Bladder Endometriosis: Symptoms, Causes, and More

Overview

• Bladder Endometriosis is a rare condition where endometrial-like cells grow inside or on the surface of the bladder.
• Occurs when these cells, usually lining the uterus, grow in other pelvic areas like ovaries or fallopian tubes.
• Affects about 5% of women with endometriosis, particularly the urinary system.

Types of Bladder Endometriosis

• Superficial Endometriosis: Occurs on the bladder surface only.
• Deep Endometriosis: Tissue extends into the bladder lining or wall.

Symptoms

• 30% of women with bladder endometriosis are asymptomatic.
• Symptoms often appear around menstruation and include:
  • Urgent or frequent urination
  • Pain when the bladder is full
  • Pain or burning during urination
  • Blood in urine
  • Pelvic pain
  • Pain on one side of the lower back
• Additional symptoms if endometriosis is elsewhere:
  • Pain during periods or sex
  • Heavy menstrual bleeding
  • Fatigue, nausea, diarrhea

Causes

• Exact cause unknown, but possible theories include:
  • Retrograde Menstruation: Backward blood flow during menstruation, implanting cells in the bladder.
  • Early Cell Transformation: Embryo leftover cells develop into endometrial-like cells.
  • Surgery: Spread during pelvic surgeries like cesarean delivery.
  • Hematogenous/Lymphatic Spread: Cells travel through lymph or blood systems.
  • Genetics: Family history may play a role.

Diagnosis

• Diagnosed through physical exams, urine tests, and imaging tests like:
  • Ultrasound: Transabdominal or transvaginal to locate endometriosis.
  • MRI: Detailed imaging of bladder and surrounding pelvis.
  • Cystoscopy: Direct bladder inspection with a scope.

Stages of Endometriosis

• Stage 1: Minimal - small patches in the pelvis.
• Stage 2: Mild - more extensive, not yet inside organs.
• Stage 3: Moderate - starting to invade pelvic organs.
• Stage 4: Severe - penetrated many organs.

Treatment Options

• Not curable, but manageable with medication and surgery.

Surgery

• Transurethral Surgery: Removal of cells via a scope in the urethra.
• Partial Cystectomy: Removes parts of the bladder with abnormal tissue.

Medication

• Hormone therapy to slow cell growth and alleviate pain, includes:
  • Gonadotropin-releasing hormone agonists
  • Birth control pills
  • Danazol

Complications

• Untreated can lead to kidney damage.
• Rarely, cancer can develop from these cells.
• May affect fertility if located in reproductive organs.

Outlook

• Surgery can relieve symptoms, but endometriosis may recur in up to 25% of cases, requiring further treatment.
• Chronic condition can significantly impact daily life, but management and support are available.