Bowel and bladder endometriosis are two of the most commonly misdiagnosed forms of endometriosis. This is because many of their respective symptoms seem nearly identical to those of several other conditions, including acute appendicitis, inflammatory bowel disease, irritable bowel syndrome, interstitial cystitis, and celiac disease, just to name a few. Complicating matters further is the fact that these other conditions can co-exist with endometriosis. To help provide clarity amidst such clinical confusion, we’ve compiled the following summary to help you recognize what may be symptoms of bladder and/or bowel endometriosis from those of other disorders.
1. WHAT ARE THE SIGNS AND SYMPTOMS OF BLADDER ENDOMETRIOSIS?
Bladder endometriosis occurs when endometrial-like cells grow on or through the walls of the bladder. The symptoms are often nonspecific, meaning that diagnosis is sometimes difficult. However, the most common symptoms include frequent urination, pain on urination, urinary urgency and urinary retention. In rare cases, patients can have bloody urine during their menses. While these symptoms may occur only during your menstrual cycle, many patients experience these symptoms chronically, any time during the month.
2. 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.
3. HOW IS BLADDER ENDOMETRIOSIS TREATED?
The treatment for bladder endometriosis is similar to that of pelvic endometriosis. It can be managed with hormonal regulating medications. However, for definitive treatment, the endometriosis needs to be surgically removed. Because endometriosis usually involves the full thickness of the bladder, a portion of the bladder wall usually needs to be removed.
4. 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, it’s sometimes difficult for patients to determine from which organ the pain is emanating.
That’s 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.
That’s why it’s important that you receive a very careful examination to rule out other disorders.