ENDOMETRIOSIS AND BLADDER HEALTH
Why bladder pain, urgency, and frequency are more connected to endo than most women are told.
By Katie Rice | Accredited Naturopath & Nutritionist | Her Herbs Founder
You've had the surgery. Or you're managing the endo as best you can. But the bladder symptoms won't settle. The urgency. The frequency. The pain when your bladder is full. The feeling that you're constantly aware of needing to go, or that something is just not right in that area.
You've probably been told it's a UTI, tested negative, and been sent home without answers. Or you've been told the endo is under control and the bladder symptoms should improve. And they haven't.
This is more common than most women realise, and it deserves a proper explanation.
Bladder Symptoms Are Common in Endometriosis
The research is clear that bladder pain, urgency, and urinary frequency are frequently reported in women with endometriosis, even when the bladder itself isn't directly involved.
A 2025 systematic review found overactive bladder symptoms in between 9 and 32 percent of women with endometriosis that hadn't spread to the urinary tract. A 2024 review found overactive bladder coexisted in around 20 percent of women with non-urinary endometriosis. These are not small numbers, and they reflect something important: you don't need bladder endometriosis to have significant bladder symptoms.
If bladder urgency, frequency, or pain has been part of your experience and it hasn't been investigated beyond checking for infection, you are not imagining it and you are not being dramatic. You are experiencing something that warrants proper assessment.
Is It Endo, Interstitial Cystitis, or Both?
This is the question women search for most, and it's the right question to be asking.
Bladder endometriosis, where endometrial-like tissue grows on or into the bladder wall, occurs in roughly one percent of people with endometriosis. It can cause cyclic pain that worsens around menstruation, blood in the urine, and in some cases damage to the upper urinary tract if it goes unrecognised. It's less common, but clinically important.
More frequently, what women experience is an overlap between endometriosis and interstitial cystitis, also called bladder pain syndrome or IC/BPS. This is a chronic bladder pain condition characterised by urgency, frequency, and pelvic pain that isn't explained by infection or another clear cause. It can coexist with endometriosis rather than being caused by it, and when both are present, symptoms are typically more severe and quality of life more significantly affected.
A 2024 study found that roughly 12 percent of women with IC/BPS also had endometriosis, and those with both conditions reported worse pain outcomes than those with either condition alone. A 2026 opinion paper highlighted that the two conditions frequently overlap in women with chronic pelvic pain, and that the diagnostic pathways for each are often not run in the same setting, meaning one is treated while the other is missed entirely.
The symptoms of bladder endometriosis and IC/BPS look similar from the outside: pelvic pain, urgency, frequency, and discomfort with a full bladder. Telling them apart requires proper investigation, not assumption.
Why Surgery Doesn't Always Fix It
This is one of the most common and most frustrating experiences women describe. Endometriosis surgery happens. The recovery is hard. And the bladder symptoms persist or return.
The research explains why. A 2025 review found surgical outcomes for bladder symptoms in endometriosis were inconsistent across studies, with some showing no improvement and one showing worsening after surgery. If bladder symptoms are driven by IC/BPS, overactive bladder, or central pain sensitisation rather than by endometriosis implants specifically, removing endometrial lesions will not resolve them. The bladder dysfunction has its own cause and needs its own treatment.
This is why the newer clinical thinking is moving toward integrated assessment, where gynaecological and urological evaluation happen together rather than in separate, unconnected appointments. A 2026 surgical opinion argued that combining laparoscopy with diagnostic cystoscopy in the same setting improves the ability to identify whether pain is bladder-centric or not, and to direct treatment accordingly.
If you've had endometriosis treatment and bladder symptoms remain, this isn't a failure of your recovery. It's a signal that the bladder piece may need its own investigation and management.
What Tests Are Worth Asking For
If bladder symptoms are part of your picture, here's what a thorough assessment might include.
Urine testing to rule out infection, which is usually the first step and often where investigation stops. It shouldn't be.
Imaging, including ultrasound or MRI, to assess whether endometrial lesions are present on or near the bladder wall or ureters.
Cystoscopy, a procedure where the inside of the bladder is examined directly, which is the most useful tool for identifying bladder endometriosis or signs of IC/BPS. This is often not ordered unless you ask specifically.
Urodynamic testing, which assesses how the bladder stores and releases urine, can be relevant when overactive bladder symptoms are prominent.
You are allowed to ask for these investigations. If bladder symptoms are affecting your daily life and they haven't been assessed beyond urine dipsticks, a referral to a urogynaecologist or a specialist with an interest in chronic pelvic pain is a reasonable request.
A Naturopathic Perspective
From a naturopathic standpoint, bladder symptoms in endometriosis sit at the intersection of inflammation, nervous system sensitisation, and pelvic floor function, and all three are addressable.
Reducing systemic inflammation through an anti-inflammatory dietary approach lowers the inflammatory burden that contributes to bladder hypersensitivity. This includes reducing dietary triggers that are commonly associated with bladder irritation, caffeine, alcohol, acidic foods, and carbonated drinks, while increasing anti-inflammatory foods that support the pelvic environment more broadly.
Pelvic floor physiotherapy is one of the most practically useful interventions for bladder symptoms in endometriosis. Pelvic floor dysfunction is extremely common in women with chronic pelvic pain, and a hypertonic or poorly coordinated pelvic floor can drive both bladder urgency and pain independently of any underlying lesions. If you haven't seen a pelvic floor physio who understands endometriosis, this is worth prioritising.
Nervous system support matters here too. Central sensitisation, where the nervous system becomes hypersensitive to pain signals, plays a role in both chronic pelvic pain and bladder pain syndromes. Practices that down-regulate the threat response and reduce overall nervous system load can meaningfully reduce symptom severity over time.
Herbal and nutritional support can be helpful for bladder comfort, urinary tract health, and the inflammatory picture, but what's appropriate depends on your full symptom picture and whether IC/BPS, bladder endo, or overactive bladder is the primary driver. This is an area where individualised naturopathic guidance makes a real difference.
Track It
Bladder symptoms follow patterns, and those patterns are clinically useful. Are symptoms worse before your period? After certain foods? During a flare? Consistent tracking gives your practitioners something to work with rather than a vague account of ongoing discomfort.
The Her Herbs Endometriosis Companion App includes bladder symptom tracking as part of the daily check-in, so that when you go to your next appointment, you have data rather than fragments of memory.
DOWNLOAD THE HER HERBS ENDOMETRIOSIS COMPANION APP
A Note From Katie
"Bladder symptoms were one of the most common things women mentioned in endo consultations, and almost always after everything else, as if they weren't sure it counted. It counts. Urgency, frequency, and bladder pain that doesn't respond to antibiotics is not a separate, unrelated problem. It's part of the picture, and it deserves proper investigation. If your bladder has never been formally assessed in the context of your endometriosis, that's worth raising at your next appointment."
-Katie Rice, Naturopath & Founder, Her Herbs
This content is for educational purposes only and does not constitute medical advice. Please consult your healthcare provider regarding your individual health concerns.
