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 can spread to other parts of the body, including the bladder. Endometriosis of the bladder, also called bladder endometriosis, occurs when endometrial tissue implants and grows on the bladder. This can cause a variety of symptoms and complications.
What is endometriosis?
Endometriosis is a condition where tissue that normally lines the uterus grows outside of the uterus. This tissue is called endometrial tissue. Each month, this tissue builds up and breaks down with the menstrual cycle. However, when endometrial tissue grows outside of the uterus, it has no way to leave the body. This leads to irritation, inflammation, and the formation of scar tissue or adhesions.
The exact cause of endometriosis is not known. Some theories include:
- Retrograde menstruation – Menstrual blood flows back through the fallopian tubes into the pelvis rather than out of the body through the vagina.
- Transformation of cells – Cells from the lining of the abdomen change into endometrial cells.
- Surgical scar implantation – Endometrial cells implant on surgical scars.
- Embryonic cell growth – Cells from the embryo in the womb migrate to other parts of the body and grow into endometrial tissue later in life.
- Immune system disorder – The immune system may not be able to recognize and destroy endometrial tissue outside of the uterus.
Endometriosis most commonly affects the:
- Ovaries
- Fallopian tubes
- Ligaments that support the uterus
- Outer surface of the uterus
- Bowel and rectum
- Bladder
However, endometrial tissue can be found anywhere in the pelvic cavity and less commonly can spread beyond the pelvis.
What are the symptoms of endometriosis?
The most common symptom of endometriosis is pelvic pain that correlates with the menstrual cycle. This includes:
- Painful periods (dysmenorrhea)
- Pain in the lower abdomen before and during periods
- Pain with intercourse
- Pain with bowel movements or urination during periods
Other symptoms may include:
- Heavy menstrual bleeding
- Bleeding between periods
- Infertility or difficulty getting pregnant
- Fatigue
- Diarrhea, constipation, bloating or nausea during periods
Some women with endometriosis have no symptoms at all. Symptoms can range from mild to severe. The severity of symptoms does not always correlate with the extent of the disease. Some women with minimal endometriosis may have severe pain, while others with extensive endometriosis may have no symptoms.
What causes endometriosis to spread to the bladder?
In most cases of bladder endometriosis, the endometrial tissue spreads to the bladder through direct extension from endometrial implants in surrounding pelvic tissues. Several factors allow endometrial tissue to spread:
- Proximity – The bladder sits right in front of the uterus, making direct spread of endometrial tissue possible.
- Retrograde menstruation – Menstrual blood flows back through the fallopian tubes and implants on pelvic structures.
- Invasive properties – Endometrial tissue can burrow and invade into underlying tissues.
- Surgical dissemination – Endometrial cells may spread during pelvic surgery.
Less commonly, endometrial tissue spreads through the bloodstream or lymphatic system from distant sites to the bladder.
The likelihood of endometriosis spreading increases with:
- More advanced endometriosis
- Deep infiltrating endometriosis
- Multiple sites of endometriosis implants
- Endometriomas or ovarian cysts related to endometriosis
How does endometriosis affect the bladder?
When endometrial tissue implants on the bladder, it continues to respond to hormones each month and thicken in preparation for menstruation. However, it has no way to exit the body. This results in:
- Inflammation – The implant swells and becomes painful.
- Bleeding – The implant bleeds into the bladder.
- Bladder irritation – This causes urinary frequency, urgency, and pain.
- Scar tissue – Repeated swelling and bleeding causes scar tissue around the implant.
- Bladder adhesion – Scar tissue can glue the bladder to nearby tissues.
- Bladder defects – Endometrial implants can wear away at the bladder wall.
- Bladder obstruction – Scar tissue may block the openings where urine drains from the kidneys into the bladder.
If left untreated, endometriosis of the bladder can cause severe damage and loss of bladder function over time.
What are the symptoms of endometriosis of the bladder?
The symptoms of bladder endometriosis often correlate with the menstrual cycle. Common symptoms include:
- Painful urination around periods
- Blood in the urine around periods
- Needing to urinate frequently or urgently around periods
- Pelvic pain that increases around periods
- Painful intercourse around periods
Other possible symptoms include:
- Abnormal uterine bleeding between periods
- Painful bowel movements around periods
- Lower back pain around periods
- Infertility or multiple miscarriages
Some women have no symptoms at all or mild nonspecific symptoms. Symptoms may remain stable, get worse or improve over time.
