Bladder Endometriosis Treatment in Newport Beach, CA

What is Bladder Endometriosis?

Bladder endometriosis occurs when endometrial-like tissue implants on or sometimes even infiltrates the wall of the bladder. Though less common than the endometriosis that affects the pelvic organs, it can cause similar debilitating symptoms.  It’s estimated 1-2% of women with endometriosis have their bladder also affected but due to its cyclical symptoms that mimic recurring UTIs, it’s often misdiagnosed , with the true prevalence slightly higher than estimates.   Also, unlike endometriosis in the pelvic area, bladder endometriosis diagnosis requires more specialized procedures like cystoscopy (surgical inspection inside the bladder) or advanced imaging for confirmation and many women with suspected symptoms do not  undergo these tests.

Thus even though bladder endometriosis is not as prevalent as other forms, it’s important to be aware of it because it can lead to debilitating cyclical pain, urinary urgency and frequency all severely impacting quality your life. If you’re experiencing cyclical bladder symptoms, particularly those that are worsening around your period and standard treatments for urinary issues aren’t helping – that’s a scenario that should be investigated deeper for the possibility of endometriosis.

What Causes Bladder Endometriosis

The reasons why superficial endometrial lesions can find their way on the bladder’s surface or deeply infiltrate into the bladder muscle wall aren’t fully understood.  However the leading theories of the possible mechanisms are as follows:

• Retrograde Menstruation:  Small amounts of menstrual blood and tissue fragments travel back up through the fallopian tubes into the pelvis. These blood and tissue fragments can then stick to the bladder’s surface and or potentially infiltrate its wall. This theory is constantly challenged though and may not be a clear cause of the disease.
• Metaplasia or Coelomic Metaplasia:  Cells on the surface of the bladder or within the pelvic lining transform into endometrial-like tissue.  What causes this transformation is unclear, but estrogen and other hormones likely play a role. High estrogen levels or imbalances might trigger the transformation, as could chronic inflammation in the pelvic area  that encourages certain cells to change their “programming”.

Having a close relative with endometriosis suggests there is a genetic predisposition component involved, as is the case with all forms of the disease.   It’s also possible that extensive endometriosis in other pelvic areas might increase the overall likelihood of bladder involvement.  Lastly, the natural movement of the bladder expanding and contracting could influence how and where endometriosis implants take root.  Because of the bladder’s function, implants on it cause a unique set of urinary symptoms alongside typical endometriosis pain.   

What are Symptoms of Bladder Endometriosis

The hallmark symptom of bladder endometriosis is pelvic pain, located in the lower abdomen near the bladder, that intensifies right before and during your period.  Often there’s a cyclic pattern linked to the menstrual cycle, month after month – a strong indicator of potential bladder endometriosis. Symptom intensity can range from mild to highly debilitating, and doesn’t always correlate with the amount of endometriosis present.  These symptoms mimic urinary tract infections (UTIs) or interstitial cystitis, so proper diagnosis is crucial. 

Dysuria or painful urination is also common and can range from a mild burning sensation to sharp and severe and may even observe blood in urine (hematuria), particularly during the cycle.  Many women also feel a need to urinate more often than usual even when the bladder isn’t full – and when they do, feel a sensation that the bladder hasn’t been emptied completely afterward.   Additionally, bladder endometriosis can exacerbate pain during sex if lesions are in an area affected during penetration.  Some women can even experience ‘referred pain’ in the lower back or side, due to certain shared nerves with the legs being irritated near the ureters (the tubes connecting the kidney to the bladder). 

What are Complications of Bladder Endometriosis

While treatable, bladder endometriosis can lead to several complications, some more serious than others.   Bladder endometriosis can be progressive, with symptoms becoming more severe over time if untreated ultimately disrupting daily activities.  The inflammation from the endometriosis can make the bladder muscles overactive causing spasms, false sensing of urination needs and pain.  However if endometriosis infiltrates deeply into the bladder wall, it can limit the bladder’s ability to hold an adequate amount of urine resulting in the actual need to indeed urinate frequently.

