Sexual Health Reproductive Health Issues Uterine Conditions Endometriosis Bladder Problems in Endometriosis By Tolu Ajiboye 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 Updated on February 25, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Monique Rainford, MD Medically reviewed by Monique Rainford, MD Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Bladder Endometriosis Painful Bladder Syndrome 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). People Images / Getty Images 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). 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 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 It's rare for a person to have bladder endometriosis without also having implants elsewhere. Your healthcare provider will likely recommend that all the other implants be removed during the same surgery. 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. 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 3 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