Bladder Weakness After Laparoscopy – What Can I Do?
What is Urinary Incontinence?
Urinary incontinence, a condition often colloquially referred to as “bladder weakness,” affects approximately 15 million women in Germany. Involuntary urine loss poses not only physical limitations but can also have adverse psychological and social consequences for those affected. It is important to note that not all cases of urinary incontinence are the same, varying from minor leaks that cannot be controlled to complete and involuntary bladder emptying, representing a spectrum of severity.
Various forms of urinary incontinence exist, with stress incontinence, urge incontinence, and mixed incontinence being the most common types [4]
Typical symptoms indicative of urinary incontinence include:
- Frequent, sudden urges to urinate.
- Urinating only in small amounts.
- Cramp-like pain in the bladder.
- Pain during urination.
- Presence of blood in the urine.
- Increased susceptibility to urinary tract infections and bladder infections.
The Incidence of Post-Endometriosis Surgery Bladder Weakness
The symptoms of bladder weakness resulting from endometriosis surgery closely resemble those arising from other causes.
In a study involving 108 women who had undergone laparoscopy to treat endometriosis, a retrospective assessment of bladder function was conducted. Various preoperative and postoperative factors were closely observed and compared. This comprehensive analysis included the evaluation of bladder function before and after endometriosis surgery. The findings revealed that approximately 19.6% of the women who had undergone laparoscopy experienced bladder dysfunction after the procedure. In concrete terms, this equates to roughly 21 out of the 108 patients encountering difficulties with urination following the surgery [5].
In a separate study, 52 patients with endometriosis underwent laparoscopic partial colon resection. After approximately 19 months, these patients returned for a follow-up examination to observe urinary symptoms. The outcome showed that 29% of these patients experienced dysuria, characterized by painful and uncomfortable bladder emptying [6].
Another study focused on 47 patients who had rectovaginal deep infiltrating endometriosis, where there is a connection between the rectum and the vagina. Within 5 years of their surgeries, these patients reported bladder weakness to their physicians. The most common complaints included a weak urinary stream and the need for what is known as the Valsalva maneuver during urination.
The Valsalva maneuver might be familiar to many as a technique used, for example, to equalize pressure during activities like flying; it involves sealing the lips and nose and then attempting to exhale forcefully. When urinating, employing this maneuver can produce a similar effect [7].
The Causes of Bladder Weakness and Its Occurrence Following Laparoscopy?
Cause of Bladder Weakness in General
Bladder weakness, particularly in women, often occurs after pregnancy or during old age. Conversely, in men, stress incontinence is more commonly associated with surgical prostate removal [4].
Causes of Bladder Weakness Following Endometriosis Surgery
The emergence of bladder dysfunction after surgery appears to be somewhat individualized. This means the bladder is sensitive to certain substances or stimuli [5]. As highlighted earlier, colorectal resection for endometriosis treatment can also be a contributing factor to urinary dysfunction [6]. For patients who have undergone surgery for rectovaginal and deep infiltrating endometriosis, there is a risk of bladder paralysis, underlining the importance of long-term monitoring for these individuals [7].
Additionally, temporary bladder weakness or urinary tract discomfort may result from the presence of a bladder catheter after surgery. It is a common practice to insert a bladder catheter during and after surgery, and this catheter can sometimes lead to irritation. While patients may experience pain and occasional involuntary urinary leakage in the short term, these issues typically resolve as the healing process progresses.
Understanding Bladder Endometriosis
As bladder weakness can be associated with the surgical treatment of bladder endometriosis, let us delve into the essential aspects:
Bladder endometriosis is a condition characterized by the presence of tissue with cells similar to those found in the uterine lining, located within or on the bladder, among other possible sites [1]. Around 0.3% to 12% of individuals with endometriosis are affected by urinary tract endometriosis (UTE), meaning that in approximately 2 out of every 100 endometriosis cases, these growths can be identified within the urinary tract.
The symptoms associated with bladder endometriosis, such as lower abdominal pain, frequent urination, and a strong urge to urinate, are highly nonspecific. Consequently, they do not provide clear indicators for an accurate diagnosis. Instead, they often resemble those of a urinary tract infection, leading to the unfortunate administration of antibiotics as treatment [2].
Managing Bladder Weakness After Endometriosis Surgery
Given the varied symptoms and causes of bladder weakness following surgery, there is no one-size-fits-all treatment. Nevertheless, several options are available.
One possibility is physiotherapy. We previously had the opportunity to interview Annika Cost, a physiotherapist specializing in endometriosis. Annika explained that pelvic floor tension can contribute to bladder floor irritation, potentially leading to premature urges to urinate. In physiotherapy, patients can keep a daily urination diary. Using these records, the situation can be analyzed to identify potential areas for improvement. This may involve addressing adhesions and muscles around the bladder and adopting urge-control strategies.
Furthermore, bladder training and pelvic floor strengthening can offer relief. Bladder training focuses on expanding the bladder’s capacity and improving urine storage.
What Post-Surgery Solutions Are Available?
For those dealing with bladder weakness following endometriosis surgery, several helpful aids can make daily life more manageable.
- Incontinence Pads: Incontinence pads, readily available at drugstores, are similar to sanitary napkins designed for use with bladder weakness. These pads come in various cuts, allowing you to find the most comfortable option.
- Incontinence Diapers and Pants: For more severe incontinence, consider incontinence diapers or pants, which are worn like regular underwear.
- Bed Liners: A bed liner can safeguard your mattress during sleep, protecting it in case of involuntary urine leakage.
Dealing with incontinence, especially at a young age, can be uncomfortable and may lead to feelings of shame, fear, and insecurity. Many questions might arise, such as the adequacy of a panty liner, concerns about stains, and how to discuss the issue with a future partner. To combat these feelings, we recommend connecting with and sharing your experiences with others who face similar challenges. The sense of community can be reassuring and alleviate insecurities. If your bladder weakness becomes overwhelming and hinders your ability to find comfort in sharing with others, consider reaching out to a medical professional and/or psychologist for support.
What is the procedure for surgery when bladder involvement is confirmed?
Upon confirming the suspicion of bladder involvement, a medical consultation is held to explore available options. Laparoscopic surgery is one such option. This procedure, known as laparoscopy, allows for the identification and removal of endometriosis foci located on the external surface of the bladder. In cases where endometriosis growth is superficial, a technique called “shaving of the bladder” may be employed. However, if endometriosis tissue infiltrates deeply into the urinary tract tissues, a partial cystectomy may be recommended to remove the affected portion of the urinary bladder [2], [3].
Do you have any questions or insights to share?
We trust you found valuable information in our blog post about bladder weakness following endometriosis surgery. If you have a personal experience you would like to share or helpful tips for others living with endometriosis; please do not hesitate to leave your comments. Your input can make a difference in supporting those going through similar challenges.
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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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