In severe untreated cases, there’s a potential risk of ureteral obstruction (narrowing or blockage of tubes carrying urine from kidneys to bladder), which can lead to a backup of urine in the kidney, causing the kidney to swell (hydronephrosis).   This of course can affect kidney function – which could produce a medical emergency.   The severity of complications varies, depending on the location and extent of the endometriosis. Seeking treatment sooner rather than later can minimize the risk of severe complications. 

How is Bladder Endometriosis Diagnosed?

Diagnosing bladder endometriosis requires a multi-faceted approach since no single test is definitive.  It starts with a comprehensive review of your medical history and any relevant medical conditions, menstrual patterns, previous surgeries, etc.  Learning about any recurrent urinary tract infections (UTI) for example or other bladder-related illnesses is essential.  Keeping a symptom diary noting pain intensity, urinary symptoms, and how these correlate with your menstrual cycle can be very helpful.  

A physical exam may also be performed to examine the muscles around the pelvic and the bladder in an attempt to locate the area of pain.

Ultrasound (Transvaginal/Transabdominal) can sometimes visualize large endometriosis bladder lesions, but can’t reliably detect in all cases.  A more specialized magnetic resonance imaging (MRI) could possibly be ordered if bladder endometriosis is strongly suspected based on symptoms.    At the end of the day the physical exam findings are combined with your medical history, symptom descriptions, and potentially imaging studies to form a complete diagnostic picture for bladder endometriosis.   If that picture warrants establishing with certainty the existence of bladder endometriosis, the final diagnostic procedure would be to inspect the lining of the bladder with a cystoscopy, or performing the cystoscopy at the time of endometriosis excision surgery 

Cystoscopy is considered the most definitive diagnostic tool to determine the existence of bladder endometriosis.  In this procedure a thin scope with a camera (cystoscope) is inserted into the bladder, allowing direct inspection to look for endometriosis lesions for visual confirmation and potentially take a biopsy.  If lesions are visible during cystoscopy, sampling them for biopsy confirms the diagnosis of endometriosis.  This may be combined with surgery to look within the pelvic area or laparoscopy.   However even with imaging and cystoscopy, some cases might only be confirmed during surgery. 

What is Bladder Endometriosis Treatment?

Treating bladder endometriosis typically involves a combined approach with the primary options being:

Hormonal Medications

Suppressing Endometriosis: Birth control pills, progestin-only options (pills, IUD, injections), or GnRH agonists/antagonists can help suppress endometriosis by reducing inflammation. Hormonal treatments mainly manage pain and urinary symptoms but will not eliminate the endometriosis itself. Not a Long-Term Solution: Medication is often used before surgery, in an attempt to control symptoms. However, the only way to get rid of the endometriosis is to perform surgical excision of the lesions

Surgical Excision

Laparoscopic excision surgery is the gold-standard treatment for bladder endometriosis, offering the best chance for long-term symptom relief and disease control. Laparoscopic excision surgery for bladder endometriosis involves:  

Preparation: Thorough imaging (MRI, cystoscopy), possibly in collaboration between a gynecologist and urologist, maps out the location and extent of endometriosis on the bladder and perform a presurgical assessment.   We’ll discuss the procedure, potential risks, and expected recovery period.

Procedure: A few small incisions in the abdomen where a laparoscope (thin tube with a camera and light) and surgical tools are inserted.  Most of the time, the Da Vinci Robot is also used for robotic assisted laparoscopy. Endometriosis lesions are meticulously excised, meaning cut out entirely at their root. This is superior to simply burning (ablating) the surface of lesions. Approaches vary based on lesion location and depth.  Superficial Lesions are excised directly from the bladder surface while deep Infiltrating lesions may require partial removal of a portion of the bladder wall (a bladder resection), followed by careful reconstruction of the bladder.

Post-Op & Recovery: Typically patients go home the same day, although an overnight stay may be necessary if a large portion of the bladder is resected.  A urinary catheter is kept in place for a period of time after surgery to allow for bladder healing.  Pain medication will be prescribed for post-surgical discomfort. Most women return to normal activities within a few weeks, with restrictions on heavy lifting initially.

Excising lesions is usually best for bladder endometriosis because it reduces the likelihood of them growing back compared to other techniques.  It also provides more complete pain relief and improvement of urinary symptoms for most women.  Many women experience some bladder dysfunction after surgery, which usually improves over time.  While highly effective, endometriosis can still recur, sometimes requiring further treatment.