Bladder Endometriosis - A Run-through

Introduction

Endometriosis is a chronic and benign condition that affects the female population. It is common and usually affects females of reproductive age. It can be a reason for pain in the pelvic area and infertility. Cells like those in the uterus develop outside the uterus and cannot exit the body. When it occurs in the bladder, it is called bladder endometriosis. The condition is rare and can be painful. There can be inflammation and pain in the bladder.

What Is Bladder Endometriosis?

A rare form of endometriosis is bladder endometriosis. When cells similar to the uterus lining (endometrial cells) develop on the surface of the bladder, it is called bladder endometriosis. The endometrial cells develop every month in the uterus. It is removed from the body during a menstrual cycle. However, when they get deposited elsewhere, they can not be removed. Studies show that five percent of women have developed endometriosis in their urinary tract. In endometriosis, the urinary bladder is the most commonly affected site in the urinary system.

What Are the Types of Bladder Endometriosis?

There are two types of endometriosis. It can be;

1. Superficial Endometriosis: When the proliferation of endometrial cells occurs on the surface of the bladder, it is called superficial endometriosis.

2. Deep Endometriosis: When the proliferation occurs in the bladder lining, it is called deep endometriosis.

What Are the Symptoms of Bladder Endometriosis?

Studies show that about thirty percent of women with the condition may not have any symptoms. Often the condition is found while testing for some other conditions like infertility. The symptoms in those who are symptomatic can include;

• Need to urinate frequently.

• Pain when the bladder is full.

• Pain or a burning sensation while urinating.

• Blood in the urine.

• Pain in the pelvic area.

• Pain in the lower back is restricted to one area.

• Blood in the urine.

When endometriosis develops in the other parts pelvis, the symptoms shown can include;

• Painful periods.

• Pain during sexual intercourse.

• Heavy bleeding.

• Tiredness.

• Nausea.

• Diarrhea.

What Are the Causes of Bladder Endometriosis?

Endometriosis usually affects women of reproductive age. The average age for a woman usually diagnosed with endometriosis is about thirty-five years. The exact cause behind bladder endometriosis is still not clear. However, experts list the causes of the condition to be:

• Retrograde Menstruation: In some women, during menstruation, the blood may lower back to the fallopian tube and the pelvic area instead of flowing out of the body. These cells then implant in the bladder wall and other parts of the pelvis.

• Early Cell Transformation: The leftover cells after embryo formation may develop into bladder endometriosis.

• Surgery: During surgeries of the pelvic region like cesarean, hysterectomy, etc., the endometrial cells may spread to the bladder. This is called secondary bladder endometriosis.

• Hematogenous or Lymphatic Spread: The cells similar to endometrial cells may travel through the blood or the lymphatic system to the bladder.

• Genetic: Endometriosis can be inherited genetically.

• Abnormality in the Peritoneum: A thin membrane that covers the organs in the abdomen is called the peritoneum. Weak peritoneal cells allow endometrial cells to embed over the organs, giving rise to endometriosis.

What Are the Stages of Bladder Endometriosis?

Bladder endometriosis is staged based on the number of endometrial cells present and the depth of invasion into the organ. It is classified into four stages, which include:

1. Stage 1 or Minimal: A few endometrial cells are seen at this stage. It is present only on the surface or around the organ.

2. Stage 2 or Mild: This stage has more extensive tissue growth. However, they do not intrude into the organ but remain on the surface.

3. Stage 3 or Moderate: This stage has widespread endometrial tissue growth. At this stage, the endometrial cells are seen to grow into the organ.

4. Stage 4 or Severe: In this stage, many endometrial-like cells are growing in many parts of the pelvic area.

How Is Bladder Endometriosis Diagnosed?

The condition is diagnosed by:

1. Physical Examination: A physical examination will be done after taking a detailed case history. The bladder and vagina will be checked for any growth.

2. Urine Test: The urine is tested for the presence of blood.

3. Ultrasound Scan: Sound waves of high frequency is used to create images of the rams within the body. An ultrasound scan can understand the exact size and location of the endometriosis.

4. Magnetic Resonance Imaging (MRI) Scan: The images of the bladder are created using Powerful magnetic and radio waves. The site and size of the endometriosis can be determined.

5. Cystoscopy: A thin, flexible tube with a lens is inserted through the urethra to get a view of the bladder. It provides a view to see if endometrial cells are present.

How Is Bladder Endometriosis Treated?

There is no complete cure for the condition. However, the symptoms can be managed by medication and surgery. Studies by the National Institute of Child Health and Human Development show that all treatments may not work well for everyone. There can be chances of recurrence in some people. The pain in endometriosis can be managed in three ways:

• Hormone Therapy: Treatments like contraceptive pills and intrauterine hormonal devices that use hormones may be used to temporarily stop menstruation. This can slow down the growth of the endometrial tissues. However, the growth is not removed away completely.

• Painkillers: People with mild symptoms can use non-steroidal anti-inflammatory drugs (NSAIDs) to relieve their pain temporarily.

• Surgery: Sometimes, surgery would be required to control the pain and growth of the endometrial cells. There are two types of surgeries done for bladder endometriosis. These include transurethral surgery and partial cystectomy. A thin tool with a blade at the tip is inserted into the bladder during the transurethral surgery, and the endometrial cells are removed. A part of the bladder is removed in partial cystectomy.

Conclusion

Bladder endometriosis is a progressive condition that can worsen if left untreated. If left untreated, it can also affect the patient’s quality of life - the pain can become severe and interfere with their daily activities. Bladder endometriosis does not cause infertility. However, other types of endometriosis in the ovaries and uterus can cause infertility. This calls for timely treatment of the condition. Lifestyle modification and diet changes can help manage the pain and other symptoms of endometriosis.