If you’ve ever experienced frequent, painful urination or persistent pelvic discomfort, your first thought might be that you have a urinary tract infection (UTI). After all, UTIs are incredibly common, especially among women. However, what if these symptoms keep returning, yet every test for a UTI comes back negative? In some cases, endometriosis could be the underlying cause.

Endometriosis is a complex and often misunderstood condition where tissue similar to the lining inside the uterus grows outside the uterus. It commonly affects the ovaries, fallopian tubes, and pelvic lining but can also impact the bladder and other nearby organs. When this occurs, it can mimic UTI symptoms, making diagnosis challenging. Let’s explore the connection between endometriosis and UTI-like symptoms and what you can do if you suspect endo is playing a role in your discomfort.

woman with endometrioisis experiencing uti like symptoms

How endometriosis can mimic UTI symptoms

The symptoms of a UTI are pretty distinct: frequent urination, burning or pain when urinating, and pelvic discomfort. However, these are also symptoms that can arise when endo affects the bladder. When endometriosis lesions grow on or around the bladder, they can cause irritation, inflammation, and pain that closely resemble a urinary tract infection.

Here are some of the key overlapping symptoms:

  • Frequent urination: Feeling the need to urinate often, even when your bladder isn’t full.
  • Painful urination (dysuria): A burning or stinging sensation while urinating, similar to a UTI.
  • Bladder pressure or discomfort: A sensation of fullness or pressure in the bladder area.
  • Pelvic pain: Discomfort in the lower abdomen or pelvis, which may be worse during menstruation.
  • Pain during sex (dyspareunia): Endometriosis-related pain can extend to the bladder, leading to discomfort during intercourse.
  • Blood in the urine (hematuria): In more severe cases of bladder endometriosis, blood may be visible in the urine, mimicking symptoms of a severe UTI.

The key difference is that while UTIs are caused by bacterial infections and can be treated with antibiotics, endometriosis is a chronic condition that requires a different approach.

woman with bladder endometriosis on the toilet

What is bladder endometriosis?

Bladder endometriosis is a specific type of endometriosis in which lesions grow on or within the bladder. Though less common than ovarian or pelvic endo, it can be a source of significant discomfort for those affected.

One of the most exciting developments in endometriosis detection is the MyReceptiva test, which looks for the presence of BCL6, a marker highly associated with endometriosis and supported by 8 years of clinical use in the infertility space (but is now available to everyone!).

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There are two main types of bladder endometriosis:

  • Superficial bladder endometriosis: Lesions grow on the outer surface of the bladder.
  • Deep bladder endo: Lesions invade the bladder wall, potentially affecting bladder function.

Because bladder endometriosis can cause symptoms that resemble interstitial cystitis (IC) or chronic UTIs, it is often misdiagnosed. If you find yourself repeatedly testing negative for UTIs but still experiencing symptoms, it’s worth discussing bladder endometriosis with your healthcare provider.

Why do UTI-like symptoms occur in endometriosis?

The primary reason endometriosis can mimic a UTI is the inflammation and irritation caused by endometrial-like tissue outside the uterus. Unlike normal endometrial tissue, which is shed during menstruation, these misplaced cells have no way to exit the body. Instead, they cause inflammation, scarring, and even adhesions (where organs become stuck together).

When these lesions affect the bladder, they can make it feel irritated and overactive, similar to an infection. Additionally, endo can contribute to pelvic floor dysfunction, which can further exacerbate urinary symptoms.

woman discussing frequent uti like symtoms with her doctor

When to suspect endometriosis instead of a UTI

If you have frequent UTI symptoms but continue to rule out bacterial infections, it’s time to consider other potential causes, such as endometriosis. Here are some signs that endo might be the real culprit:

  • Recurring symptoms: You frequently experience UTI-like symptoms, but urine cultures come back negative.
  • Symptoms worsen around your period: Endometriosis symptoms are often cyclical, flaring up before or during menstruation.
  • Pelvic pain beyond UTIs: You experience chronic pelvic pain, painful periods, or pain during sex.
  • Antibiotics don’t help: UTIs typically improve quickly with antibiotics, whereas endo-related symptoms persist.

Getting the right diagnosis

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If you suspect endometriosis is the cause of your symptoms, speaking with a doctor who specializes in the condition is key. Because endo doesn’t show up on standard urine tests or even many imaging scans, diagnosis often requires a combination of medical history, pelvic exams, and in some cases, laparoscopic surgery.

However, an advanced non-surgical detection tool is now available. MyReceptiva™ is a specialized test that detects the presence of BCL6, a protein marker associated with inflammation and endo. This test can be particularly valuable for individuals struggling with infertility, unexplained pelvic pain, or recurrent pregnancy loss. If bladder endometriosis is suspected, this test may help provide valuable insights before resorting to surgery. Learn more, and use code RESCRIPTED for $85 off!

woman covering her mons pubis

Treatment options

If endometriosis is responsible for your UTI-like symptoms, treatment options will depend on the severity and location of the lesions. Some common approaches include:

  • Hormonal therapy: Birth control pills, progestins, or GnRH agonists can help suppress endometriosis growth.
  • Pain management: Over-the-counter or prescription pain relievers can help with discomfort.
  • Lifestyle changes: Consider diet, exercise, and additional remedies such as acupuncture.
  • Pelvic floor therapy: If muscle dysfunction is contributing to symptoms, physical therapy may help.
  • Surgery: In cases of severe bladder endo, laparoscopic surgery may be necessary to remove lesions.

If you’ve been struggling with recurrent UTI symptoms but never seem to test positive for an infection, it may be time to consider endometriosis as a potential cause. Because bladder endometriosis can be challenging to diagnose, advocating for yourself and seeking the right specialists is crucial.

MyReceptiva™ offers an advanced, non-invasive way to detect endometriosis and may be a valuable tool for those experiencing unexplained urinary symptoms. If you suspect you have endo, don’t hesitate to seek answers — it’s the first step toward finding relief and reclaiming your quality of life.

Kristyn Hodgdon is the Co-Founder and Chief Creative Officer at Rescripted and host of From First Period To Last Period.