Bladder Problems in Endometriosis

Endometriosis is a medical condition where tissue similar to the endometrium (uterine lining) grows outside the uterus, in areas such as the fallopian tubes or the ovaries. The condition affects millions of women around the world. Its main symptoms are pelvic pain, painful periods, and pain during sex.

There are two main conditions that can cause you to experience bladder problems with endometriosis. You may have bladder endometriosis (the endometrial tissue grows in or on the bladder), or you may have painful bladder syndrome (interstitial cystitis).

Bladder Endometriosis

The endometrial tissue that grows outside the uterus is described as implants. In rare cases, implants can grow in the bladder or on its surface. This is called bladder endometriosis. 

Research estimates that only 1% of women with endometriosis will have implants that affect their urinary system, a condition called urinary tract endometriosis (UTE).

The other parts of the urinary tract that can be affected are the ureters, occurring in 9% to 23% of UTE cases. Bladder endometriosis can be severely painful and uncomfortable. 

Symptoms

It is possible to have bladder endometriosis without having endometrial implants in other parts of your body like your ovaries, but it is extremely rare. In 90% of cases, women with bladder endometriosis have ovarian implants, superficial peritoneal implants, and adhesions.

You may experience symptoms of endometriosis when implants grow in other places. This includes diarrhea, nausea, pain during sex, fatigue, heavy and painful periods, and infertility. Some of the symptoms of bladder endometriosis resemble those of endometriosis in other areas, and the condition can also cause its own symptoms.

Some symptoms of bladder endometriosis include:

• Blood in the urine (hematuria)
• Frequent urination
• Painful urination (dysuria)
• Bladder pain
• Urgent urination
• Pelvic pain
• Lower back pain

These symptoms may get worse during your periods.

Sometimes bladder endometriosis doesn't cause any symptoms at all, and it may be discovered during a medical test for another purpose.

Diagnosis

If you have been diagnosed with endometriosis and have bladder or urinary tract problems that aren't improving with treatment, your provider may be considering bladder endometriosis as the cause.

During an evaluation for possible bladder endometriosis, certain steps are helpful with the diagnosis.

• Physical examination: Your healthcare provider will examine your vagina and bladder for any endometrial growths.
• Ultrasound: Your practitioner may use an ultrasound to see whether you have implants in your bladder.
• MRI: An MRI may be used to obtain images of your bladder and pelvis and to see whether there are implants in these structures.
• Cystoscopy: Your practitioner may insert a cystoscope into your urethra to check your bladder for implants.

Treatment

The course of treatment your practitioner recommends depends on the extent of your bladder endometriosis and the severity of symptoms.

Hormonal treatments

Medication like progestin/progesterone, oral contraceptives, and gonadotropin-releasing hormone (GnRH) agonists may be prescribed to reduce the growth of implants in/on the bladder. Hormonal treatments may reduce the symptoms of bladder endometriosis, but their effect can be temporary.

Surgery

Your healthcare provider may recommend surgery to treat your bladder endometriosis if the position of the implants is surgically accessible.

During surgery, all the implants, or as much of them as possible, will be removed. 

The different surgical options for treating bladder endometriosis include:

• Laparoscopy
• Open-surgery (laparotomy)
• Partial cystectomy
• Transurethral resection

Painful Bladder Syndrome

Painful bladder syndrome, otherwise known as interstitial cystitis, can also cause bladder symptoms for women who have endometriosis.

Painful bladder syndrome is a chronic condition where there is constant pelvic pain and pressure and discomfort in the bladder. To be diagnosed with painful bladder syndrome, these symptoms must be accompanied by at least one other urinary tract symptom, like frequent or urgent urination, that is not caused by an infection or any other apparent reason.

Painful bladder syndrome is known as endometriosis "evil twin" because their symptoms are very similar. Although it is possible to have one without the other, many women who have endometriosis also have painful bladder syndrome. In fact, according to peer-reviewed studies, 60% to 66% of women with endometriosis have painful bladder syndrome.

Like endometriosis, the cause of painful bladder syndrome is unknown.

Diagnosis

If you have symptoms of painful bladder syndrome, your healthcare provider will ask about your medical history and perform a physical examination.

They may order the following tests:

• Cystoscopy is a procedure to examine the inside of the bladder.
• Potassium sensitivity test involves the insertion of a solution to determine whether there is pain.
• Urinalysis may be used to rule out other conditions like UTIs.

In some cases, painful bladder syndrome is diagnosed when surgical treatment for endometriosis does not provide significant pelvic pain relief, or when pelvic pain recurs quickly after surgical treatment.

Treatment

Painful bladder syndrome is treated in many ways.

• Lifestyle changes: This includes cutting down on alcohol and caffeine intake, quitting smoking, reducing stress, and engaging in more physical activity.
• Bladder training: This is to help your bladder hold more urine before you have to go.
• Physical therapy: It is recommended to be done with a therapist who has experience in treating pelvic floor problems.
• Over-the-counter pain medication: This can help alleviate your pelvic and bladder pain.
• Prescription medications: Examples include Pentosan polysulfate (Elmiron), antihistamines, and tricyclic antidepressants like amitriptyline.
• Surgery: This is usually a last resort treatment. Surgery can be performed to expand the bladder, remove the bladder, or divert the flow of urine.

A Word From Verywell

If you've been having bladder pain, rest assured that it can be treated. It may take some time to determine the cause and the best treatment approach. If you’re trying to conceive or plan to have kids later in life, you should make sure to tell your practitioner because some of the treatments for bladder pain can affect your fertility.