QC: Bladder Issues and Endometriosis With Dr. Yaniv Larish

Dr. Yaniv Larish, a board-certified urologist, joins us to explore the complicated relationship between endometriosis and bladder symptoms. We uncover how urinary issues like urgency, frequency, and nocturia can be important indicators of endometriosis involvement in the urinary tract.

• Common bladder symptoms include urgency, frequency, nocturia, and feelings of incomplete emptying
• Patients often deny urinary or fecal incontinence but admit to wearing pads daily or difficulty cleaning after bowel movements
• No definitive test exists for endometriosis other than surgery, making proper questioning essential
• Many patients have been dismissed by doctors, making it harder to get accurate symptom reporting
• Surgical interventions may involve trade-offs between pain relief and preserving bladder function
• Post-surgical issues can occur if nerves governing bladder function are affected during treatment
• Cases requiring second or third opinions often involve complex reconstruction after previous surgeries

Do you have more questions? Send them in by using the link in the top of the description of this podcast episode or by emailing contact@endobattery.com or visiting the endobattery.com contact page.

Chapters

• 0:00 Quick Connect Introduction

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to Endo Battery's Quick Connect, your direct line to expert insights. Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1: 0:51

Welcome back to Endo Battery Quick Connect, where we keep it real, recharged and ready to dive deep into the realities of living with endometriosis. Today I am thrilled to welcome a guest whose expertise sheds light on an often overlooked part of the endo journey the bladder. That's right, those frequent trips to the bathroom, the urgency, the burning, the pressure. It's not just in your head and it's not just your uterus. Joining us today is Dr Yaniv Larish, a board-certified urologist, who brings both compassion and clarity to the table. He's here to help us untangle the complicated relationship between endometriosis and bladder symptoms. Let's get started. What are some of the things that you notice for those that when you're going into surgery and you know that you're going to have an involvement in that surgery, what are some things that maybe the patient describes that cues you guys into?

Speaker 2: 1:37

Yes. So I typically get involved whenever the patient complains of urgency, that when they got to go they got to go. Frequency, meaning they're going more often than their peers. Nocturia, meaning they're waking up in the middle of the night. Feelings of incomplete emptying of the bladder. Whether that's perceived or simply fact is irrelevant. If they feel like they're not emptying the bladder, that's a problem.

Speaker 2: 1:59

Urinary incontinence, fecal incontinence and you know it's funny if you ask anybody with endometriosis if they have urinary incontinence or fecal incontinence, the answer is always no, no, no, I don't have. But if you ask, you know, do you wear a pad every day? Is the pad wet at the end of the day? No, but that's just discharge. No, no, it's not. You know, there's something else going on there. Or fecal incontinence, you know. Do you have a hard time getting clean after you finish pooping? Do you have to wipe a thousand times to get clean, you know?

Speaker 2: 2:30

And so we have sort of a set number of questions that we ask to sort of figure out who needs to be involved in a case if it's particularly challenging, and obviously that's part of the battery of testing, of questioning that we do, you know.

Speaker 2: 2:44

As you know, the problem with endometriosis is among many problems with endometriosis. One of the biggest challenges with endometriosis is there's no test short of the surgical intervention, right, there's no gold standard test, and so if you don't ask the right questions, it's very hard to get a good intuition or sense that the patient may have it. And the questions are, you know, they're difficult to sort of get to the bottom of, especially if the patient's been poo-pooed by a doctor a thousand times or by a thousand doctors a thousand times. So it's challenging, but I will say that that's typically how I get involved is if we feel that there's a problem functionally, or, of course, if we have imaging that demonstrates, you know, obstruction or frank involvement of the urinary tract, whether it's in the ureters or in the bladder, then of course, you know, my involvement is reconstructive in nature.

Speaker 1: 3:35

What do you see, though, after? So you get in there, you do all the work. Are there issues that some of these patients have after that reconstruction?

Speaker 2: 3:44

Look, you know every surgery. There's no such thing as a free lunch, right, right. So you know. To think that we can do surgery without having some trade-off is intellectually dishonest.

Speaker 1: 3:58

Right.

Speaker 2: 3:59

So you can have somebody who has horrific 10 out of 10 pain, 29 out of 30 days a month, and fix that, but that might come at a cost of, you know, not emptying your bladder. Well, right, If the nerves are involved and you have to remove the nerves that govern bladder function in order to get relief of pain, you're going to sometimes see that and that's something that needs to be dealt with. You know, same thing with defecatory dysfunction. It's a similar sort of problem. You know, obviously, the way that we do surgery. We preserve nerves and we do a really, really nice job of sort of limiting the negative sequelae of surgery.

Speaker 2: 4:39

Right, right but we also oftentimes see cases that are second opinion, third opinion They've already had two or three surgeries. You know, sometimes the damage is already done and now the job is to sort of undo the effects of a hurricane after it's gone through.

Speaker 1: 4:53

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.