Everything You Need To Know About: Bladder Endometriosis

It might surprise you to know, but endometriosis isn't 'just a bad period', despite a lot of misconception around the disease. Affecting (at least!) 1 in 10 women worldwide, endometriosis is a complex and often debilitating condition that affects millions of women worldwide, primarily those of reproductive age.

While it commonly involves the pelvic organs such as the uterus, ovaries, and fallopian tubes, it can also affect other areas of the body, including the bladder. Bladder endometriosis is often found within advanced stages of the disease when it penetrates and affects their function.

Understanding Endometriosis

So what is endometriosis? Often referred to as 'end' it's a disease that is characterised by the presence of endometrial-like tissue outside the uterus. While it's the not exactly the same as the uterine lining that we are familiar with as part of the menstrual cycle, this tissue behaves in a similar way - it builds up and breaks down in a cyclical way.

Endometriosis is commonly found in the pelvic cavity, on or around organs such as that the uterus, fallopian tubes and ovaries, but it also can be found on various pelvic structures, leading to inflammation, scarring, and the formation of adhesions. Despite extensive research, the exact cause of endometriosis remains unclear, although hormonal, genetic, and immunological factors are believed to play a role.

How does it affect the bladder?

Bladder endometriosis occurs when the endometrial-like tissue implants itself on the bladder wall or within the bladder itself. This can lead to a range of symptoms, including urinary urgency, frequency, and pain. As the bladder fills with urine, the presence of endometrial tissue can cause discomfort or a sensation of pressure. Additionally, during menstruation, the hormonal changes can exacerbate inflammation and pain, further impacting bladder function.

In severe stages of the disease (Stage III and Stage IV), bladder endometriosis can lead to the formation of bladder nodules or lesions, which may result in bleeding during menstruation and potentially compromise urinary continence. Moreover, the proximity of the bladder to other pelvic structures affected by endometriosis, such as the uterus and ovaries, can contribute to the complexity of the condition and its management.

What are the common symptoms of bladder endometriosis?

Symptoms of bladder endometriosis can vary in severity and may overlap with other urinary or gynaecological conditions, making diagnosis challenging. Common symptoms include:

1. Urinary urgency: A sudden and compelling need to urinate, which may be accompanied by discomfort or pain.

2. Urinary frequency: Frequent urination, often with small volumes of urine voided each time.

3. Pelvic pain: Discomfort or pain in the pelvic region, which may worsen during menstruation or sexual intercourse.

4. Hematuria: Blood in the urine, particularly during menstruation, indicating potential bladder involvement.

It's important to note that not all individuals with bladder endometriosis will experience all of these symptoms, and their severity can vary from person to person.

How is it diagnosed?

Diagnosing bladder endometriosis requires a thorough evaluation by a healthcare provider with expertise in the condition. This typically involves a combination of medical history, physical examination, and diagnostic tests.

Imaging studies such as ultrasound or magnetic resonance imaging (MRI) may be used to visualise the bladder and surrounding structures for any abnormalities or lesions.

Additionally, cystoscopy, a procedure in which a thin tube with a camera is inserted into the bladder, may be performed to directly examine any endometrial implants or nodules.

How is it treated?

The treatment of bladder endometriosis aims to relieve symptoms, preserve bladder function, and improve quality of life. The gold standard treatment for bladder endometriosis is surgical excision, which involves removing the endometrial tissue from the bladder wall or within the bladder itself. This procedure is typically performed by a skilled gynecological surgeon with expertise in minimally invasive techniques such as laparoscopy.

During surgery, the surgeon carefully excises the endometrial implants while preserving as much healthy bladder tissue as possible. In cases where extensive bladder involvement or scarring is present, more extensive surgical techniques, such as partial bladder resection, may be required. Following surgery, hormonal therapy may be recommended to suppress menstruation and reduce the risk of disease recurrence.

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