Bladder Problems After Hysterectomy And What To Do About It
It is not uncommon that women complain about bladder problems after hysterectomy like lack of bladder control, bladder spasms, a burning feeling, and frequent visits to the bathroom.
We all know that having problems with our bladder is a part of getting old.
But, if you have to face problems like incontinence in your early forties, that is hard to accept. However, there is often no need for concern, as most of these problems will resolve in time. A hysterectomy is a major operation that can weaken the ligaments or damage supporting structures.
After the hysterectomy, your bladder will miss the support it had from your uterus, and its place in the pelvis will be different. During your hysterectomy recovery period, the pelvis tissues will heal, and your feeling and control of the bladder will gradually return.
Sometimes these problems bladder after hysterectomy persist. Bladder issues that may need medical attention are:
- bladder injury
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 About Kegel Exercises
These are not only useless for non-relaxing pelvic floor dysfunction, but may actually be harmful. Kegel exercises are used for relaxation dysfunction, to tone muscles that are not supporting the sphincter. Piling such contractions on top of muscles that are spasming only compounds the pelvic pain.
Now, the importance of the correct diagnosis becomes evident. There are various pelvic floor problems, and strategies for one type can worsen other types if there is no diagnosis or if the diagnosis is wrong.
In the next part of this 3-part series, I will discuss how the correct diagnosis is achieved, whichsadlyis rare. This is why the patient with pelvic pain who comes to me has been to an average of 8 other doctors before me, with incorrect diagnoses ranging from fibromyalgia to previous birth trauma to its all in your head. When a woman goes through a series of doctors who cannot diagnose the cause of her pelvic pain correctly, she is often referred to a pain management doctor, and this specialist is notorious for knowing very little gynecology, causing her to be sent back to yet another gynecologist who doesnt understand the philosophy of chronic pain. Back and forth she goes, with more doctor visits resulting in no help whatsoever.
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A Case Of Bladder Endometriosis That Became Symptomatic During The Third Trimester
Endometriosis may become symptomatic during pregnancy.
When a mass detected in the bladder, the most appropriate tool for diagnosis is cystoscopic biopsy.
Cystoscopy during pregnancy may fail to detect bladder nodules.
With decidual changes endometriotic nodules in the bladder can mimic malignancy during pregnancy.
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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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.
- Eat a healthy diet
- Exercise regularly
- 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 .
What Causes Bladder Endometriosis
Doctors dont know exactly what causes bladder endometriosis. A few possible theories are:
- Retrograde menstruation. During menstrual periods, blood may flow backward through the fallopian tubes and into the pelvis instead of out of the body. Those cells then implant in the bladder wall.
- Early cell transformation. Cells left over from the embryo may develop into endometrial-like cells.
- Surgery. Endometrial cells may spread to the bladder during pelvic surgery, such as during a cesarean delivery or hysterectomy. This form of the disease is called secondary bladder endometriosis.
- Hematogenous/lymphatic spread. Endometrial-like cells may travel through the lymph system or blood to the bladder.
- Genes. Endometriosis sometimes runs in families.
These tests can help your doctor diagnose bladder endometriosis:
- Ultrasound. This test uses high-frequency sound waves to create pictures from inside your body. A device called a transducer is placed on your belly or inside your vagina . An ultrasound can show the size and location of the endometriosis.
- MRI scan. This test uses powerful magnets and radio waves to look for endometriosis in your bladder. It can also find the disease in other parts of your pelvis.
- Cystoscopy. During this test, your doctor inserts a scope through your urethra to view your bladder lining and check for endometriosis.
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Overactive Bladder Problems After Hysterectomy
Sometimes nerve damage or infections are the reason for an overactive bladder after surgery. This crazy, unstoppable feeling of having to go to the toilet, even if you have little or no urine in the bladder, is due to the bladders detrusor muscle malfunctioning. After a hysterectomy, overactive bladder problems include frequent visits to the bathroom, even during the night , and leaking urine.
What can you do about it?
Strengthen the pelvic muscles with Kegel exercises. Avoid substances that will irritate the bladder like coffee, alcohol, carbonated drinks, and spicy meals. Get rid of the extra pounds, as your extra weight can have a notable impact on the pelvic floor muscles that support your bladder. There are several medications that can help to relax the Detrusor muscle. Common side effects of these medications are dry mouth, constipation, and sometimes confusion.
Read more in our post: 5 Effective home remedies for overactive bladder
If The Organs Are Intact Why Do Adhesions Cause Dysfunction In Them
- Bowelcolon and rectum. The bowel has nerve endings which cause pain only one waydistension. This is why babies get colic pain with their intestines being so small. This pain response is a warning signal that something inside of the bowel is going wrongusually obstruction from contents getting hung up in transit from the stomach to the rectum. Constipation and the pain that comes with it is one such warning signal. Also, infections can cause the bowel motion to slow down, causing obstruction as things pile up andthendistention andthenpain. When endometriosis causes bowel to stick together, there is no longer an unrestricted path of movement of contents twists and turns cause hang-ups that cause distension when the smoothness of the transit is impaired.
- Bladder. An inflammatory process in the bladder wall or via other things sticking to it will naturally be irritated with the normal goings-on of the bladder .
