QC: Bladder Issues and Endometriosis With Dr. Yaniv Larish

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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

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to Endo Battery's QuickConnect, your direct line to
expert insights.
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(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.

(00:51):
Welcome back to Endo BatteryQuick Connect, where we keep it
real, recharged and ready todive deep into the realities of
living with endometriosis.
Today I am thrilled to welcomea guest whose expertise sheds
light on an often overlookedpart of the endo journey the
bladder.
That's right, those frequenttrips to the bathroom, the
urgency, the burning, thepressure.
It's not just in your head andit's not just your uterus.
Joining us today is Dr YanivLarish, a board-certified

(01:13):
urologist, who brings bothcompassion and clarity to the
table.
He's here to help us untanglethe complicated relationship
between endometriosis andbladder symptoms.
Let's get started.
What are some of the thingsthat you notice for those that
when you're going into surgeryand you know that you're going
to have an involvement in thatsurgery, what are some things
that maybe the patient describesthat cues you guys into?

Speaker 2 (01:37):
Yes.
So I typically get involvedwhenever the patient complains
of urgency, that when they gotto go they got to go.
Frequency, meaning they'regoing more often than their
peers.
Nocturia, meaning they'rewaking up in the middle of the
night.
Feelings of incomplete emptyingof the bladder.
Whether that's perceived orsimply fact is irrelevant.
If they feel like they're notemptying the bladder, that's a

(01:59):
problem.
Urinary incontinence, fecalincontinence and you know it's
funny if you ask anybody withendometriosis if they have
urinary incontinence or fecalincontinence, the answer is
always no, no, no, I don't have.
But if you ask, you know, doyou wear a pad every day?
Is the pad wet at the end ofthe day?
No, but that's just discharge.

(02:19):
No, no, it's not.
You know, there's somethingelse going on there.
Or fecal incontinence, you know.
Do you have a hard time gettingclean after you finish pooping?
Do you have to wipe a thousandtimes to get clean, you know?
And so we have sort of a setnumber of questions that we ask
to sort of figure out who needsto be involved in a case if it's
particularly challenging, andobviously that's part of the

(02:41):
battery of testing, ofquestioning that we do, you know
.
As you know, the problem withendometriosis is among many
problems with endometriosis.
One of the biggest challengeswith endometriosis is there's no
test short of the surgicalintervention, right, there's no
gold standard test, and so ifyou don't ask the right
questions, it's very hard to geta good intuition or sense that

(03:02):
the patient may have it.
And the questions are, you know, they're difficult to sort of
get to the bottom of, especiallyif the patient's been poo-pooed
by a doctor a thousand times orby a thousand doctors a
thousand times.
So it's challenging, but I willsay that that's typically how I
get involved is if we feel thatthere's a problem functionally,

(03:23):
or, of course, if we haveimaging that demonstrates, you
know, obstruction or frankinvolvement of the urinary tract
, whether it's in the ureters orin the bladder, then of course,
you know, my involvement isreconstructive in nature.

Speaker 1 (03:35):
What do you see, though, after?
So you get in there, you do allthe work.
Are there issues that some ofthese patients have after that
reconstruction?

Speaker 2 (03:44):
Look, you know every surgery.
There's no such thing as a freelunch, right, right.
So you know.
To think that we can do surgerywithout having some trade-off
is intellectually dishonest.

Speaker 1 (03:58):
Right.

Speaker 2 (03:59):
So you can have somebody who has horrific 10 out
of 10 pain, 29 out of 30 days amonth, and fix that, but that
might come at a cost of, youknow, not emptying your bladder.
Well, right, If the nerves areinvolved and you have to remove
the nerves that govern bladderfunction in order to get relief

(04:19):
of pain, you're going tosometimes see that and that's
something that needs to be dealtwith.
You know, same thing withdefecatory dysfunction.
It's a similar sort of problem.
You know, obviously, the waythat we do surgery.
We preserve nerves and we do areally, really nice job of sort
of limiting the negativesequelae of surgery.
Right, right but we alsooftentimes see cases that are

(04:42):
second opinion, third opinionThey've already had two or three
surgeries.
You know, sometimes the damageis already done and now the job
is to sort of undo the effectsof a hurricane after it's gone
through.

Speaker 1 (04:53):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(05:17):
Until next time, keep feelingempowered through knowledge.