Bladder And Bowel Problems
Endometriosis affecting the bladder or bowel can be difficult to treat and may require major surgery.
You may be referred to a specialist endometriosis service if your bladder or bowel is affected.
Surgery for endometriosis in the bladder may involve cutting away part of the bladder.
A tube called a urinary catheter may be placed in your bladder to help you pee in the days after surgery.
In a few cases, you may need to pee into a bag attached to a small hole made in your tummy. This is called a urostomy and itâs usually temporary.
Treatment for endometriosis in the bowel may involve removing a section of bowel.
Some women need to have a temporary colostomy while their bowel heals. This is where the bowel is diverted through a hole in the tummy and waste products are collected in a bag.
Page last reviewed: 18 January 2019 Next review due: 18 January 2022
Symptoms Of Bladder Endometriosis
As the location and size of bladder endometriosis can vary considerably from patient to patient, so do the symptoms.
A significant proportion of patients present with so-called urinary storage symptoms when first diagnosed. These can include bladder irritation, urgency, frequency, and painful symptoms when the bladder is full. Less commonly, patients report blood in the urine.
Importantly, the symptoms tend to occur cyclically with the menstrual cycle and are usually worse in the days leading to the period. As Dr. Seckin has stated, if the symptoms are overlapping the periods, menstruation, before, during and after, certainly bladder endometriosis should be suspected.
Endometriosis And Interstitial Cystitis
A 2018 study showed that people with endometriosis often have bladder pain syndrome, also known as interstitial cystitis .1 This bladder inflammation can cause pelvic pain symptoms and bladder tenderness that can feel like a UTI.2 In my case, this led to an over prescription of antibiotics that didn’t treat the underlying problem.
After a couple years of complaining that the antibiotics weren’t helping, my OBGYN finally sent me to a urologist. The first one told me just to pee after sex, which wasn’t helpful since my pain wasn’t actually from an infection. I wanted a second opinion, so I went to another urologist. After a cystoscopy when a doctor puts a terrifyingly long camera into the urethra it showed my entire bladder lining was red: a sign of chronic inflammation.
Need more info about bladder problems caused by endometriosis?
As far as I know, I don’t have endometriosis on or in my bladder. However, an endometriosis specialist told me that endometriosis causes systematic inflammation, which can lead to the release of pro-inflammatory cytokines throughout the bloodstream. And if my pelvic organs are already inflamed from endo, sex can irritate my endometrial lesions even further.
IC can result from non-endo related issues, but gynecologists should be aware that the two often overlap.3,4 It’s important to identify the cause of the symptoms in order to treat them effectively.
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Endometriosis Symptoms Mistaken For Something Else
Each month during menstruation, the endometrial lining found inside the uterus sheds from the body. When the endometrial tissue normally found inside the uterus grows outside the uterus, in other parts of the body, it is known as endometriosis. When endometrial tissue outside the uterus breaks down and sheds as it would during a normal menstrual cycle, it is unable to drain from the body, causing inflammation and pain. Endometrial growths have been found on the ovaries, fallopian tubes, bladder, on the outside of the uterus, lining the pelvic cavity and between the vagina and rectum. While rare, growths have also been found in the arm, thigh and lung.
According to the Endometriosis Foundation of America, endometriosis affects an estimated 1 in 10 women during their reproductive years or 200 million women worldwide. In terms of U.S. estimates, there is quite a variation in the estimated prevalence of endometriosis in the general and infertile populations. One study showed that 1-7% of fertile individuals undergoing tubal ligation had endometriosis, but among infertile individuals it might be as high as 10-50%.
According to the Endometriosis Foundation of America, it takes 10 years from symptom onset to receive an accurate diagnosis of endometriosis. The long diagnostic process is due to a lack of knowledge among the general public and medical community. Sadly, many endometriosis patients are misdiagnosed, often multiple times.
What You Need To Know
- Endometriosis is derived from the word endometrium, which is the tissue that lines the uterus. Patients with endometriosis have endometrial-type tissue outside of the uterus
- Endometriosis affects an estimated 2 to 10 percent of American women between the ages of 25 and 40.
- Women with endometriosis are more likely to have infertility or difficulty getting pregnant
- Symptoms of endometriosis may include: excessive menstrual cramps, abnormal or heavy menstrual flow and pain during intercourse.
- Laparoscopy, a minimally invasive surgical procedure, can be used to definitively diagnose and treat endometriosis.
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Managing Pain From Endometriosis On The Ovaries
Pain from lesions, implants, scarring, adhesions, and cysts on the ovaries is common. Endometriosis pain can be severe and can have an impact on quality of life. Members of MyEndometriosisTeam report feeling varying levels of pain in and around their ovaries. My right ovary feels like its always swollen and inflamed, wrote one member. Another commented, My ovaries are killing me and Im so nauseous.
There are several approaches for managing endometriosis pain caused by endometriosis on the ovaries.
