Bladder Endometriosis
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Evidence-based guidance on endometriosis affecting the bladder: how it presents, is diagnosed, and treated, plus practical tips for managing urinary symptoms and protecting pelvic health.
Overview
Bladder endometriosis happens when endometrial‑like tissue grows on or into the bladder wall, most often as part of deep infiltrating disease. Symptoms commonly include urinary urgency, frequency, burning, pain with a full bladder or during urination, and sometimes blood in the urine that worsens around periods. UTIs may be suspected repeatedly, yet cultures can be negative. Because symptoms overlap with bladder pain syndrome, careful evaluation helps distinguish endometriosis from conditions like Interstitial Cystitis.
Diagnosis relies on targeted imaging—transvaginal or transabdominal Ultrasound with a filled bladder and pelvic MRI—and occasionally cystoscopy to assess the inside of the bladder. Treatment ranges from anti‑inflammatory and hormonal options that reduce inflammation and pain to surgery when lesions invade the bladder muscle or cause complications. Laparoscopic or robotic partial cystectomy or nodulectomy is planned using detailed imaging and a multidisciplinary approach, as outlined in Surgery and Excision Surgery. Symptom care often pairs medical therapy with pelvic floor strategies from Pelvic Floor PT and individualized guidance from Urinary Symptoms.
How can I tell bladder endometriosis from a UTI or interstitial cystitis (IC/BPS)?
Bladder endometriosis often causes cyclical flares—worse around periods—with urgency, frequency, burning, or blood in the urine, while urine cultures are repeatedly negative. IC/BPS causes bladder pain and urinary symptoms without endometrial lesions and is not strictly cyclical. When symptoms persist despite UTI treatment, evaluation for both conditions is reasonable; see Interstitial Cystitis for distinctions.
What tests diagnose bladder endometriosis?
Targeted transvaginal or transabdominal ultrasound with a partially filled bladder can visualize nodules or bladder wall thickening, and pelvic MRI helps define depth and surgical planning. Urine tests rule out infection, and cystoscopy may be used when hematuria is present or imaging is inconclusive. Learn how each test is used in Diagnostics & Imaging, Ultrasound, and MRI.
Can medications resolve bladder lesions, or is surgery required?
Hormonal therapies such as continuous progestins, combined pills, or GnRH analogs/antagonists can reduce inflammation and urinary symptoms, but they typically do not remove deep bladder lesions. Surgery is considered when pain persists, lesions invade the detrusor muscle, or there is obstruction or bleeding. The choice depends on goals, imaging findings, and response to medical therapy.
What does surgery involve and what is recovery like?
Most procedures are performed laparoscopically or robotically, often with a urologist, to excise the nodule or perform a partial cystectomy while preserving bladder function. A temporary catheter is common for several days to support healing, and recurrence is lower with complete excision. For expectations and planning, see Excision Surgery, Robotic Surgery, and Postoperative Recovery.
How can I manage urinary symptoms day to day?
Pelvic floor physical therapy can reduce guarding and urgency, while bladder training and paced hydration help limit frequency. Some patients benefit from identifying bladder irritants (for example, caffeine or carbonated drinks) and using heat or TENS during flares; discuss medications such as antispasmodics with your clinician. For broader strategies, explore Urinary Symptoms and supportive care in Pelvic Floor PT.
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