Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, most commonly on the ovaries, fallopian tubes, and tissue around the uterus. In rare cases, endometriosis tissue can be found in other parts of the body, including the bladder. Getting endometriosis in the bladder is uncommon, but possible.
What is endometriosis?
Endometriosis occurs when tissue that normally lines the inside of the uterus grows outside of the uterus. This tissue responds to hormones in the same way that the tissue lining the uterus does – it thickens and sheds each month with your period. However, when endometriosis tissue is outside of the uterus, it has no way to leave the body. This leads to inflammation, scar tissue formation, and adhesions.
The most common locations for endometriosis include:
– Ovaries
– Fallopian tubes
– Ligaments that support the uterus
– Outer surface of the uterus
– Rectovaginal septum (the tissue between the rectum and vagina)
However, endometriosis lesions can sometimes be found in other areas of the body, including the bladder.
What are the symptoms of endometriosis?
The most common symptoms of endometriosis include:
– Painful periods (dysmenorrhea)
– Pain during or after sex (dyspareunia)
– Painful bowel movements or pain with urination during periods
– Excessive bleeding during periods
– Infertility
– Fatigue
– Bloating
– Constipation, diarrhea, or feeling that bowel does not empty completely
When endometriosis occurs in the bladder, it may cause additional pelvic pain symptoms such as:
– Painful urination (dysuria)
– Urinating frequently
– Blood in the urine (hematuria)
Can endometriosis grow inside the bladder?
Yes, in rare cases endometriosis tissue can be found growing inside the bladder. This is known as bladder endometriosis or endometriosis of the urinary tract.
Bladder endometriosis accounts for around 1-2% of all endometriosis cases. It occurs when endometriosis lesions from nearby pelvic organs like the uterus, ovaries, or fallopian tubes invade into the wall of the bladder. The lesions can become embedded quite deep within the bladder wall.
Risk factors for bladder endometriosis
Factors that may increase the risk of developing bladder endometriosis include:
– Severe pelvic endometriosis – Women who already have substantial endometriosis growths in the pelvis are more likely to have the lesions spread to the bladder.
– History of pelvic surgery – Previous surgeries like cesarean section or hysterectomy may open pathways for endometriosis to spread into the bladder.
– Uterine abnormalities – Women born with an abnormal uterus may be more prone to having endometriosis implants spread into the bladder.
How is bladder endometriosis diagnosed?
Diagnosing endometriosis in the bladder can be challenging. Tests used may include:
– Pelvic exam – Feeling for tender nodules in the bladder.
– Ultrasound – A transvaginal ultrasound may detect bladder lesions, but imaging does not give definitive diagnosis.
– Cystoscopy – A small camera is inserted into the bladder allowing direct visualization of lesions. This is the most accurate way to diagnose bladder endometriosis.
– Biopsy – Taking a small sample of the bladder tissue for pathology can confirm endometriosis if cystoscopy findings are uncertain.
– MRI – MRIs can identify thickened areas of the bladder that may correspond to endometriosis growths. However, confirmation with cystoscopy/biopsy is recommended.
How is bladder endometriosis treated?
Treatment options for endometriosis in the bladder include:
– Pain medications – NSAIDs, prescription pain relievers, etc can help manage pain symptoms.
– Hormonal therapy – Birth control pills, progestins, GnRH agonists may be used to try to slow endometriosis growth and inflammation.
– Surgery – Removal of endometriosis lesions and scar tissue provides effective treatment. Both cystoscopic surgery and open abdominal procedures can be used depending on lesion size and location.
– Hysterectomy with removal of ovaries – A definitive surgery for endometriosis that stops estrogen production and halts disease progression. Only considered for severe cases.
The specific treatment recommended will depend on the size and depth of bladder lesions, whether the patient wishes to preserve fertility, their age, and severity of symptoms. Treating bladder endometriosis requires the expertise of a specialist like a gynecologist or urogynecologist.
What happens if bladder endometriosis goes untreated?