Can Bladder Endometriosis Be Treated By Minimally Invasive Techniques
Yes, but only by an experienced surgeon. To resect a portion of the bladder and repair the bladder by video-assisted laparoscopy or robotic-assisted laparoscopy requires a high level of skill with those instruments. As mentioned, Drs. Nezhat were the first to perform minimally invasive surgeries for the treatment of all forms of endometriosis, including bladder endometriosis. After nearly 3 decades, Drs. Nezhat have now performed among the most, if not the most, endometriosis surgeries in the world using minimally invasive and robotic techniques.
A cystoscopy, as shown above, is a procedure in which a camera is placed inside of your bladder to help your doctor visualize your bladder and provide an accurate diagnosis.
However, even a cystoscopy can sometimes miss endometriosis that affects only the outside of the bladder. Therefore, multiple diagnostic tools are sometimes required to achieve an accurate diagnosis.
With the bladder so close to the uterus, its sometimes difficult for patients to determine from which organ the pain is emanating.
Thats why a careful examination is required so that your doctor can properly treat each area.
A common symptom of bladder endometriosis is urinary frequency. However, urinary frequency can also be a symptom of many other disorders.
Thats why its important that you receive a very careful examination to rule out other disorders.
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How Women With Endometriosis Can Decrease Their Risk
My specialty is womens cardiovascular health, so I talk with premenopausal and postmenopausal women every day about decreasing their heart disease risk. What I tell them is similar to what I advise my younger patients who have endometriosis: Try to stay as metabolically healthy as possible.
- Maintain a healthy weight to prevent Type 2 diabetes and other obesity-related conditions
- Control your blood pressure
Though no patients have asked yet about endometriosis and heart disease, I think this study is important enough for me to change how I approach health-history questions with patients. I usually take a pregnancy history, because pregnancy complications are associated with future risk of cardiovascular disease. If appropriate, we also talk about menopause and hormone therapy.
Now Im also going to ask whether my patients have endometriosis. This simple question will alert us to women who may be at higher risk for heart disease and prompt us to emphasize early the importance of lifestyle changes. Also, I may advise these women to try the non-surgical treatments before proceeding with surgical menopause.
If you have endometriosis and are concerned about your heart disease risk, request an appointment with a cardiologist or call .
Consider Ic In Cpp Patients Refractory To Treatment For Endometriosis
It is not uncommon for endometriosis to recur after surgery however, this often does not take place for years. Wheeler and Malinak reported on a study of 423 patients who had undergone conservative surgery for endometriosis. The annual rate of recurrence for biopsy-confirmed endometriosis ranged from only 0.9% in the first postoperative year to 13.6% in the eighth year. Therefore, if symptoms recur within the first 12 months after surgical therapy, IC should be considered as a possible cause and recurrent endometriosis is unlikely.
When therapy for the symptoms of endometriosis is unsuccessful, increasing evidence suggests that IC may be an underlying cause. Interstitial cystitis may be the sole cause of symptoms, or occur concurrently with other causes such as endometriosis or myofascial pain. In one study by Clemons et al, 45 women scheduled to undergo diagnostic laparoscopy for CPP were also evaluated with cystoscopy. Interstitial cystitis was diagnosed in 17 patients and endometriosis in 21 . Of the 21 patients diagnosed with endometriosis, 7 also had IC.
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What Is The Role Of Surgery For Urinary Tract Endometriosis
Surgery is indicated if fertility is a major goal, where symptoms fail to respond to medical therapies, or where ureteric obstruction has been confirmed. Untreated ureteric obstruction may lead to irreversible kidney damage.
As in bowel endometriosis, endometriosis of the urinary tract represents the severe end of the disease spectrum. Optimal management requires a team of specialists working together to thoroughly assess the risks and benefits of treatments and to determine the optimal care.
At CARE, we specialise in endoscopic management of severe endometriosis. Our multidisciplinary team includes specialist nurse educator, gynaecologists, colorectal surgeons , and urologists .
What Are The Symptoms
The main symptom is pain in your pelvis, usually during your period. You might also feel pain during sex, bowel movements, and when you pee. Other symptoms include heavy periods, fatigue, diarrhea, constipation, bloating, and nausea.
Most of the time, the stage and type of your condition doesnât affect your symptoms. For example, a person with stage 1 endometriosis may have worse pain than someone with stage 4. The exception is infertility. Women with stages 3 or 4 are more likely to have trouble getting pregnant than those with stages 1 or 2.
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Bladder Problems With Endometriosis
Endometriosis is a medical condition in which tissue similar to the lining of the uterus grows outside the uterus, such as on the fallopian tubes or ovaries. This condition affects millions of women around the world.Its main symptoms are pelvic pain, dysmenorrhea, and pain during intercourse.
There are two situations in which you appear bladder problems in endometriosis. You may suffer from bladder endometriosis, or you may suffer painful bladder syndrome .
Other Possible Risks Of Hysterectomy
Aside from the recurrence of endometriosis after hysterectomy, there are some other possible risks of hysterectomy. Like any other operation, you doctor will inform you of both minor and serious risks that may be involved, although some are not very common.