How is bladder endometriosis diagnosed?
If bladder endometriosis is suspected, the following diagnostic tests may be performed:
- Pelvic exam – Feeling for pelvic tenderness, masses or pain.
- Urinalysis – Checking for blood or abnormal cells in urine.
- Cystoscopy – A small scope inserted in the urethra to view the bladder lining.
- Imaging – Ultrasound, CT scan or MRI to visualize the bladder.
- Laparoscopy – Keyhole surgery to view implants directly and take a biopsy.
Laparoscopy and biopsy provide the most definitive diagnosis. Imaging and cystoscopy can suggest bladder endometriosis but cannot confirm it.
What complications can occur with bladder endometriosis?
Potential complications from endometriosis growing on the bladder include:
- Recurring bladder infections – Endometriosis creates an environment prone to bacteria overgrowth.
- Bladder obstruction – Scar tissue blocks urine flow, causing dysfunction.
- Kidney damage – Backed up urine leads to kidney impairment over time.
- Loss of bladder capacity – Endometriosis destroys healthy bladder tissue.
- Vesicouterine fistula – A tract forms between the bladder and uterus.
- Cancer risk – Rarely, bladder endometriosis transforms into cancer.
Prompt treatment helps reduce the likelihood of complications. However, some bladder damage may be permanent.
How is bladder endometriosis treated?
Treatment focuses on relieving symptoms, limiting damage to the bladder and preventing recurrence. Options may include:
- Pain medication – Anti-inflammatories and analgesics manage pain.
- Hormonal therapy – Estrogen suppression limits endometrial implant growth.
- Surgery – Laparoscopic or open surgery removes endometrial implants.
- Bladder repair – Repairing defects or obstructions of the bladder.
- Hysterectomy – Removal of the uterus is an option for severe cases.
The best approach depends on the size and location of implants and the extent of bladder damage. Treatment may require a combination of medication, surgery and bladder repair procedures. Even with treatment, endometriosis of the bladder may still recur.
What is the outlook for bladder endometriosis?
The prognosis for bladder endometriosis depends on:
- Size of endometrial implants
- Depth of penetration into bladder tissue
- Degree of bladder damage
- Whether there is kidney obstruction
- How well the condition responds to treatment
Mild endometriosis with superficial implants may cause minimal bladder problems. More extensive disease can lead to irreversible bladder damage and kidney impairment.
With early diagnosis and proper treatment, many women have relief of symptoms and protection from severe complications. However, even after treatment, endometriosis of the bladder may still recur.
Careful monitoring, long-term medications or repeat surgeries may be needed to preserve bladder function. Women with bladder endometriosis face higher risks of urinary tract problems. Working closely with specialists is key to the best outcome.
Prevention of bladder endometriosis
There are no sure ways to prevent endometrial implants from developing on the bladder. However, the following measures may reduce the overall risk:
- Using hormonal birth control to suppress menstrual cycles
- Taking anti-inflammatory medication before and during periods
- Using medications to shrink endometriosis implants
- Avoiding implantation during surgery with careful surgical technique
- Removing endometriosis lesions early before they can spread
- Hysterectomy in cases of severe endometriosis
While bladder endometriosis cannot always be prevented, early diagnosis and treatment of general endometriosis may reduce the likelihood it will spread to the bladder.
Key Points
- Bladder endometriosis occurs when endometrial tissue from the uterus implants and grows on the bladder.
- It can cause severe bladder pain, urinary dysfunction and complications.
- Symptoms often correlate with the menstrual cycle.
- Laparoscopy and biopsy confirm the diagnosis.
- Treatment involves pain relief, hormone therapy, surgery and sometimes bladder repair.
- Close monitoring and repeat treatment may be needed.
- Early diagnosis and management is key to reducing bladder damage.
Conclusion
Endometriosis of the bladder is a rare but serious complication. As endometrial implants grow, they can cause increasing bladder problems and pain. With prompt diagnosis and treatment, many women find relief, but the condition may still recur. Preventing endometriosis from spreading to the bladder in the first place remains a challenge. Increased awareness of bladder endometriosis helps women seek help early when the outcomes are better. Ongoing research continues to look for more effective therapies for this chronic and frustrating women’s health problem.