Understanding the urinary tract
The urinary system is made up from a group of structures designed to help our bodies remove toxic fluids. This includes the urethra (the tube which carries urine from the bladder to the outside of the body), the bladder (the pouch located in the lower abdomen which stores urine), the two ureters (the tubes which carry urine from the kidneys to the bladder) and the kidneys.
The purpose of this system is to eliminate waste by enabling us to pass urine, acting as a draining system to the body.
What is urinary tract Endometriosis?
Urinary tract Endometriosis occurs when endometriosis is found on the surface (known as superficial Endometriosis) or deep inside the wall of the urinary bladder or the urethra.
When Endometriosis is found in this area of the body, it can begin to disrupt the process in which we store and release urine.
As Endometriosis progresses, occasionally it can affect other urinary organs, such as the ureter. The lower part of the ureter which lies inside the pelvis is more likely to be affected by Endometriosis than the upper part of the ureter that lies above the pelvis.
The kidneys are also located above the pelvis.
What are the risks?
When urinary tract Endometriosis is left untreated, there is a chance it can progress, causing the ureter to become partially or (in rarer instances) entirely closed. This can lead to the impairment of function to the kidney, which (less commonly) can result in kidney loss.
Early diagnosis is KEY.
Do I have urinary tract Endometriosis?
Similar to those of pelvic Endometriosis, symptoms of urinary tract Endometriosis can also range from mild to the severe and often they are intermittent in nature.
They tend to be worse during menstruation or in the lead up (around 2-5 days before).
Although some people, especially those within the later stages of Endometriosis (moderate - severe) can experience pain and symptoms outside of menstruation or even continuously throughout the month.
Conversely, urinary tract Endometriosis can also be asymptomatic – meaning some people may not know they have the condition usually until later when they may undergo a procedure for something else, or when the ureter may become partially or entirely closed.
What are the signs to look out for?
Symptoms can vary from one person to another. Some may experience one or two symptoms whereas others may experience a combination of them.
The following symptoms may be associated with urinary tract Endometriosis (the list is not exhaustive) and include:
Pain when urinating
Pain when the bladder is full
The feeling of needing to pass urine more urgently or frequently than usual
A dull ache to acute pain or cramping in the lower back or kidney area (known as loin pain)
Urinary tract infection (UTI) like symptoms i.e., pain or a burning sensation when urinating; pain in the lower abdomen
Passing blood in urine may also suggest signs of endometriosis
If you are experiencing unusual pain that is stopping you from carrying out your usual daily activities like attending school or work, or if you have noticed changes around your periods or urinary habits, there is a chance you might have Endometriosis, or it could be the cause of something else.
It is important to tell your GP as early as possible.
It's important to know ...
When the urinary tract becomes affected by Endometriosis, the condition is usually found elsewhere, most commonly within the pelvis - meaning those experiencing symptoms of urinary tract Endometriosis may also experience symptoms of Endometriosis affecting other areas in the body at the same time.
Some people can have urinary tract Endometriosis without experiencing signs of the condition elsewhere, although this is less common.
How is urinary tract endometriosis diagnosed?
This type of Endometriosis can often be difficult to diagnose because sometimes the symptoms can be non-specific (meaning the symptoms are generalised and difficult to pinpoint). Many of the respective symptoms may also appear to be similar to several other conditions, such as a bladder infection; kidney infection; pelvic inflammatory disease (PID) and interstitial cystitis (IC). To further confuse matters, these other conditions can co-exist with Endometriosis.
Which tests will I find most helpful?
more about these tests and what to expect.
What treatments are available?
Treatment for urinary tract Endometriosis is similar to that of pelvic endometriosis. It can be helped with a combination of pain relief and anti-inflammatory medications, pelvic floor physiotherapy, and alternative therapies such as acupuncture.
Hormonal regulating medications to limit, help regulate or temporarily stop your periods may also benefit. However, for more severe cases, treatment of the Endometriosis may require surgical intervention, if other treatments are not effective.
When is the right time to consider surgery?
Your doctor may recommend surgery for different reasons, these may include:
When your symptoms are severe and medical treatments have not worked
When Endometriosis is limiting/stopping your kidneys from working properly.
What to expect during surgery
When Endometriosis is found affecting the urinary tract, the affected area will often need to be ‘shaved’, ‘burnt’ or in some instances (depending on severity) part of the bladder or urinary organ may need to be removed.
Your surgeon may place a thin scope into your urethra and bladder to diagnose Endometriosis. Depending on the severity of the Endometriosis, your surgeons may need to remove the part of your bladder that is affected, this is known as a partial cystectomy. In these instances, a temporary catheter and/or stent may be fitted for a short duration of time to allow time for the bladder to heal.
Your medical team should discuss the available treatments with you, taking into consideration the severity of your symptoms, your age, medical history, and various other individual circumstances along with any possible side effects, risks, and complications.
The importance of seeking specialist help
Because of the complexities of this type of Endometriosis, surgical treatment is preferably carried out by an accredited Endometriosis specialist – meaning a gynaecologist working with a urologist where required.
This is because not all gynaecologists are familiar with Endometriosis. Furthermore, not all surgeons are trained specifically in diagnosing and treating the condition.
Finding expert help early on can help prevent delayed or misdiagnosis, poor treatment, and inadequate care.
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