Bladder Endometriosis: A Complete Manual for Causes, Symptoms, Diagnosis, and Treatment

Endometriosis occurs when tissue similar to the lining of the uterus grows outside it, often in the pelvis, impacting organs such as the ovaries or fallopian tubes.

Bladder Endometriosis specifically refers to the growth of this tissue within or on the bladder’s surface, often resulting in bladder pain.

There is also a chance that the ureters will be impacted, where research from a 2014 case report suggests that up to 5 percent of women with Endometriosis exhibit it within their urinary system.

This article discusses the symptoms, risk factors, stages, diagnosis, treatment of bladder endometriosis and what happens if not treated.

What is Bladder Endometriosis

Endometriosis is prevalent, impacting about 10% of women in their reproductive years. 

Nonetheless, Endometriosis Bladder is relatively uncommon, occurring in only about 1% of individuals with Endometriosis.

Bladder Endometriosis is a type of Endometriosis, that manifests as superficial growths on the bladder’s surface.

Rarely, it could have an impact on the ureter, the muscular tube that joins the kidney and bladder.

Endometriosis in bladder can develop on its own (primary) or develop after pelvic surgery (secondary).

When Endometriosis develops in this region, it can interfere with the normal urinary storage and release functions.

Symptoms of Bladder Endometriosis

Symptoms also differ from person to person based on the location and size of the lesions among patients. 

Patients often receive their initial diagnosis upon experiencing symptoms associated with storing urine, which typically follow a cyclic pattern.

They tend to worsen in the days leading up to menstruation.

Urgent or frequent need to urinate

This symptom refers to a sudden and compelling urge to urinate more frequently than usual. 

Pain when your bladder is full

Endometriosis in the bladder can cause discomfort or pain when the bladder reaches its capacity or becomes full. 

This lower abdominal or pelvic discomfort, which can be minor to severe, may feel like pressure, aching, or cramps.

Burning or pain when you urinate

Endometriosis affecting the bladder can lead to a burning sensation or pain during urination. 

This discomfort may be similar to the sensation experienced with an Urinary Tract Infection.

Blood in your urine

Hematuria, which is blood in the urine, can occur with Bladder Endometriosis. 

This may manifest as visible blood or pink-tinged urine. 

It usually happens because the bladder contains endometrial tissue, which might bleed when urinating.

Pain in your pelvis

Pelvic pain is a common symptom of Bladder Endometriosis and can vary in intensity. 

The lower abdominal or pelvic region may experience a throbbing pain, a dull aching, or a sudden stabbing sensation.

The pain may worsen during menstruation or as the bladder fills up.

Pain on one side of your lower back

Lower back pain, particularly on one side, can be associated with Endometriosis Bladder. 

This pain may radiate from the pelvic region to the lower back.

It can be worsened by a full bladder, menstruation, or certain movements.

Bladder Endometriosis vs. Interstitial Cystitis

Bladder Endometriosis and Interstitial Cystitis are two distinct conditions that can share similar symptoms, leading to confusion in diagnosis. 

Endometriosis in bladder involves the growth of the tissue similar to the lining of the uterus outside it on the bladder walls, often causing pain or discomfort, particularly as the bladder fills. 

Interstitial Cystitis, on the other hand, is a chronic bladder condition. It’s marked by bladder pain, urinary urgency, and frequency. 

Interstitial Cystitis (IC) shares similar symptoms with Bladder Endometriosis. 

These symptoms may include:

• Frequent and urgent need to urinate
• Needing to urinate at night
• Pelvic pain that lasts six months or more
• Pain in the bladder

Medical professionals theorize that Interstitial Cystitis could be because of the harm to the bladder’s lining.

These symptoms may occur regardless of bladder filling. 

Both conditions can cause discomfort and affect quality of life. 

Accurate diagnosis by a healthcare professional is crucial for proper management and treatment.

Stages

Endometriosis is classified into stages based on the quantity of tissue present and the depth of infiltration into organs. 

