Both are leading causes of chronic pelvic pain; both have similar symptoms. In fact, more than 70% of cases presenting with symptoms of bladder Endometriosis are identical to those of Interstitial Cystitis.(1) So how do you know if you have Endometriosis of the bladder or Interstitial Cystitis?
Endometriosis of the Bladder
Bladder involvement is found in approximately every seventh to eighth case of diagnosed Endometriosis.(2) Symptoms range from mild discomfort to excruciating pain, and can include pyuria (pus in the urine), dysuria (pain or burning with urination), dyspareunia (painful intercourse), flank pain radiating toward the groin, hematuria (blood in the urine), fever, hypertension, excessive fatigue, tenderness around the bladder and/or kidneys, and urinary frequency, urgency or retention. Endometriosis of the bladder may initially present with such a simple sign as painful urination, sometimes being mistaken for a urinary tract infection. However, all urine cultures will be negative and symptoms will not respond to typical antibiotic therapy.(3)
If left untreated, bladder Endometriosis may cause serious complications. Ureter obstruction, hydronephrosis (distention of the pelvis and kidneys with urine), irreversible kidney damage and permanent loss of kidney or bladder function have all resulted in cases of severe, infiltrating disease.
Diagnosis may be made laparoscopically or through a procedure called a cystoscopy. In a cystoscopy, a urologist passes an instrument called the cystoscope through the urethra into the bladder, enabling him or her to look inside and take tissue samples. Transvaginal sonograms are also useful and more effective than abdominal ultrasounds or MRIs in detecting the disease.(4) However, biopsy results showing the presence of endometrial glands and stroma are still necessary for a definitive diagnosis.
Treatment is consistent with other methods used to relieve symptoms of Endometriosis; surgical, hormonal or alternative therapy. Often, relief is obtained following thorough removal of disease by a specialist. In more rare, advanced cases, part of the bladder may even be surgically removed through a procedure known as cystectomy.
Interstitial Cystitis
Interstitial Cystitis, like Endometriosis, is a chronic pelvic pain disorder. IC affects an estimated 700,000 Americans; 90% of which are female.(5) Symptoms may include feelings of pressure or tenderness around the bladder, intense pelvic pain, fatigue, dysuria (pain or burning with urination), hematuria (blood in the urine), urinary frequency, urgency or retention, and dyspareunia. Women's symptoms will often get worse during menstruation. As with Endometriosis, some sufferers also complain of IBS, allergies and migraines.
Like Endometriosis of the bladder, all urine cultures will be negative and symptoms will not respond to typical antibiotic therapy.(6)
Another similarity between the two disorders is the uncertainty regarding cause - while there are several theories regarding the etiology of both, definitive causes remain unknown. One theory being studied with respect to IC is that it is an autoimmune response following a bladder infection. Other theories include the belief that bacteria may be present in the bladder cells, but remains undetectable through routine cultures; that certain substances in urine may be irritating to IC sufferers; and that the condition, like Endometriosis, may be hereditary.(7)
IC is a diagnosis of exclusion. Physicians must rule out other disorders like urinary tract or vaginal infections, cancer of the bladder, cystitis, kidney stones, neurological disorders, STDs (sexually transmitted diseases), bacteria in the urine, chronic bacterial and nonbacterial prostatitis (in men), and...Endometriosis.
Like Endometriosis, the most important test to confirm IC is the cystoscopy. Pinpoint hemorrhages on the bladder wall, discovered during the cystoscopy, are hallmark signs of IC. IC (like Endometriosis) is currently incurable; however, there are many treatment options. Symptom relief can potentially be obtained through such measures as bladder distention, bladder instillation (or "bladder wash"), medications like Elmiron (pentosan polysulfate sodium), aspirin and ibuprofen for discomfort, antidepressants, antihistamines, narcotics like Tylenol with Codeine, TENS units (Transcutaneous Electrical Nerve Stimulation), alternative therapies, and modifications in nutritional and lifestyle habits, such as eliminating alcohol, high acid foods like tomatoes or spices, chocolate, caffeinated and citric beverages, and those products with artificial sweeteners from the diet, quitting smoking, and performing gentle stretching exercises.
Surgery can also be considered when other treatments have failed. In severe, extreme cases, bladder removal can be performed. However, as with hysterectomy for Endometriosis, some patients will still continue to experience variable IC symptoms.
Patients with Endometriosis and IC both speak of underdiagnosis and undertreatment of these conditions. Sufferers of both diseases may feel ignored, experience depression and suffer from chronic pelvic pain, seemingly with no end or relief in sight. Research is desperately needed into both areas to discover what causes these diseases and more importantly, how to cure them.
DISEASE SNAPSHOTS:
FACTS-AT-A-GLANCE
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| Symptoms include: pressure or tenderness around the bladder, mild to intense pelvic pain, dysuria (pain or burning with urination), dyspareunia (painful intercourse), hematuria (blood in the urine), fatigue, and urinary frequency, urgency or retention. Women's symptoms may be worse during menstruation. | Symptoms include: flank pain radiating toward the groin, tenderness around the bladder/kidneys, pyuria (pus in the urine), mild to intense pelvic pain, dysuria (pain or burning with urination), dyspareunia (painful intercourse), hematuria (blood in the urine), fever, hypertension, fatigue, and urinary frequency, urgency or retention. Symptoms may increase during menses |
| Sometimes mistaken for an infection; however, there is a marked absence of bacteria and failure to respond to antibiotics. | Sometimes mistaken for an infection; however, there is a marked absence of bacteria and failure to respond to antibiotics. |
| Incurable; treatments are aimed at symptom relief. Treatments range from medical therapy to surgical to alternative. | Incurable; treatments are aimed at symptom relief. Treatments range from medical therapy to surgical to alternative. |
You are Not Alone - Help is Out There: Where to Get Support
Endometriosis Research Center
http://www.endocenter.org/
National Kidney & Urologic
Diseases Information Clearinghouse
http://www.niddk.nih.gov/health/urolog/pubs/cystitis/cystitis.htm
Interstitial Cystitis Association
http://www.ichelp.org/
Intercyst.org
http://www.intercyst.org/
References:
(1) "Bladder endometriosis:
conservative management," J Urol 2000 Jun;163(6):1814-7 (ISSN: 0022-5347).
Westney OL; Amundsen CL; McGuire EJ, Division of Urology, University of
Texas Health Science Center-Houston.
(2) "Endometriosis of the
urinary bladder," Int Urol Nephrol 1999;31(1):39-44 (ISSN: 0301-1623).
Gajda M; Tyloch J; Tyloch F; Skok Z; Sujkowska R; Krakowiak J, Department
of Clinical Pathomorphology, University School of Medical Sciences, Bydgoszcz,
Poland.
(3) "Operational Obstetrics
& Gynecology: Chapter 13 - Problems with Urination." Department
of the Navy Bureau of Medicine and Surgery.
(4) "Pre-operative assessment
of bladder endometriosis," J Hum Reprod 1997 Nov;12(11):2519-22 (ISSN:
0268-1161). Fedele L; Bianchi S; Raffaelli R; Portuese A, Department
of Obstetrics & Gynecology, University of Verona, Policlinico Borgoroma,
Italy.
(5), (6) & (7)
The National Institute of Diabetes and Digestive and Kidney Diseases, NIH
Publication No. 99-3220, August 1999/updated February 2000.
Copyright ©2000 by Heather C. Guidone. All rights reserved. Do not reproduce without express permission.