Author: Dr. Madhu Bagaria
What is Bowel Endometriosis?
Bowel endometriosis occurs when cells similar to the lining of the uterus implants either on the surface of the bowel wall or grows into its deeper layers causing deep infiltrating endometriosis. It can occur in 3-37% of endometriosis cases. Majority of the bowel endometriosis is found in the large bowel where it can involve the sigmoid colon or the rectum. Similarly the implants can also involve the small intestine and appendix.
What are the symptoms of Bowel Endometriosis?
Bowel endometriosis can be a totally silent condition or can present in different ways and hence can be misdiagnosed as irritable bowel syndrome, inflammatory bowel conditions.
It can be a silent condition or present with symptoms such as:
- Abdominal pain
- Constipation or diarrhea
- Difficulty with bowel movement
- Pain with sexual intercourse
- Bloating
- Nausea
- Frequency of bowel movements
- Rectal bleeding
This happens due to the chronic state of inflammation which is caused due the presence of these implants. These symptoms may worsen during the time of the menstrual cycles.
Since the symptoms of bowel endometriosis can be so different, it requires a high degree of suspicion. Some of the patients may have an extensive workup with their GI specialist including multiple MRIs, colonoscopy, endoscopy but no diagnosis made. Contrary to the belief, colonoscopy cannot diagnose endometriosis as these implants are on the surface of the bowel from outside, while colonoscopy is the scope of the inside of the bowel mucosa. If the endometriosis is severe to invade the mucosa of the bowel, colonoscopy can pick up those rare cases.
How is Bowel Endometriosis diagnosed?
While Imaging technology like MRI have continued to evolve, they are not sensitive in diagnosing endometriosis, especially the superficial endometriosis which has implants on the surface of the bowel. Depending on the expertise of the center, MRI and deep pelvic ultrasound (different than the regular ultrasound) can pick up some deeper implants on the rectum and sigmoid region.
Can Bowel Endometriosis be treated?
Definite diagnosis of bowel endometriosis requires surgery to remove the suspected lesion and subjecting them to pathology. You can also try hormonal therapy to help with your symptom management while waiting for the surgery.
Type of the surgery does depend on the extent of the lesion. Superficial disease can be managed by shaving of the lesion which respects the superficial disease. In this type of surgery, the inside of the bowel lumen is not cut open. You are able to go home the same day.
Sometimes you may need a disc resection to remove a small portion of the bowel. Hole is made in the lumen of the bowel and this is stitched. Deeper nodules, multiple nodules or extensive disease may need segmental resection. In this a small portion of the bowel is resected completely and the two ends are then joined together. Rarely segmental resection may need a temporary colostomy bag which is an outpouching on the abdominal wall to collect the fecal material. This is temporary and the bowel can be restored at a later date. Disc resection and segmental resection are done with the help of our colorectal team of surgeons.
Endometriosis is a progressive condition. If you don’t treat it, the disease may remain the same or progress in its severity. Although a progressive condition, the incidence of cancer with endometriosis is extremely rare and intestinal cancer is a very rare condition.
If you believe you are experiencing the symptoms of bowel endometriosis, schedule an appointment with a pelvic pain specialist today to have your symptoms reviewed.