These stages are as follows:

• Stage 1 (Minimal): Characterized by small patches of Endometriosis found on or around pelvic organs
• Stage 2 (Mild): Involves more extensive patches compared to stage 1, but they have not yet invaded the pelvic organs
• Stage 3 (Moderate): Endometriosis becomes more widespread, with infiltration beginning into pelvic organs
• Stage 4 (Severe): Endometriosis has deeply penetrated numerous pelvic organ

Causes

The precise cause of Endometriosis Bladder remains uncertain. 

Researchers have formulated various theories to explain how the condition begins.

Some of the risk factors are as follows:

• Retrograde menstruation: Menstrual blood may flow backward into the pelvis, leading to cell implantation in the bladder wall
• Genetic factors: Certain genetic traits may predispose individuals to the development of endometriosis.
• Hormonal imbalances: Fluctuations in hormone levels, particularly estrogen, can influence the growth of endometrial tissue outside the uterus.
• Immune system dysfunction: Abnormalities in the immune system’s response may play a role in the development and progression of endometriosis.
• Surgery: Endometrial cells may spread to the bladder during procedures such as cesarean section or hysterectomy, causing secondary endometriosis of the bladder.
• Genetic factors: Endometriosis can have a hereditary component, as it can run in families

How is Bladder Endometriosis diagnosed

In diagnosing Endometriosis in bladder, the initial step involves a physical pelvic examination conducted by a doctor. 

Subsequently, they typically screen for blood in the individual’s urine. 

Following this, the doctor may proceed with additional tests like the following:

• Ultrasound: Using high-frequency sound waves, an ultrasound scan creates images of the body’s interior. Although Endometriosis tissue is not visible through this method, it can help identify cysts and rule out other issues
• MRI: Magnetic Resonance Imaging (MRI) employs magnets and radio waves to generate detailed internal images.This allows doctors to detect abnormal tissue growth, locate it precisely, and assess its extent
• Cystoscopy: In a cystoscopy procedure, a small tool with a camera is inserted through the urethra by the doctor. This enables them to examine the bladder lining for any presence of Endometriosis tissue

Treatment for Bladder Endometriosis

Endometriosis has no cure, but symptoms, including pain, can be managed. 

The main treatments for Endometriosis pain are:

• Hormone therapy: This includes contraceptive pills or hormonal IUDs to suppress menstruation and slow tissue growth
• Pain medications: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen can help with mild symptoms
• Surgical treatments: Surgery may remove abnormal tissue, relieving symptoms temporarily but not preventing regrowth

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What happens if Endometriosis Bladder is not treated

Endometriosis in bladder is a progressive condition, meaning it worsens over time. 

Without treatment, it can greatly affect quality of life, causing severe pain that interferes with daily activities. 

Coping with chronic pain may also worsen mental health issues like depression and anxiety. 

In rare cases, untreated Endometriosis can spread to the ureters, which connect the bladder to the kidneys.

The same can potentially cause kidney damage. 

Endometriosis Bladder itself doesn’t lead to infertility. 

Yet, individuals with abnormal bladder tissue may also have it in their ovaries or other reproductive organs, which can cause infertility. 

However, treatments are available for infertility related to Endometriosis. 

Doctors may recommend surgery to remove the abnormal tissue caused by Endometriosis. 

Alternatively, they may suggest In Vitro Fertilization (IVF) to address infertility associated with the condition.

Conclusion

Bladder Endometriosis specifically involves the tissue similar to the lining of the uterustissue growing within or on the bladder, resulting in bladder pain. 

While Bladder Endometriosis itself is uncommon, it can occur spontaneously or after pelvic surgery. 

Symptoms vary but typically include urinary issues and cyclic pelvic pain. 

Diagnosing Bladder Endometriosis involves physical exams and imaging tests like ultrasound, MRI, or cystoscopy. 

Treatment focuses on managing symptoms through hormone therapy, pain medications, or surgery. 

Untreated Endometriosis can worsen over time, affecting quality of life and worsening mental health issues. 

While Bladder Endometriosis doesn’t directly cause infertility, it may coexist with ovarian or reproductive organ involvement, impacting fertility. 

However, treatments such as surgery or IVF are available for Endometriosis-related infertility.

Stay informed and seek timely medical intervention for effective management and improved quality of life.

Frequently Asked Questions

• nichd.nih.gov
• sciencedirect.com
• karger.com