Endometriosis and lower urinary tract symptoms

Lead author Iwona Gabriel, MD, PhD, an ob-gyn research collaborator at Brigham and Women's Hospital in Boston, said that some of the women with endometriosis she has studied complain anecdotally about serious LUTSs and overactive bladder. “Given the dearth of research on this topic in the medical literature, I was motivated to evaluate the association between endometriosis and LUTSs in a large cohort of female adolescents and adults,” Gabriel said.

The analysis comprised 1161 women with (n = 520) and without (n = 641) surgically confirmed endometriosis who were enrolled in the Women's Health Study from Adolescence to Adulthood between 2012 and 2018.

Most participants from both groups were White, non-Hispanic and nulliparous, with the mean age of women with endometriosis 20.8 years compared to 24.5 years for those without. The median body mass index (BMI) of both groups was similar: 23.2 kg/m2 vs. 23.6 kg/m2.

LUTSs was common among both groups, reported by 43.8% of all participants. But women with endometriosis experienced acyclic pelvic pain 5 times more frequently than those without: 65% vs 13%.

They were also more likely to report the following symptoms than those without endometriosis: difficulty passing urine (7.9% vs. 2%); still feeling full after urination (18.8% vs 4.7%); having to urinate again within minutes of urinating (33.1% vs 17.0%); dysuria (11.7% vs 4.9%); and pain when the bladder is full (23.0% vs 4.9%).

However, for women with endometriosis, the analysis revealed that the likelihood of LUTSs did not differ by the revised American Society for Reproductive Medicine stage (1/2I vs 3/4) or duration of endometriosis-associated symptoms.

“The unbiased data of the analysis supports what we see in our daily practice,” Gabriel told Contemporary OB/GYN®. “We hope that this research will enlighten clinicians caring for women with endometriosis about the increased co-occurrence of LUTSs and improve overall medical care.”

A higher prevalence of LUTSs in women with endometriosis might be connected to changes in pelvic sensation because both of these disorder results in alterations in local innervation.

Because the analysis sheds light on the possible relationship between endometriosis and LUTSs, “it will hopefully encourage physicians caring for women with endometriosis to ask about these symptoms, treat and/or refer them to the appropriate specialists for further management,” said Gabriel, an associate professor of ob-gyn and oncological gynecology at the Medical University of Silesia in Bytom, Poland.

As a first option, women experiencing LUTSs can follow the standard recommendations for behavioral and dietary changes. “These include pelvic floor rehabilitation, avoidance of bladder irritants, bladder retraining, and medications as needed,” Gabriel said. “When conservative options fail, referral to a urogynecologist is advised.”

If the women’s health study is replicated by other investigators, “it would be interesting to consider looking at common etiologies for both conditions through genetic and microbiome trials,” Gabriel said.

Reference

1. Gabriel I, Vitonis AF, Missmer SA, et al. Association between endometriosis and lower urinary tract symptoms. Fertil Steril. Published online January 31, 2022. doi:10.1016/j.fertnstert.2022.01.003