Urinary symptoms and ureter involvement should not be ignored.
Endometriosis can involve the bladder or ureters. The ureters are the tubes that carry urine from the kidneys to the bladder, so involvement can matter for kidney drainage. Not every urinary symptom is endometriosis, but urinary symptoms that are cyclical, severe, recurring, worsening or linked with pelvic pain should be assessed properly.
What bladder endometriosis means
Bladder endometriosis means endometriosis-like tissue is found on or in the bladder. Bladder endometriosis is describes as endometrial-like tissue inside or on the surface of the bladder. It may occur with deep pelvic endometriosis, although it can occasionally occur separately. Bladder symptoms can also be caused by other conditions, such as urinary tract infection, bladder pain syndrome, pelvic floor dysfunction or inflammation. This is why proper assessment matters.
What ureter endometriosis means
Ureter endometriosis means endometriosis-like tissue involves one or both ureters. The ureters carry urine from the kidneys to the bladder. If endometriosis affects or compresses a ureter, it can interfere with urine drainage from the kidney. Ureter endometriosis is often associated with deep infiltrating endometriosis and can sometimes be asymptomatic. In some cases ureter obstruction can cause urine backflow into the kidney, kidney enlargement and possible kidney damage if not recognised.
Symptoms that may be relevant
Urinary symptoms linked with endometriosis may include:
- pain when passing urine
- burning during urination
- bladder pressure
- urinary urgency
- needing to wee more often
- pain when the bladder is full
- pain after emptying the bladder
- pelvic pain linked with urination
- repeated UTI-like symptoms
- negative urine tests despite symptoms
- lower back or flank pain
- blood in urine
- urinary symptoms that worsen around a period
Why ureters matter
Ureter involvement matters because symptoms can be mild, unclear or absent. Some people may have pelvic pain, urinary symptoms, repeated infections, flank pain or blood in urine. Others may not notice symptoms until kidney drainage is affected. This is why suspected ureter involvement should be taken seriously. It may need kidney and urinary tract imaging, endometriosis specialist review and urology input.
Assessment and imaging
Assessment may include:
- symptom review
- urine testing to check for infection or blood
- pelvic examination if appropriate and consented to
- pelvic ultrasound
- specialist ultrasound
- MRI for suspected deep disease
- kidney or urinary tract imaging
- cystoscopy in selected bladder cases
- ureteroscopy or further urology assessment in selected ureter cases
- review by an endometriosis specialist team
A normal scan does not always rule out endometriosis, so symptoms and specialist judgement still matter.
When urology input may be needed
Urology may be needed if bladder or ureter involvement is suspected, especially if surgery is being considered. This may be relevant where there is:
- suspected bladder endometriosis
- suspected ureter involvement
- blood in urine
- flank pain
- kidney drainage concerns
- repeated UTI-like symptoms
- pain when the bladder is full
- deep disease near the bladder or ureters
- surgery planned close to the urinary tract
Bladder and ureter endometriosis surgery can be technically challenging and often requires a multidisciplinary approach with a urologist.
Treatment planning
Not everyone with urinary symptoms needs surgery. Care may include:
- checking for urinary tract infection
- symptom review and monitoring
- pain relief where appropriate
- hormonal symptom management in selected cases
- pelvic physiotherapy if pelvic floor tension is involved
- bladder symptom management
- specialist endometriosis review
- urology input
- planned surgery where bladder or ureter disease is confirmed or strongly suspected
If surgery is discussed, ask what procedure may be needed, whether a urologist will be involved, and what will happen if bladder or ureter disease is found.
Questions to ask
You may want to ask:
- Could bladder or ureter endometriosis be possible?
- Could pelvic floor dysfunction or bladder pain syndrome also be involved?
- Should I see urology?
- Do I need kidney or urinary tract imaging?
- Would specialist ultrasound or MRI help?
- What would imaging show or miss?
- If surgery is planned, will the bladder and ureters be assessed?
- Would a urologist be available if needed?
- What symptoms are urgent?
Prepare before you speak with a healthcare professional
Use our Prepare for Appointment Tool to organise your symptoms, questions, previous treatments, test results, scan results and priorities before your appointment. Try to record:
- when urinary symptoms happen
- whether symptoms link to your period or ovulation
- whether there is pain before, during or after urination
- whether pain changes when the bladder is full or empty
- whether urine tests showed infection
- whether there is blood in urine
- whether you have lower back or flank pain
- whether symptoms happen with bowel, pelvic or fatigue symptoms
- how symptoms affect daily life
You do not need a perfect diary. A clear symptom pattern can help the conversation feel more focused.
Finding the right type of care
Use the Endometriosis Care Directory to explore different types of endometriosis-related care providers. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.
Final reminder
Bladder and ureter symptoms deserve proper assessment, especially when they are cyclical, severe, recurring, worsening or linked with pelvic pain. Ureter involvement matters because it can affect kidney drainage, sometimes with few or unclear symptoms. If urinary tract endometriosis is suspected, endometriosis care may need urology input and specialist imaging. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.