Category: Bladder Endometriosis

Bladder endometriosis is an uncommon but potentially debilitating form of deep infiltrating endometriosis (DIE) in which endometrial-like tissue grows on or within the bladder wall. Affecting an estimated 1–2% of people with endometriosis, this condition falls under the broader category of urinary tract endometriosis, which may also involve the ureters and kidneys. Though uncommon, bladder endometriosis can cause significant urinary, pelvic, and reproductive complications if left untreated. Early diagnosis and specialized treatment are key to managing symptoms and preserving bladder function and fertility.

Endometriosis is a chronic inflammatory disease where tissue similar to the endometrium (the inner lining of the uterus) is found outside the uterus. These misplaced cells respond to hormonal changes during the menstrual cycle, leading to inflammation, internal bleeding, and the development of scar tissue and adhesions. When this tissue infiltrates the bladder—either on the surface (peritoneal) or deep into the bladder wall—it can result in a range of urological symptoms that may significantly impair quality of life.

Symptoms of Bladder Endometriosis

The symptoms of bladder endometriosis can be confusing, as they often mimic common urinary tract conditions like interstitial cystitis or recurrent urinary tract infections (UTIs). Many patients are misdiagnosed for years before receiving a correct diagnosis. The hallmark feature of bladder endometriosis is that symptoms tend to worsen during menstruation, though they may also persist throughout the cycle.

Common symptoms include:

• Painful urination (dysuria), especially during menstruation

• Increased urinary frequency and urgency

• Bladder pain or pressure, often mistaken for a UTI

• Pelvic pain, especially deep in the lower abdomen

• Blood in the urine (hematuria), typically during menstruation

• Pain during intercourse (dyspareunia)

• Lower back pain

• Fatigue and discomfort affect daily activities

In severe cases, bladder endometriosis can lead to reduced bladder capacity, urinary retention, or obstructive uropathy if nearby ureters are also involved.

Diagnosing Bladder Endometriosis

Diagnosing bladder endometriosis requires a careful evaluation by a specialist familiar with the condition. Because symptoms overlap with other urinary disorders, patients may need several tests to rule out infections or structural abnormalities.

Diagnostic tools include:

• Pelvic ultrasound or transvaginal ultrasound may suggest bladder wall thickening or lesions, though they often miss small or deeply embedded nodules.

• Magnetic Resonance Imaging (MRI) with contrast is one of the most effective imaging techniques for identifying bladder and other deep infiltrating endometriosis.

• Cystoscopy, an internal exam of the bladder using a small camera, can detect endometriosis lesions inside the bladder and allows for biopsy if needed.

• Laparoscopy, a minimally invasive surgical procedure, remains the gold standard for confirming a diagnosis. It also allows for treatment at the time of discovery.

Treatment Options for Bladder Endometriosis

Treatment for bladder endometriosis depends on the severity of symptoms, lesion depth, and the patient’s reproductive goals. The two main treatment paths are medical therapy and surgical intervention.

• Hormonal treatments, including birth control pills, progestins, and gonadotropin-releasing hormone (GnRH) agonists, may suppress the menstrual cycle and reduce lesion activity. While these can offer symptom relief, they do not remove the lesions and are not curative.

• Surgical treatment is often required for moderate to severe bladder endometriosis. Laparoscopic excision surgery performed by an endometriosis specialist is the preferred approach. It allows for the precise removal of bladder lesions while preserving bladder function. In some cases, a partial bladder wall resection may be necessary.

Multidisciplinary care involving a gynecologist and urologist ensures optimal outcomes, especially when the bladder and nearby organs are involved.