Why It Hurts When I Pee During My Period

Understanding Kidney Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, leading to fibrosis. This disease can have a negative impact on the reproductive organs, bowels, bladder, and, in rare cases, even the kidneys. Kidney endometriosis, although extremely uncommon, can occur as a secondary condition due to a blockage in the ureters called hydroureter. [^1^]

Endometriosis of the kidneys

It’s important to note that kidney endometriosis accounts for less than 1% of urinary tract endometriosis cases and only 1.2% of all endometriosis cases. However, raising awareness about endometriosis may shed more light on this rare occurrence. [^2^]

Causes of Kidney Endometriosis

The exact cause of endometriosis remains unclear, and it’s even more challenging to understand why this condition sometimes affects the kidneys. During the menstrual cycle, the endometrial tissue thickens and sheds in response to hormonal changes. This process might lead to the formation of endometrial cysts in the kidneys, known as endometriomas. However, the precise cause is still uncertain. Some researchers believe that an overactive immune response might allow endometrial lesions to infiltrate the kidneys. [^3^]

With each menstrual cycle, more endometrial cysts accumulate in the kidneys, potentially invading the fibrous layer surrounding them, called the renal capsule. This invasion can cause pain, and blood clots might obstruct the ureter, resulting in renal colic—a type of kidney pain. As the condition progresses, the shape and normal function of the kidneys can be severely affected by the endometrial cysts. [^3^]

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Symptoms of Kidney Endometriosis

Kidney endometriosis can remain asymptomatic for several years, often discovered incidentally during the evaluation of other conditions. However, if a woman who has undergone endometriosis surgery experiences ongoing urinary problems, it could indicate the presence of urinary tract or kidney endometriosis. Look out for the following symptoms which may suggest kidney endometriosis:

  • Lower back pain that coincides with the menstrual cycle and can extend down the legs.
  • Blood in the urine that occurs during the menstrual cycle.
  • Difficulty urinating.
  • Recurrent urinary tract infections. [^4^]

Diagnosing Kidney Endometriosis

Given that most physicians are not well-versed in endometriosis, patients with kidney endometriosis often face misdiagnosis, with kidney cancer being mistakenly identified. This misdiagnosis can delay timely treatment or even result in incorrect treatment approaches. To avoid this, it’s crucial to consult with a specialist who can carefully review the patient’s medical history and conduct a pelvic examination.

Key indicators of kidney endometriosis include lower back pain and cyclical blood in the urine, which can be alleviated with hormonal treatments like birth control. Additionally, imaging tests such as magnetic resonance imaging (MRI) scans or contrast-enhanced computed tomography (CECT) can be performed to visualize endometrial lesions in and around the kidneys. However, to definitively diagnose kidney endometriosis, a histopathologic examination of kidney tissue obtained through a biopsy is necessary. It’s important to note that this invasive approach carries potential complications. [^5^]

Treatment Options

Left untreated, kidney endometriosis can lead to kidney damage and even kidney failure. Treatment options for kidney endometriosis involve managing the symptoms and removing endometrial lesions. Just like any other type of endometriosis, the symptoms can be managed with medications such as GnRH agonists and oral contraceptives. However, the most effective approach is to remove the endometrial lesions through minimally invasive laparoscopic surgery. It’s crucial that this surgical procedure is performed by a team of specialized surgeons, including gynecological, adrenal, and urological laparoscopic experts, due to the high risk of complications that may arise, such as damage to the bowel, bladder, ureter, and corresponding blood vessels. [^6^]

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Patient Story

Elina Kharnak’s case sheds light on the less common ramification of endometriosis—kidney involvement. Although rare, endometriosis can silently attack the kidneys, causing ureteral endometriosis—an endometriosis that affects the ureters. Swelling in the kidneys and potential kidney loss can occur when endometriosis wraps around one or both ureters. Unfortunately, Elina was diagnosed with kidney endometriosis when it was already too late to prevent kidney damage. [^7^]

To read more about Elina’s story, visit 5 WS.

References

[^1^]: DrSeckin. (n.d.). Why Does It Hurt When I Pee On My Period? [Photograph]. Retrieved from https://5ws.wiki/wp-content/uploads/why-does-it-hurt-when-i-pee-on-my-period-1.jpg
[^2^]: DrSeckin. (n.d.). Why Does It Hurt When I Pee On My Period?
[^3^]: DrSeckin. (n.d.). Causes of Kidney Endometriosis.
[^4^]: DrSeckin. (n.d.). Symptoms of Kidney Endometriosis.
[^5^]: DrSeckin. (n.d.). Diagnosis of Kidney Endometriosis.
[^6^]: DrSeckin. (n.d.). Treatment Options for Kidney Endometriosis.
[^7^]: DrSeckin. (n.d.). Patient Story: Endometriosis Killed My Kidney, Says Patient. [Photograph]. Retrieved from https://5ws.wiki/wp-content/uploads/why-does-it-hurt-when-i-pee-on-my-period-2.jpg

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