- Infections: The infections may occur in the area of surgery or even in the lungs or urinary system. To avoid this, surgeons usually administer prophylactic antibiotics before and after the surgery.
- Bleeding or formation of blood clots: There is also a risk of bleeding or formation of blood clots after surgery. Blood clots can travel to the lungs and cause complications like pulmonary embolism. Pressure stockings and medications like heparin can be applied to prevent formation of blood clots besides, encouraging early ambulation after surgery also helps.
- Damage to some internal structures like the bowels, the bladder or the ureters, which are in the pelvic area may occur, but these are rare complications.
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Endometriosis Of The Kidneys And Bladder
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Endometriosis is well known for causing pelvic area problems, like painful periods. As if that wasnt hard enough, endometriosis can show up in other parts of the body, like the urinary tract. The urinary tract includes all the organs that handle urine: two kidneys, two ureters , the urinary bladder , and the urethra . Endometriosis in the urinary tract is uncommon, affecting between 1 and 12 percent of people with endometriosis. People with deep infiltrating endometriosis are more likely to have endometriosis of the urinary tract.1,5
How Is Bladder Endometriosis Diagnosed
Bladder endometriosis is diagnosed by biopsy, where a portion of the endometrial implant is sampled from inside the bladder. In order to obtain the sample, a procedure called cystoscopy is first performed, where a camera is placed in the bladder in order to visualize the lesion and bladder anatomy. This allows for accurate sampling. Another reason for cystoscopy is to rule out other causes of bladder symptoms, such as interstitial cystitis or rarely, bladder cancer.
Interstitial cystitis is a chronic pain condition of the bladder and can also cause pelvic pain and urinary symptoms similar to endometriosis. Patients can have both interstitial cystitis and endometriosis. Therefore, it is important to perform cystoscopy on all patients with bladder symptoms to make these diagnoses because the treatment for these conditions is very different.
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How Is Bowel Endometriosis Diagnosed
Bowel endometriosis is usually diagnosed by laparoscopy and proctoscopy . If you are having symptoms of constipation alternating with watery diarrhea, then your physician may order a CT scan of your abdomen to rule out an obstruction of the bowel that can be caused by endometriosis or another type of abnormal mass.
If you are having any rectal bleeding, then a gastrointestinal specialist should evaluate you to rule out the possibility of colon cancer. In fact, all patients age 50 years or older should be screened for colon cancer regardless of symptoms, as bowel cancer is the 3rd most common cancer in the U.S.
As mentioned, symptoms of bowel endometriosis are similar to other gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, and even appendicitis. Sometimes patients have these diseases along with bowel endometriosis. Therefore, a thorough workup is required by both your gynecologic surgeon and a gastrointestinal specialist to make the diagnosis of these disorders.
What Are The Symptoms Of Urinary Tract Endometriosis
Women with urinary tract endometriosis have few or no symptom. Some present with infertility. Others experience urgency, frequency, pain on passing urine, in the flank or the back, recurrent urinary tract infections. Some women see blood in urine at times of menstruation. Other women give a history of having had surgery including hysterectomy for endometriosis many years prior.
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Endometriosis And Your Reproductive Organs
Endometriosis is a condition in which endometrial tissue grows outside of your uterus. That means this tissue can grow on any number of organs located in your pelvic region. In many cases, this tissue often grows on the ovaries, fallopian tubes, cervix, vagina, and the exterior support structures of the uterus.
While already problematic because of the misplacement of this tissue, this tissue also acts as if it was inside your uterus, thickening with each menstrual cycle. Since youre unable to shed the tissue out as you normally would through your period, it can turn into adhesions and interfere with the functioning of your reproductive organs.
Endometriosis Symptoms And Treatments
Endometriosis is a condition when cells from the lining of the womb attach themselves to other parts and organs in the body. These cells act on the same hormones as the womb and build up, break down and bleed. In the womb these cells would be shed during the monthly cycle as part of a womans period, however, these other cells located in other parts of the body cannot escape and can cause inflammation, pain and scar tissue.
Around 1.5 million women in the UK are affected, it is a condition that can affect any woman of childbearing age.
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Talk To Others Who Understand
MyEndometriosisTeam is the social network for people with endometriosis. More than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.
Do you have endometriosis that affects your ovaries? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Conditions Endometriosis Is Often Mistaken For
Endometriosis is more common than once thought. It has been misdiagnosed and understudied from years. It has recently been determined that girls as young as 8 can be diagnosed with it. It can cause pain, bleeding, and even infertility. Endometriosis can spread. It can even get worse during pregnancy. As hard as it is to diagnose, there are treatment options that can relieve symptoms and keep it from spreading. The best thing you can do when you learn you have endometriosis is to learn all you can. Knowledge is the one thing that can give you hope and answers.
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The Rise Of Charities For Endometriosis
Australian model Natalie Archer has recently set up a charity called The Endometriosis Coalition, which is working towards educating health care professionals and the general public on endometriosis signs and symptoms so women are validated and receive earlier treatment. You can also visit for online support in managing endometriosis.