Bladder endometriosis: Symptoms and treatment

Endometriosis, a condition where tissue similar to uterine tissue grows outside the uterus, affects many women in the reproductive stage. It usually occurs in the pelvis or lower abdomen, but it can appear on other parts of the body too. The list includes the bladder as well. Bladder endometriosis is rare, but when it happens, it can cause a lot of discomfort. It can lead to problems while peeing and pain during sex. It can also cause severe period pain every month. We tell you what causes this form of endometriosis, and what you can do about it.

What is bladder endometriosis?

“It is a rare form of endometriosis in which tissue similar to the lining of the uterus grows on or inside the bladder,” says obstetrician and gynaecologist Dr Chetna Jain. The abnormal tissue can either grow on the outer surface of the bladder or  can penetrate the bladder wall The most common site for endometriosis is the pelvic area (69.2 percent) followed by the intestines (9.9 percent) and bladder (6.4 percent), as per a study published in the Obstetrics & Gynecology Science journal in 2015.

“It does not directly impact fertility, but if you have endometriosis in your ovaries then it may not be easy to have a child,” says the expert.

What are the symptoms of bladder endometriosis?

Bladder endometriosis can cause a mix of urinary and menstrual-related symptoms. Blood in the urine and discomfort while peeing are two common symptoms associated with bladder endometriosis, as per an analysis published in Best Practice & Research Clinical Obstetrics & Gynaecology in 2024.

1. Urinary symptoms

• Feeling the need to pee often, even when your bladder is not full
• Painful urination
• Blood in urine
• Feeling like urine is still left after peeing

2. Pelvic and menstrual symptoms

• Severe pelvic pain, especially during menstruation
• Painful periods
• Pain during sex, especially during deep penetration
• Pain in the lower abdomen or lower back

What are the causes of bladder endometriosis?

The exact cause of this condition is not clear, but here are some reasons:

• Retrograde menstruation: In retrograde menstruation, some of the period blood flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. “This blood contains endometrial cells that can implant and grow on the bladder, ovaries, and other pelvic organs,” says the expert.
• Direct spread from uterus: Endometrial tissue can spread directly from the uterus to the bladder, especially if it is located close to the bladder wall.
• Surgeries: “Women who have had C-sections, hysterectomies, or other pelvic surgeries are at higher risk,” says Dr Jain. Endometrial cells may attach to the bladder due to surgical trauma.
• Hormonal imbalance: High estrogen levels may encourage the growth of endometrial tissue in abnormal locations.

How to diagnose bladder endometriosis?

“Diagnosing bladder endometriosis can be challenging as its symptoms often mimic urinary tract infections,” says the expert. If there is an infection in the urinary tract, it can also lead to frequent urination, and pain during sex.

Here’s how it can be diagnosed:

1. Medical history and symptom assessment

Your doctor will ask you about:

• Pelvic pain and period pain severity
• Urinary symptoms such as painful urination, urgency, frequent urination, and blood in urine
• Pain during sex
• History of endometriosis
• Previous pelvic surgeries

2. Urine tests

A urinalysis will help to rule out UTIs or bladder infections. The non-invasive procedure involves the doctor visually examining your urine. “If your urine tests are clear, but you still experience symptoms, it may be due to bladder endometriosis,” says the expert.

3. Ultrasound

It is best for detecting larger bladder endometriosis lesions. A transvaginal ultrasound provides a detailed view of the bladder and organs near it. “However, small or deeply embedded endometrial growths may not be visible during this ultrasound,” says the expert.

Treatment for bladder endometriosis

Bladder endometriosis treatment focuses on relieving symptoms and reducing inflammation.

1. Hormonal therapy

“Hormonal therapy can lower estrogen levels, and slow down the growth of endometrial tissue,” says the expert. It is an effective way to manage bladder endometriosis, according to research published in The Journal Of Urology in 2020. It can be taken as a pill or injection, but this therapy does not remove bladder lesions.

2. Laparoscopic surgery

Laparoscopic surgery, which is minimally invasive removal of lesions, is often suggested to people with bladder endometriosis. “A surgeon will remove endometrial tissue from the bladder. It is effective for long-term relief of symptoms,” says Dr Jain.

3. Partial cystectomy

This surgery is done in severe cases where lesions penetrate deep into the bladder wall. The affected part of the bladder is surgically removed. “It is more invasive than laparoscopy, but can be curative. It is recommended if bladder endometriosis severely affects urination,” says the expert.

4. Dietary changes

Go for an anti-inflammatory diet, which means you should eat leafy greens, berries, turmeric, ginger, flaxseeds, and fatty fish. “These foods can reduce inflammation and help to control the symptoms of bladder endometriosis,” says Dr Jain. Also, drink plenty of water and avoid spicy foods.

Endometriosis can affect different body parts, including the bladder. In case of bladder endometriosis, you will have peeing problems, and pain during periods and pain. Hormonal therapy can help, but if you can also go for surgery.