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You may be familiar with the term endometriosis, especially if you’re someone dealing with painful menstrual periods or other uncomfortable symptoms occurring during your cycle. Endometriosis is a condition in which the endometrial tissue or tissue and cells very similar to it, finds it way outside of the uterine cavity and grows in the pelvis and other surrounding organs. Endometrial lesions are commonly noted surrounding the reproductive organs like the fallopian tubes and ovaries, and it is also very common to find endometrial lesions on and around the bowel and intestines.
Endometriosis is a very painful condition that impacts 1 in 9 and the common symptoms of endometriosis are painful periods, painful intercourse, chronic pelvic pain, infertility, and even gastrointestinal and balder symptoms. Sometimes, endometriosis can spread to the bowel, intestines, or rectum – and this is when bowel endometriosis results.
In bowel endometriosis, those lesions – or cells and tissue – grow on the surface or inside the intestines or rectum, and sometimes even in other parts of the bowel. This can lead to severe pain for patients during their menstrual cycle and outside of it, and even with the absence of a cycle!
Bowel endometriosis symptoms include:
You will also want to pay attention to the more common symptoms of endometriosis that are GI related:
As a pelvic pain specialist on the front lines of endometriosis, I have also seen and heard of women complaining of only mucous coming from the rectum and not stool when they feel the urge to have a bowel movement. In addition to this, varying cycles of constipation and diarrhea during the cycle is also very common when endometriosis is involving the bowels. Nausea and vomiting and/or an intolerance of certain foods only when menstruating can also be a sign of bowel endometriosis.
I encourage patients to pay attention to their symptoms. Pain is never normal! Your health care provider should always listen to your symptoms and discuss a plan of action for addressing them.
Unfortunately, diagnosis of any type of endometriosis can be difficult – but it is possible! Obtaining a diagnosis of bowel endometriosis is likely to involve a minimally invasive procedure where a camera is inserted into the abdomen to look around for endometrial lesions. There will likely also be a consult with a gastroenterologist (GI specialist) to rule out any other bowel abnormalities that would be a source of similar symptoms.
Generally, the evaluation by the gastroenterologist will have normal internal bowel findings, as the endometriosis is on the outside of the bowels causing increased pressure and pain. It is still important that things like polyps or cancer are ruled out. It is unlikely your GI will “see” endometriosis in a colonoscopy, for example, since most of the growth occurs outside of the bowel, rather than inside of it, but it is essential to rule things out.
Bowel endometriosis can be treated during the procedure used to diagnose the problem – a laparoscopic excision surgery is the most common treatment for bowel endometriosis. While the camera is inside and identifies the endometrial lesions, they can then be removed. Medical follow up is necessary and use of hormonal therapies or other treatments for endometriosis should be utilized to prevent recurrence.
If endometriosis is found on the bowel, patients can often have a discussion with their pelvic pain specialist and endometriosis excision surgeon about better bowel habits, an anti-inflammatory lifestyle and seeking the help of a pelvic floor specialist to address pain and inflammation in the pelvic floor because of the endometriosis. At Pelvic Rehabilitation Medicine, our ultrasound guided pelvic nerve and muscle treatments are often part of a whole-body protocol for endometriosis patients as part of their pelvic floor treatment.
Treating bowel endometriosis and preventing recurrence is key, not only for pain relief but also for fertility preservation, should that be of concern for the patient.
The important thing to remember is that symptoms discussed here should never be considered normal menstrual symptoms, even if they have been present for many years during cycles and should always be discussed with a medical professional.