Bladder Issues and Endometriosis: It isn’t that you are drinking too much water
Q: How often are bladder issues or pain throughout the genitourinary tract a symptom of endometriosis?
A: Most people think that they have a small bladder or that they drink too much water, but in reality, urinary urgency, urinary frequency, incomplete bladder emptying, pain with urination, nocturia or getting up at night to urinate, incontinence or physically pushing to urinate are often symptoms of endometriosis. Endometriosis on the bladder or on the ureters can cause bladder symptoms that feel like a urinary tract infection, but never test positive for a UTI.
Genitourinary endometriosis is among the most common sites of endometriosis outside of the reproductive system. The incidence varies between 53-85% of people with deeply infiltrative endometriosis or DIE will have some form of genitourinary endometriosis.
Q: How often does endometriosis affect the bladder and urinary tract?
A: Urinary Tract Endometriosis (UTE) is found in about half of all patients with deeply infiltrative endometriosis. In those with UTE, the bladder is the most commonly affected organ and is involved in approximately 85% of those cases. The ureters are often involved as well. Ureteral endometriosis and disease near the ureters are often the source of flank pain in those with the disease.
Q: Is surgery often required for those with bladder issues and endometriosis?
A: Excision of endometriosis, which removes the disease at its root, removes it from the genitourinary system. Most with genitourinary endometriosis will not find symptomatic relief from birth control pills. Endometriosis is an inflammatory condition. Disease outside of the reproductive system typically does not respond to birth control medication. Incomplete surgery, or surgery that only attends to the reproductive organs, does not relieve disease in the genitourinary system.
Surgery for bladder endometriosis and genitourinary endometriosis often takes a team approach. In addition to the GYN surgeon, often there is a urologist or urogynecologist in the operating room. Postoperatively, especially for those with bladder symptoms, pelvic physical therapy may be beneficial, as well as dietary intervention.
Q: Does genitourinary endometriosis interfere with pregnancy?
A: Yes, disease outside of the reproductive system impacts fertility. Endometriosis affects between 30% and 50% of those with infertility. The disease can cause scarring, inflammation, and anatomical distortions that interfere with fertilization and implantation. The inflammation from the disease itself can contribute to miscarriage and implantation failures. Disease anywhere in the body has been shown to increase the chances of a miscarriage or implantation failure. Endometriosis does not have to be in the reproductive system to cause infertility, and when treating infertility, endometriosis needs to be excised from everywhere to enhance fertility.
Q: Are bladder-related symptoms only from the actual disease on the bladder or in the genitourinary system?
A: Disease on the genitourinary organs can cause symptoms, but disease anywhere in the pelvis contributes to bladder symptoms. This is because the bladder serves as the main sensory driver of the pelvis. It is like a command center for all the pain signals in the pelvis. Once the pelvis experiences pain for longer than 3-6 months, the bladder begins to interpret the pain signals. This interpretation can perpetuate symptoms even after surgery for some. Bladder conditions like interstitial cystitis or painful bladder syndrome are often called endometriosis’s “evil twin.” This is due to the connection of the bladder to sensory nerves.
Even after all the endometriosis has been fully excised from the bladder and genitourinary organs, if bladder symptoms persist, methods to treat the bladder directly may be used. Pelvic Physical Therapy to relax muscle spasms that both bladder issues and endometriosis cause can be helpful, as can a low-oxalate diet. In some cases, people need medication, nerve injections, or sacral neuromodulation to help fully alleviate their bladder issues.
