Bladder weakness after laparoscopy – What can I do?

What is bladder weakness?

Urinary incontinence, or more commonly known as bladder weakness, affects around 15 million women in Germany. Involuntary loss of urine is not only a physical restriction; psychological stress and social consequences can also have a negative impact on the lives of those affected. However, bladder weakness is not always the same as bladder weakness: from a few drops that cannot be “held” to complete, involuntary bladder emptying, there are various degrees.

There are also various forms of urinary incontinence. The most common of these are stress incontinence, urge incontinence, or even a mixed form of the two incontinence. [4]

The following symptoms are typical indications of bladder weakness:

  • Frequent urge to urinate
  • Urinating only in small quantities
  • Cramp-like pain in the bladder
  • Pain when urinating
  • Traces of blood in the urine
  • Increased incidence of urinary tract infections and bladder infections

Frequency of bladder weakness after endometriosis surgery

Symptoms of bladder weakness due to surgery are consistent with symptoms of bladder weakness due to other causes.

In a study, 108 women who underwent laparoscopy for their endometriosis disease underwent a retrospective assessment of bladder function. Various preoperative and postoperative factors were observed and compared, respectively. These included bladder function before and after endometriosis surgery. 19.6% of the operated women experienced bladder dysfunction after laparoscopy. This means that about 21 out of 108 patients had difficulty urinating after the procedure. [5]

In another study, 52 endometriosis patients underwent laparoscopic partial colon resection. After approximately 19 months, the patients presented for a follow-up examination to observe urinary symptoms. The result: dysuria (painful, uncomfortable bladder emptying) was found in 29% of the patients. [6]

In another study, 47 patients who had rectovaginal deep infiltrating endometriosis (connection between the rectum and vagina) presented to their surgeons with bladder weakness within five years of their surgery. Most commonly, the patients complained of a weak urinary stream and the need for what is called a Valsalva maneuver when urinating.

The Valsalva maneuver may be familiar to many: to equalize pressure, for example when flying, we press our lips together and hold our nose. With tense abdominal muscles, we try to “exhale” through the closed nose and mouth. When urinating, this procedure can have a similar effect. [7]

What can be the causes of bladder weakness and why does it occur specifically after a laparoscopy?

Cause of bladder weakness in general

In general, bladder weakness in women often occurs after pregnancy or in old age. In men, on the other hand, stress incontinence occurs more often after surgical removal of the prostate. [4]

Causes of bladder weakness after endometriosis surgery.

Bladder dysfunction after surgery appears to be idiosyncratic. This means that the bladder exhibits some hypersensitivity to substances or stimuli. [5] Colorectal resection for the treatment of endometriosis, as described above, may also be a cause of urinary dysfunction. [6] For patients who have undergone surgery for rectovaginal and deep infiltrating endometriosis, the procedure carries a risk of bladder paralysis. Therefore, it can be concluded that patients operated for deep infiltrating endometriosis need to be observed for a long time. [7]

Furthermore, short-term bladder weakness or pain in the urinary tract may also occur after surgery due to a bladder catheter. During and even after surgery, patients often have a bladder catheter placed, which may be responsible for irritation. Both pain and involuntary urinary leakage may occur for a short time, but should usually disappear during the healing process.

What is bladder endometriosis?

Since bladder weakness can occur in connection with surgical treatment of bladder endometriosis, you will learn the most important things here:

In bladder endometriosis, tissue whose cells resemble the cells of the uterine lining is found in and/or on the bladder, among other places. [1] Approximately 0.3 – 12% of those affected suffer from urinary tract endometriosis (UTE). Which, conversely, means that the growths could be detected in the urinary tract in about two out of 100 endometriosis sufferers.

The symptoms and complaints of bladder endometriosis are very unspecific (pain in the lower abdomen, frequent urination, urge to urinate, etc.) and are therefore unfortunately not clear identification characteristics that necessarily lead to the correct diagnosis. On the contrary, because the symptoms resemble a urinary tract infection, affected individuals are often treated with antibiotics and thus, regrettably, incorrectly. [2]

What can help with bladder weakness after endometriosis surgery?

Due to the versatility of symptoms and causes of bladder weakness after surgery, there is no universal therapy. However, there are different options.

One of the possibilities is physiotherapy. In an interview, we were already allowed to speak with Annika Cost, a physiotherapist who specializes in endometriosis. Annika describes in the interview that a tension of the pelvic floor can be one of the causes of irritation of the bladder floor. This can, for example, trigger a premature urge to urinate. In physiotherapy, one can then create a diary of daily urination. Based on the entries, the situation can be analyzed and opportunities for improvement can be identified. For example, adhesions and muscles located around the bladder can be worked on, and certain habits can be changed with so-called urge-push strategies.

In addition, bladder training and strengthening the pelvic floor can provide relief. Bladder training involves training the bladder to stretch more and store more urine, among other things.

What are the small aids after surgery?

In case of bladder weakness after endometriosis surgery, the following aids can make everyday life easier:

For example, you can buy incontinence pads in all drugstores. The pads, like a sanitary napkin that you put in your panties during your period, are also used for bladder weakness. Incontinence pads are basically the same as incontinence pads, but have a different cut. It is best to try out which design is more comfortable for you to wear. For more severe incontinence, you can also try incontinence diapers or incontinence pants, which are put on like underwear. Another aid for involuntary urine leakage is a bed liner, which protects your mattress while you sleep.

Incontinence is quite a shameful topic: suffering from bladder weakness at a young age is uncomfortable for many women. But shame is not the only silent companion of incontinence. Many sufferers also feel fear and insecurity:

Is my panty liner enough?

Will I have a stain between my legs?

When will I go to the toilet next time?

How do I explain my problem to a future partner?

We understand this very well. That’s why we strongly encourage you to connect and share with other sufferers. Seeing that you are not alone, and feeling cohesion can help you a lot with your insecurities. If your bladder weakness stresses you so much that you can’t find comfort in sharing with others, contact your doctor and/or psychologist.

What is the procedure for surgery with bladder involvement?

If the suspicion of bladder involvement is confirmed, all options are discussed in a medical consultation. One option is laparoscopic surgery. During the so-called laparoscopy, foci that are located on the outside of the bladder can be secured and removed. If the endometriosis grows superficially, a so-called shaving of the bladder can be performed. However, if the endometriosis tissue grows deep infiltrating the tissues of the urinary tract, the affected part of the urinary bladder can be removed in a partial cystectomy. [2],[3]

Do you have any questions?

We hope you were able to take away some information from our blog post about bladder weakness after endometriosis surgery. If you’d like to share your story, feel free to let us know in the comments. Do you have any tips for other sufferers, perhaps? What has helped you with your bladder weakness? Feel free to post in the comments!

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  1. Kolodziej, A., Krajewski, W., Dolowy, L., & Hirnle, L. (2015). Urinary Tract Endometriosis. Urology Journal, 12(4), 2213-2217.
  2. 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.
  3. 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.
  4. Katzemich, Sarah. “What makes the bladder strong.” Deutsche Apotheker Zeitung, 21 (2019): 52-54,
  5. 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.
  6. 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.
  7. 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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