Bladder Weakness After Laparoscopy – What can I do?
Understanding Bladder Weakness
Urinary incontinence, often referred to as bladder weakness, affects approximately 15 million women in Germany. Beyond its physical implications, involuntary urine loss carries psychological and social repercussions, casting a shadow over the lives of those impacted. Yet, not all cases of bladder weakness are identical; degrees of severity vary considerably.
Urinary incontinence presents in diverse forms. The prevalent types encompass stress incontinence, urge incontinence, and a combination of both [4].
Several telltale indicators serve as markers of bladder weakness:
- Frequent and sudden urges to urinate.
- Limited urine volume per instance.
- Cramp-like sensations within the bladder.
- Discomfort during urination.
- Traces of blood within the urine.
- Heightened susceptibility to urinary tract infections and bladder infections.
Frequency of Bladder Weakness Post-Endometriosis Surgery
Bladder weakness symptoms after surgery align with symptoms triggered by other factors.
In a study encompassing 108 women who underwent laparoscopy for endometriosis, an evaluation of bladder function was retrospectively conducted. A comparative analysis of preoperative and postoperative factors was executed, focusing on bladder function alterations before and after endometriosis surgery. Findings indicated that 19.6% of these women encountered bladder dysfunction post-laparoscopy. This translates to approximately 21 out of 108 patients facing urination difficulties following the procedure [5].
In a separate study involving 52 endometriosis patients who underwent laparoscopic partial colon resection, a follow-up examination after around 19 months assessed urinary symptoms. The outcome revealed that 29% of patients experienced dysuria—painful or uncomfortable bladder emptying [6].
Furthermore, another study featuring 47 patients who underwent surgery for rectovaginal deep infiltrating endometriosis (involving the rectum and vagina) reported instances of bladder weakness within five years post-surgery. The predominant complaint revolved around a weak urinary stream and the necessity for a Valsalva Maneuver when urinating.
The Valsalva Maneuver, a familiar concept for many, involves closing the lips and holding the nose to equalize pressure during activities such as flying. When applied during urination, it mimics a similar effect, often aiding the process [7].
Causes of Bladder Weakness: General and Post-Endometriosis Surgery
General causes of bladder weakness
Bladder weakness tends to manifest differently based on gender and specific circumstances. In women, occurrences often follow pregnancy or surface during older age. For men, stress incontinence can arise post-prostate surgery [4].
Causes of bladder weakness after endometriosis surgery
Bladder dysfunction after surgery presents as an intricate interplay of factors. It seems to stem from a unique bladder hypersensitivity to stimuli or substances [5]. Additionally, colorectal resection performed for endometriosis treatment, as discussed earlier, might contribute to urinary dysfunction [6]. In the context of patients who have undergone surgery for rectovaginal and deep infiltrating endometriosis, the risk of bladder paralysis exists. Consequently, close, prolonged observation becomes essential for these cases [7].
Moreover, transient bladder weakness or urinary tract discomfort might result from a bladder catheter used during surgery. Placement of a bladder catheter is common during and after surgical procedures, but it may trigger irritation. Although brief episodes of pain and involuntary urinary leakage can occur, they usually subside during the healing process.
Understanding Bladder Endometriosis
To comprehend the potential connection between bladder weakness and surgical interventions for bladder endometriosis, it is crucial to delve into the fundamentals:
Bladder endometriosis involves the presence of tissue with cellular resemblance to the uterine lining cells, situated within or on the bladder, among other potential locations [1]. Notably, an estimated 0.3 – 12% of affected individuals experience urinary tract endometriosis (UTE). In other words, these growths are detected within the urinary tract in about two out of every 100 individuals with endometriosis.
The symptoms and manifestations associated with bladder endometriosis are notably nonspecific – ranging from lower abdominal pain to frequent urination and urges to urinate. Unfortunately, these vague indicators do not provide clear-cut identification criteria leading to an accurate diagnosis. Paradoxically, due to the resemblance of these symptoms to those of a urinary tract infection, individuals afflicted with bladder endometriosis often receive antibiotics, an incorrect course of treatment [2].
Managing Bladder Weakness Post-Endometriosis Surgery
Addressing bladder weakness following endometriosis surgery requires tailoring solutions to the individual’s symptoms and underlying causes, given the multifaceted nature of the condition. Several approaches are available:
Physiotherapy emerges as a viable option. In a conversation with Annika Cost, a specialized physiotherapist in endometriosis, it was highlighted that pelvic floor tension could contribute to bladder floor irritation. This tension might trigger untimely urges to urinate. Physiotherapy involves maintaining a daily urination diary to analyze patterns and identify areas for improvement. Techniques encompass addressing adhesions and muscles around the bladder, along with implementing urge-push strategies to alter habits.
Bladder training seeks to enhance bladder capacity by training it to stretch more and hold greater volumes of urine. Strengthening the pelvic floor can also alleviate bladder weakness symptoms. Focusing on these muscles through exercises can provide support in managing urinary function.
