediate pre-operative care
The patient is reassured of positive prognosis of surgery. Baseline vital signs are checked and recorded. The urethral catheter is passed with strict aseptic techniques. About 30-45 minutes prior to surgery, the pre-operative drugs that is Atropine 0.5mg and Promethazine (Phenergan) 25mg are given intramuscularly to help relax muscles and dry secretions.
A sterile operation gown and head cap is used to dress the patient up. The patient is then taken to the theatre with her folder and the accompanying nurse keeps reassuring her.
An operation bed is prepared to receive the patient from the theatre. A post anaesthetic tray is set up containing; vomit bowl, dressing towel, kidney dish (containing swab holding forceps, dissecting forceps, tongue holding forceps and spatula), a gallipot with guaze swaps, an injection tray, Mouth Gag, a receiver for soiled swabs, a receiver to receive mouth wash, a gallipot with cold water, a receiver to receiver mouth wash, temperature, pulse and respiration tray, Blood pressure apparatus and charts for recording. A drip stand, dressing pack, oxygen cylinder, IV tray and suction machine are put in place before the arrival of the patient.
The patient’s level of consciousness is quickly assessed as soon as the patient is received from the theatre. Monitor the chest for movement and place fingers around the nostrils to determine if she is breathing. Check and record vital signs such as temperature, pulse, respiration and Blood pressure.
Patient’s general condition and effect of aneathesia must be assessed. The incisional site is reinforced with extra dressing if bleeding occurs. If bleeding is severe, the surgical team or theatre staff is informed and the patient is sent back to the theatre for further investigation and management.
The patient is turned to the dorsal position with the head turned to one side without pillows to facilitate breathing and prevent aspiration of the secretions which may cause hypostatic pneumonia. More blankets are added to the top sheet if the patient feels cold.
The patient is put in the dorsal position without pillows with the head turned to one side to maintain a patent airway to facilitate breathing and drainage from the mouth to prevent aspiration. This is continued until she regains consciousness.
The patient is reassured and measured employed to relieve patient’s pain are explained to the patient. Diversional therapy such as patient watching television, listening to radio or music, reading and interesting book is provided for patient to divert her mind from the pain. The patient may also be engaged in conversation as a diversional therapy and to establish rapport.
The patient’s family is encouraged to take part in patient’s care to help allay anxiety.
The level of patient’s consciousness and her general condition must be assessed by the nurse. Vital signs such as temperature, pulse, respiration and Blood pressure are monitored every 15 minutes for the first 2 hours, then 30 minutes for the next 4 hours and hourly until the general condition of the patient is stable.
The incisional site is observed for bleeding. Intravenous fluids are monitored for regular flow as ordered. The urethral catheter is observed for kinking and frequency of urine flow; the colour, amount, smell and constituents are also noted.
A strict intake and output chart and airway patency is observed to prevent asphyxia. Observe patient for complications such as shock, haemorrhage, wound dehiscence and evisceration.