Endometriosis is a UTI – What is going wrong?
Mr Hemant Vakharia, consultant gynaecologist and advanced laparoscopic surgeon at London Gynaecology, worked on the Refinery29 article providing insight on the problem of misdiagnosing Endometriosis for a UTI.
Why are UTIs a common misdiagnosis when someone has endometriosis?
The bladder, uterus, ovaries and bowel are situated very close together in the pelvis and endometriosis symptoms can often be incorrectly attributed to these other structures. We commonly see patients who have been diagnosed with irritable bowel syndrome who ultimately are found to have endometriosis. Similarly, patients with endometriosis who suffer with lower abdominal pain are told they have a UTI. In addition, endometriotic deposits can affect the bladder and in some cases go all the way through the wall of the bladder. This can result in pain when passing urine or when the bladder is full and these can also be symptoms of a UTI. Some patients can also experience blood in their urine which can both be a sign of endometriosis or a UTI.
What should patients be doing to have their symptoms investigated further?
Patients who suffer with severe period pain, pain with intercourse, pain opening their bowels or passing urine should see their GP and asked to be referred to an endometriosis specialist. We know that endometriosis can be difficult to identify on scan and therefore assessment by an endometriosis specialist is really important to get a diagnosis. We also know that in some cases patients may be taken seriously so if their symptoms are persistent and severe it is important to ask for a referral to a specialist.
What’s the impact of having antibiotics when you don’t need them, as is often the treatment for UTIs?
Taking antibiotics in the absence of an infection can lead to antibiotic resistance developing which can mean in the future there may be more bacteria resistant to antibiotics. Additionally antibiotics can affect the good bacteria in your body leading to patients developing other problems like thrush or bowel symptoms.
We know women’s health issues often take longer to diagnose, is this just another example of a wider problem in the medical space?
In 2020 the All Party Parliamentary Group (APPG) published a report on their inquiry into endometriosis. It showed that average diagnosis times for endometriosis have not improved in over a decade – it still takes 8 years on average to get a diagnosis. Prior to getting a diagnosis and with symptoms:
58% visited their GP more than 10 times
43% visited doctors in hospital over 5 times
53% visited A&E;
I think there are a number of reasons which include the need for more education on the subject and the need to take patients seriously. Dismissing severe period pain as ‘normal’ should be consigned to the history books. Menstruation can also be a taboo subject in some cultures and patients may be reluctant to seek help.
Periods which are very painful that limit your quality of life should not be regarded as ‘normal’ and there are lots of things that can be done to help patients in this situation. Early referral and investigation is essential and educating patients, employers and the general public will help patients to have the confidence to seek help sooner. Additionally, increased awareness of endometriosis in primary care physicians through education will also lead to prompt specialist referral.
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