Sexual Health Reproductive Health Issues Uterine Conditions Endometriosis Bladder Problems in Endometriosis By Tolu Ajiboye linkedin Tolu Ajiboye is a health writer who works with medical, wellness, biotech, and other healthcare technology companies. Learn about our editorial process Tolu Ajiboye Medically reviewed by Medically reviewed by Brian Levine, MD on September 23, 2019 linkedin Brian Levine, MD, MS, FACOG, is board-certified in obstetrics and gynecology, as well as in reproductive endocrinology and infertility. Learn about our Medical Review Board Brian Levine, MD on September 23, 2019 Print Table of Contents View All Bladder Endometriosis Painful Bladder Syndrome Endometriosis is a medical condition where tissue similar to the endometrium (uterine lining) grows outside the uterus, like on the fallopian tubes or 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 conditions that can cause you to experience bladder problems in endometriosis. You may have bladder endometriosis, or you may suffer from painful bladder syndrome (interstitial cystitis). People Images / Getty Images Bladder Endometriosis In rare cases, implants (the tissue that grows outside the uterus) 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, an umbrella condition called urinary tract endometriosis (UTE). Bladder endometriosis is the most common type of UTE, occurring in 70% to 75% of cases. 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 Your doctor may suspect that you have bladder endometriosis if you have been diagnosed with endometriosis and continually have bladder or urinary tract problems that so far have not been treated successfully with regular treatments. Some symptoms you may experience include: Blood in the urine (hematuria)Frequent urinationPainful urination (dysuria)Bladder painUrgent urinationPelvic painLower back pain These symptoms may get worse when you’re menstruating. You may also experience symptoms of endometriosis when implants grow in other places. This includes diarrhea, nausea, pain during sex, fatigue, heavy and painful periods, and infertility. Conversely, you may have bladder endometriosis and not experience any symptoms at all. Sometimes it is simply discovered during a medical test for another purpose. 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. Diagnosis There are different ways that bladder endometriosis is diagnosed. Physical examination: Your doctor will examine your vagina and bladder for any endometrial growths (implants).Ultrasound: Your doctor may use an ultrasound to see your bladder and find out how much the implants there are if any.MRI: An MRI may be used to obtain images of your bladder and pelvis. This way your doctor can check for the growth of endometrial lining.Cystoscopy: Your doctor may insert a cystoscope into your urethra to check your bladder for implants. Treatment The course of treatment your doctor recommends depends on the severity of your bladder endometriosis and what other treatments have been used, if any. 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 doctor may recommend you undergo surgery to treat your bladder endometriosis. Ideally, this recommendation should only come after the position of the implants has been ascertained, and that you indeed have bladder endometriosis and not some other condition that causes lesions/growths in the bladder. During surgery, all the implants (or as much of them as possible) will be removed. The different surgical options for treating bladder endometriosis include: LaparoscopyOpen-surgery (laparotomy)Partial cystectomyTransurethral resection Because, it's rare for a person to have bladder endometriosis, and not have implants elsewhere, your doctor will likely recommend that all the other implants be removed during the same surgery. Painful Bladder Syndrome There exists another situation where women who have endometriosis, but not bladder endometriosis, may experience bladder problems. This is called painful bladder syndrome, otherwise known as interstitial cystitis. Painful bladder syndrome is a chronic condition where there is constant pelvic pain as well as pressure, and discomfort felt 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 very 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% (possibly even more) of women with endometriosis have painful bladder syndrome. Like endometriosis the cause of painful bladder syndrome is unknown. Diagnosis To formally diagnose you with painful bladder syndrome, your doctor will ask about your medical history and perform a physical examination. They may order the following tests: CystoscopyPotassium sensitivity testUrinalysis (This test may be used to rule out other conditions like UTIs that may be causing those symptoms.) In some cases, painful bladder syndrome is diagnosed when a patient has been surgically treated for endometriosis but does not experience significant pelvic pain relief, or pelvic pain recurred suspiciously quickly. Treatment Painful bladder syndrome is treated in many ways. Lifestyle changes such as 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 this is done with a therapist with experience, or who specializes, in pelvic floor problems.Over-the-counter pain medication to help alleviate your pelvic and bladder painPrescription medications like 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 Regardless of the cause of your bladder pain—be it bladder endometriosis or painful bladder syndrome—you should know that it can be treated. Make sure you explore your options extensively with your doctor. Finally, if you’re trying to conceive or plan to have kids later in life, you should make sure to communicate this to your doctor as some of the treatments for bladder pain can affect your fertility. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017 Mar;6(1):34-41. doi:10.1007/s13669-017-0187-1 Mettler L, Gaikwad V, Riebe B, Schollmeyer T. Bladder endometriosis: possibility of treatment by laparoscopy. JSLS. 2008 Apr-Jun;12(2):162-5. Paulson JD, Delgado M. The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain. JSLS. 2007 Apr-Jun;11(2):175-81. Additional Reading Diagnosis of Interstitial Cystitis. National Institute of Diabetes and Digestive and Kidney Diseases. Published July 1, 2017. Leone Roberti Maggiore U, Ferrero S, Candiani M, Somigliana E, Viganò P, Vercellini P. Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation. Eur Urol. 2017;71(5):790-807. doi:10.1016/j.eururo.2016.12.015 Maccagnano C, Pellucchi F, Rocchini L, et al. Diagnosis and Treatment of Bladder Endometriosis: State of the Art. Urol Int. 2012;89(3):249-258. doi:10.1159/000339519 Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017 Mar;6(1):34-41. doi:10.1007/s13669-017-0187-1