When I started as a fellow at Pacific Endometriosis and Pelvic Surgery about 6 months ago, it was after working almost 10 years as a general OB/GYN. I was relatively familiar with transvaginal ultrasound, but primarily to assess for early pregnancy and its complications. Now as a fellow, I’ve learned to routinely do a
“Under Pressure”: How Endometriosis Can Impact the Bladder
Bladder pain, urinary urgency, and frequent trips to the bathroom are common symptoms for many patients with endometriosis—but that doesn’t always mean there is endometriosis within the bladder itself. At consult appointments at Pacific Endometriosis and Pelvic Surgery, we often hear concerns about whether endometriosis could be in the bladder. While it’s possible, true full-thickness bladder endometriosis is actually quite rare. What’s more common is that these bladder symptoms stem from other related conditions, like pelvic floor dysfunction or interstitial cystitis (IC), which often coexist with endometriosis.
For clarification, bladder endometriosis refers to endometriosis that is within the muscular layer of the bladder. Much more common is endometriosis in the peritoneum overlying the bladder, which we refer to as peritoneal endometriosis. When deeply infiltrating bladder endometriosis is present, it can often be seen on a transvaginal ultrasound (by a specialist) or pelvic MRI. A cystoscopy—a procedure that uses a small camera to look inside the bladder—can confirm full-thickness bladder endometriosis. Surgical treatment typically involves making an incision into the bladder, removing the lesions of endometriosis with a margin of normal tissue, and then closing the resulting opening with sutures. This usually means needing to keep a catheter in place for 1–2 weeks after surgery and having follow-up imaging to ensure the bladder has fully healed.
Luckily, however, needing this type of surgery is rare, as most bladder symptoms aren’t due to endometriosis within the bladder itself. More commonly, symptoms such as urinary urgency and frequency are the result of pelvic floor muscle spasm—a common response to chronic pelvic pain. Another frequent culprit is interstitial cystitis (IC), also known as painful bladder syndrome (PBS). This is a chronic condition that causes bladder pressure, pain, and frequent urination, often mimicking a urinary tract infection but without any bacteria present. Dr. Cindy Mosbrucker has written a detailed article about interstitial cystitis, available on our website, for those who want a deeper dive into this complex and often misunderstood condition.
The overlap between endometriosis and other conditions can make diagnosis tricky, which is why a thoughtful, whole-person evaluation is so important. At Pacific Endometriosis and Pelvic Surgery, we aim to understand and address all the possible contributors to bladder and pelvic pain that patients are experiencing. Whether symptoms stem from bladder endometriosis, pelvic floor tension, or interstitial cystitis, our goal is to identify the underlying cause and create a treatment plan that brings lasting relief.
For clarification, bladder endometriosis refers to endometriosis that is within the muscular layer of the bladder. Much more common is endometriosis in the peritoneum overlying the bladder, which we refer to as peritoneal endometriosis. When deeply infiltrating bladder endometriosis is present, it can often be seen on a transvaginal ultrasound (by a specialist) or pelvic MRI. A cystoscopy—a procedure that uses a small camera to look inside the bladder—can confirm full-thickness bladder endometriosis. Surgical treatment typically involves making an incision into the bladder, removing the lesions of endometriosis with a margin of normal tissue, and then closing the resulting opening with sutures. This usually means needing to keep a catheter in place for 1–2 weeks after surgery and having follow-up imaging to ensure the bladder has fully healed.
Luckily, however, needing this type of surgery is rare, as most bladder symptoms aren’t due to endometriosis within the bladder itself. More commonly, symptoms such as urinary urgency and frequency are the result of pelvic floor muscle spasm—a common response to chronic pelvic pain. Another frequent culprit is interstitial cystitis (IC), also known as painful bladder syndrome (PBS). This is a chronic condition that causes bladder pressure, pain, and frequent urination, often mimicking a urinary tract infection but without any bacteria present. Dr. Cindy Mosbrucker has written a detailed article about interstitial cystitis, available on our website, for those who want a deeper dive into this complex and often misunderstood condition.
The overlap between endometriosis and other conditions can make diagnosis tricky, which is why a thoughtful, whole-person evaluation is so important. At Pacific Endometriosis and Pelvic Surgery, we aim to understand and address all the possible contributors to bladder and pelvic pain that patients are experiencing. Whether symptoms stem from bladder endometriosis, pelvic floor tension, or interstitial cystitis, our goal is to identify the underlying cause and create a treatment plan that brings lasting relief.