- Ovaries, uterus, fallopian tubes. These organs have their own unique functions involving releasing an egg for fertilization, moving it down the tube, or implanting a fertilized egg for pregnancy. The inflammation from the immunological effects of endo can mess with the biochemistry of this exquisite process, causing infertility and the kinking of the tubes from other things adhesing to them can cause mechanical blockage even to the point of a tubal pregnancy if a fertilized egg gets stuck in your tube.
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Can An Inverted Uterus Cause Uti
Most commonly, the uterus lies horizontally over the bladder, as do the ovaries. As the uterus enlarges with pregnancy, or perhaps with a large fibroid, it will cause increasing pressure on the bladder, and this results in increasing urinary frequency, pressure symptoms, and perhaps lower abdominal protrusion.
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 Does Endometriosis And Exercise Fit Into All Of This
Endometriosis can hurt directly it can hurt indirectly . It will cause pelvic floor pain from spasm, which can then progress on to become its own disease, which correct exercises can help or incorrect exercises can worsen. And this pain can even continue when the endometriosis has been removed surgically. If the endo is gone, you may be tempted to ask, then why does it still hurt? While some surgeons give up at this point and proceed to hysterectomy, a trip to a pelvic floor physical therapist may make that drastic step unnecessary. This is especially poignant, since endo sufferers often have endo-related infertility, and removing the uterus is a final burning of the bridges.
This is a tragedy which happens all too often!
Are Endometriosis And Interstitial Cystitis Related
Endometriosis and interstitial cystitis have similar symptoms. Both conditions can be challenging to diagnose, and some patients are misdiagnosed with one, the other, or both.
Additionally, studies show that women with endometriosis are up to four times more likely to develop interstitial cystitis. But what is the connection between these two painful and disruptive conditions?
First, lets review what endometriosis and interstitial cystitis are.
Endometriosis is a reproductive health issue that causes endometrial tissue to form outside of the uterus, leading to painful adhesions.
Interstitial cystitis is an immune system dysfunction that denudes the protective coating of the bladder, allowing urine to irritate the bladder.
Both conditions cause disruptive symptoms, including:
- Tenderness and trigger points in the abdomen
- Pelvic floor dysfunction
- Pain in the low back, hips, groin, and tailbone
- Painful intercourse
- Urinary urgency and incontinence
The conditions are so similar and co-occur so frequently that you might hear them referred to as the evil twins of pelvic pain.
Why is it challenging to tell the difference between endometriosis and interstitial cystitis?
There are a few reasons why endometriosis and interstitial cystitis are hard to differentiate.
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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 it’s 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
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How Is Bowel Endometriosis Treated
Bowel endometriosis is treated by removing the lesion from the bowel. The most common site of bowel endometriosis is the rectum, followed by the sigmoid colon. Most often bowel endometriosis involves the surface of the bowel, but severe cases can involve the full thickness of the bowel and invade into the wall and inside of the bowel. This type of bowel endometriosis should be treated by excising a portion of the affected bowel.
Endometriosis Not Only Can Cause Damage To The Kidneys But It Can Cause Kidney Loss
The type of endometriosis that damages kidneys is called ureteral endometriosis.
We dont know why endometriosis occurs in the first place, which makes treatment all the more difficult, begins Kurian Thott, MD, an OBGYN specializing in urogynecology with Mary Washington Healthcare in VA.
Endometriosis can be present or has been identified in almost every organ or tissue in the body, e.g., lungs, brain and kidneys.
The most common way endometriosis affects the kidneys is when it affects the ureters .
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Getting The Right Diagnosis
As people with endometriosis know, getting the right diagnosis is key to treating the condition. Simply knowing my bladder was inflamed and not infected helped me treat my symptoms more appropriately, and my chronic bladder pain ultimately resolved. When I stopped the vicious cycle of antibiotics that led to yeast infections, it felt like my immune system got a break. I treated the pain with urinary analgesics or ibuprofen instead of unhelpful antibiotics.
Most importantly, I took a break from sex when it felt like my bladder was irritated. I can’t tell you exactly what relieved my chronic bladder pain, but receiving the proper diagnosis helped me on the path to a resolution.
Can Bowel Endometriosis Be Treated By Minimally Invasive Techniques
Yes, but only by an extremely experienced surgeon. Operating on or near the bowels can be very dangerous and only those surgeons highly skilled at video-assisted laparoscopy and robotic-assisted laparoscopy should be treating bowel endometriosis. In terms of experience and advanced skill, youve definitely come to the right place because Dr. Camran Nezhat and his brothers, Drs. Farr and Ceana Nezhat, were actually the ones who first performed these advanced minimally invasive surgeries for the treatment of all forms of endometriosis, including bowel endometriosis. They achieved this revolutionary change to surgery nearly 3 decades ago, in the days when others were still derisively dismissing minimally invasive surgery as barbaric. .
Because of their extensive experience, Dr. Camran Nezhat and his brothers have found that the more conservative procedure called disc excision of the bowel is better for the patient. A disc excision of bowel endometriosis is where a circular portion around the endometriotic lesion is removed and the bowel is then repaired with sutures and staples. Utilizing this conservative approach means that an entire portion of the bowel does not need to be removed, which reduces the risk of any potential complications. Only in selective cases where there is severe stricture of the bowel or conservative management has failed, is a complete bowel resection needed.
Other symptoms of bowel endometriosis include diarrhea the antithesis of constipation.
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