Assistance Measures Post-Surgery
In the context of managing bladder weakness following endometriosis surgery, various aids can contribute to enhancing everyday comfort:
For example, you can buy incontinence pads. Readily available at pharmacies and stores, incontinence pads resemble sanitary napkins, designed to be worn in panties. These pads are tailored to manage bladder weakness, offering discreet protection. Different designs are available, enabling individuals to choose the most comfortable fit. For more pronounced cases of incontinence, individuals might consider incontinence diapers or pants. Resembling regular underwear, these aids offer greater absorbency and protection. Bed liners offer protection for mattresses during sleep, a valuable aid for those experiencing involuntary urine leakage.
Bladder weakness often brings with it emotional challenges. Many individuals experience feelings of shame, fear, and insecurity. Concerns about leaks, stains, explaining the issue to future partners, and navigating everyday activities can be overwhelming. It is essential to recognize that you are not alone in this journey. Connecting and sharing with other individuals experiencing the same issue can provide a sense of community and support. If the emotional impact becomes burdensome, seeking guidance from a doctor or psychologist can be beneficial.
Remember, addressing bladder weakness requires a multifaceted approach that encompasses both physical management and emotional well-being.
What is the Procedure for Surgery with Bladder Involvement?
Upon confirmation of bladder involvement, a comprehensive medical consultation delves into available options. One viable approach is laparoscopic surgery. In this procedure, known as laparoscopy, identified foci positioned on the external bladder surface can be meticulously addressed and excised. When endometriosis presents in a superficial manner, a technique termed “shaving” is employed to delicately manage the situation. Conversely, if the endometriosis infiltrates deeply into the tissues of the urinary tract, a partial cystectomy might be undertaken, involving the removal of the affected segment of the urinary bladder [2],[3].
Do you have any questions?
We trust that our blog post concerning bladder weakness following endometriosis surgery has provided valuable insights. If you have gained knowledge or found resonance, we would be delighted to hear your thoughts in the comments. Your story holds significance—do not hesitate to share. Do you have any advice to offer? Your tips could be of immense help. Let your experiences guide others. Join the conversation in the comments section!
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References
- Kolodziej, A., Krajewski, W., Dolowy, L., & Hirnle, L. (2015). Urinary Tract Endometriosis. Urology Journal, 12(4), 2213-2217. https://doi.org/10.22037/uj.v12i4.2838
- Burghaus S, Schäfer SD, Beckmann MW, Brandes I, Brünahl C, Chvatal R, Drahoňovský J, Dudek W, Ebert AD, Fahlbusch C, Fehm T, Fehr PM, Hack CC, Häuser W, Hancke K, Heinecke V, Horn LC, Houbois C, Klapp C, Kramer H, Krentel H, Langrehr J, Matuschewski H, Mayer I, Mechsner S, Müller A, Müller A, Müller M, Oppelt P, Papathemelis T, Renner SP, Schmidt D, Schüring A, Schweppe KW, Seeber B, Siedentopf F, Sirbu H, Soeffge D, Weidner K, Zraik I, Ulrich UA. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020). Geburtshilfe Frauenheilkd. 2021 Apr;81(4):422-446. doi: 10.1055/a-1380-3693. Epub 2021 Apr 14. PMID: 33867562; PMCID: PMC8046516.
- Sevelda U, Lamche M, Hudelist G, Mechsner S, Rohloff N, Götte N, Kiesel L, Krentel H, Kohl Schwartz AS, Wölfler MM, Mitter V, Rauchfuss M, Haeberlin F, Eberhard M, von Orelli S, Imthurn B, Imesch P, Fink D, Leeners B, Young S, Kennedy Burns M, Di Francesco L, Nezhat A, Nezhat C. Endometriosis – Current diagnosis and therapy. Endometriosis Current. 2018;1:2-34.
- Katzemich, Sarah. “What makes the bladder strong.” Deutsche Apotheker Zeitung, 21 (2019): 52-54, https://www.deutsche-apotheker-zeitung.de/daz-az/2019/daz-21-2019/was-die-blase-stark-macht.
- Won HR, Maley P, Chetty N, Chan K, Abbott J. Bladder dysfunction after gynecologic laparoscopic surgery for benign disease. J Minim Invasive Gynecol. 2012 Jan-Feb;19(1):76-80. doi: 10.1016/j.jmig.2011.09.013. Epub 2011 Nov 25. PMID: 22118884.
- Ballester M, Chereau E, Dubernard G, Coutant C, Bazot M, Daraï E. Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery. Am J Obstet Gynecol. 2011 Apr;204(4):303.e1-6. doi: 10.1016/j.ajog.2010.11.011. Epub 2011 Jan 21. PMID: 21256472.
- Possover M. Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltrating rectovaginal and/or parametric endometriosis. Fertil Steril. 2014 Mar;101(3):754-8. doi: 10.1016/j.fertnstert.2013.12.019. Epub 2014 Jan 11. PMID: 24424366
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