Endometriosis Bowel Symptoms


Many women suffer with a range of distressing symptoms of the bowel caused by endometriosis. 

However, too many doctors still do not think of endometriosis when their patients report symptoms such as intermittent constipation or diarrhoea, or alternating bouts of the two or bleeding from the rectum.

Most importantly, they do not think to ask woman if their bowel symptoms vary with their menstrual cycle – the key feature of bowel involvement due to endometriosis. As a result, some young women are not being diagnosed.

 

bowel symptoms endometriosis

Causes of Bowel Endometriosis

Most bowel symptoms are not due to the presence of endometriosis on the surface of the bowel itself. Rather, they are usually due to irritation from implants and nodules located in adjacent areas, such as the Pouch of Douglas, uterosacral ligaments, and recto-vaginal septum.

In those cases where the endometrial implants are located on the bowel, the implants are usually lying on the outside surface of  the rectum rather than in the bowel itself. Nevertheless, endometriosis can penetrate into and through the bowel wall on some occasions.

The large bowel is a much more common site of endometriosis than the small bowel. Some symptoms are due to adhesions constricting, twisting, or pulling on the bowel.


How common is it?


Studies suggest that bowel endometriosis estimates vary quite a lot because it is hard to detect. There may be ranges from about five percent up to a third of women suffer from endometriosis of the bowel. These figures depend on the quality of the study and how carefully doctors look for the disease and their level of expertise in treating endometriosis.

90% of bowel endometriosis cases involve the rectum and large intestine


Symptoms often look like IBS

Painful bowel movements, bloating, constipation or diarrhea that increase around periods, and sometimes rectal bleeding with periods. Deep pelvic pain with sex can be another clue when the rectovaginal area is involved.

Because these signs cross over with gut problems, many women get sent down a GI path first. Scans can come back as normal, that is unless you have an experience surgeon who will recognise the pattern of symptoms.


Diagnosis of Bowel Endometriosis

Bowel endometriosis is difficult to diagnose due to the location of the disease and the inability of imaging tests to locate the disease.

Initial diagnosis relies a great deal on the woman's description of her symptoms and menstrual history. Bowel symptoms due to endometriosis are generally only present or worse around the time of the period, though they may be present throughout the month for some women. 

They are also usually reported along with one or more of the classical symptoms of endometriosis, such as painful periods and painful intercourse, rather than on their own.

A gynaecologist may refer their patient to a Gastro-Intestinal specialist if he or she is not sure whether the bowel symptoms are due to endometriosis or another cause.

Occasionally, the gynaecologist may refer the woman to a specialist for a colonoscopy.  A colonoscopy is an examination of the inside of the gastro-intestinal tract with a telescope-like instrument. In most women with endometriosis, the colonoscopy will be normal because endometrial implants and nodules rarely penetrate through the wall of the bowel wall so they are not visible during a colonoscopy. 

In order to formally diagnose and treat bowel endometriosis, laparoscopic surgery must be performed


Diagnostic options may include:

  • Vaginal examination
  • Ultrasound
  • Sigmoidoscopy and/or Laparoscopy - operations to look inside your bowel and abdomen respectively
  • CT and/or MRI scan – if deep endometriosis is suspected



Endometriosis Affects on the Bowel


Treatment for Bowel Endometriosis

Endometrial nodules in the Pouch of Douglas, uterosacral ligaments, and recto-vaginal septum are generally larger and deeper than ordinary implants. They do not usually respond to drug treatment so they will usually be removed surgically. 

Bowel endometriosis surgery is usually performed as a team effort by a specialist gynaecologist (expert in advanced laparoscopic excision of endometriosis) and a specialist colorectal surgeon (bowel surgeon). Because they are difficult to reach, there is a danger that the bowel may be damaged accidentally during surgery. Therefore, the surgeon must be experienced at laparoscopic surgery.

Cutting (excision) or shaving techniques are usually used to remove the disease. Superficial endometrial implants on the surface of the bowel are usually removed by carefully removing the relevant part of the membrane that covers the bowel wall.

If the endometriosis has penetrated through a section of the bowel wall, that section of the bowel may have to be removed. Few gynaecologists are able to perform this surgery, and as mentioned above, a bowel surgeon will be called in to perform the resection.

How serious is Bowel Endometriosis?

Bowel endometriosis is generally not life-threatening, but in some cases it can be serious causing very painful symptoms.   Deeply infiltrating lesions can grow thick and cause severe narrowing or partial blockage of the bowel. This can lead to constipation, diarrhea. and boating.  Complete bowel obstruction or a tear in the bowel wall are considered to be very rare, but they are dangerous emergencies.

The first signs of bowel endometriosis usually include painful bowel movements during periods, cyclical bloating or "endo belly," and alternating constipation or diarrhea that worsen significantly during menstruation. As you can see, there is a common cross-over with some of the symptoms of endometriosis, but pain in bowel is a good indicator that the bowel may be involved. 

If your symptoms have changed or worsened you need to get this checked out with your doctor. Leaving bowel endometriosis untreated will only get worse with worsening scar tissue and could possibly lead to a blockage.




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About the Author

Hi, I am Carolyn Levett, the Founder here at endo-resolved - I am an Integrative Health Coach having studied nutrition, naturopathy and aromatherapy as well as being a published author of three endometriosis books. I used to suffer from severe endometriosis and was fortunate to be able to regained my health and recover from this disease with the support of nutrition, natural therapies and lots of determination.

My motivation is to help other women with endometriosis to heal their bodies so they may start to overcome this awful disease without having to totally rely on toxic drugs and surgeries which can cause further damage  -  with healing thoughts, Carolyn.




Reference:

https://www.endometriosis-uk.org/endometriosis-and-bowel

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/

https://www.everydayhealth.com/endometriosis/bowel-endometriosis/



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