Leaving endometriosis in the bladder untreated may lead to some potentially serious consequences, such as:
– Worsening pain symptoms – Discomfort and pelvic pain will tend to steadily increase over time.
– Bladder damage – As the lesions grow larger they can progressively weaken the bladder muscular wall, leading to decreased bladder capacity.
– Kidney damage – Severe bladder endometriosis can sometimes obstruct the openings where urine drains from the kidneys to the bladder (ureters). This can cause inflammation and permanent kidney damage from urine backing up.
– Cancer risk – There may be a slightly elevated cancer risk for women with endometriosis, especially if lesions are allowed to persist long-term.
– Infertility – Endometriosis is one of the top causes of female infertility. Left untreated, it can worsen over time lowering chances of conception.
That is why getting an accurate diagnosis and proper treatment of bladder endometriosis is extremely important, especially for women hoping to preserve fertility.
Can bladder endometriosis come back after treatment?
Unfortunately, endometriosis has a high rate of recurrence after treatment. Even with expert excision surgery, endometriosis returns 5-10 years later in 40-50% of women.
For bladder endometriosis specifically, the recurrence rate depends on the comprehensiveness of treatment:
– With hormone therapy alone, recurrence rates are around 83% over 3 years.
– After cystoscopic surgery to remove bladder lesions, the recurrence rate is 19-25% over 5 years.
– Following comprehensive surgery to excise all endometriosis deposits in the pelvis along with bladder lesions, the recurrence rate falls to around 15% over 5 years.
To minimize the chances of endometriosis recurring, having thorough surgical excision by an endometriosis specialist is recommended. Hormone therapy or repeat surgeries may be needed to manage symptoms long-term.
Prevention of bladder endometriosis
There are no sure ways to prevent endometriosis from occurring in the bladder completely. However, the following measures may help lower the overall risk:
– Achieving early diagnosis – Getting evaluated quickly for suspected endometriosis based on symptoms can lead to earlier treatment before disease spreads.
– Taking birth control pills – Continuous cycling or extended cycle OCPs may slow endometriosis growth by preventing periods.
– Considering hysterectomy – Removal of the uterus stops menstrual flow, which deprives endometriosis of estrogen stimulation.
– Excision surgery – Thorough surgical removal of all visible endometriosis lesions by an expert can help prevent recurrence.
– Avoiding reoperation – Repeat surgeries seem to increase the risk of atypical endometriosis locations like the bladder or far from the pelvis.
– Hormone therapy after surgery – Anti-estrogen medications may help prevent microscopic disease from reforming into symptomatic lesions.
Outlook for women with bladder endometriosis
When endometriosis invades the bladder, it can negatively impact quality of life and cause frustrating urinary symptoms. However, the outlook is often good with proper management.
Key points about the prognosis for bladder endometriosis:
– Symptoms are usually manageable – Medications and hormonal treatments can typically control pain quite well.
– Bladder function can be preserved – Despite infiltrating the bladder wall, lesions seldom severely impact bladder function if treated early.
– Fertility can still be achieved – Especially if complete excision is done before extensive scarring occurs, pregnancy is very possible.
– Risk of cancer is low – Endometriosis only slightly elevates cancer risk. With treatment, malignancy is uncommon.
– Recurrence is common but manageable – Repeat treatments and vigilance about new symptoms is needed.
While bladder endometriosis is a challenge to treat, keeping up with treatment options offers women the chance to live full, active lives. Connecting with online support groups and specialists who understand the disease can help women thrive while coping with endometriosis.
Conclusion
In summary, endometriosis rarely affects the bladder, but it is possible for endometriosis tissue to implant and grow within the bladder wall. Symptoms like pelvic pain, urinary frequency, and pain with urination may indicate bladder involvement. Cystoscopy and biopsy allow for accurate diagnosis. Treatment requires medication or surgery to remove lesions, sometimes along with hormonal therapy to prevent recurrence. Despite potential for recurrence, prompt diagnosis and treatment helps preserve bladder function and fertility. While coping with endometriosis in any location presents challenges, patient education and connecting with specialists allows women to manage symptoms effectively.