Stomach ache

Bowel Endometriosis: Symptoms, Causes And Treatment

December 7, 2020

Bowel endometriosis can be quite painful. In this condition, the tissue lining of your uterus (called endometrial tissue) begins to grow into your bowels. It is a type of endometriosis.

Endometriosis happens when endometrial tissues start growing into other places within your pelvis. This could include places like your fallopian tubes and ovaries. For bowel endometriosis, the inside or surface of your bowels is the affected site.

Almost 35% of women who have endometriosis develop bowel endometriosis. Most of these cases affect the lower parts of the intestines. But it usually does not get to the rectum. Endometriosis can also affect the small intestine or appendix.

In more serious cases, endometriosis affects both the rectum and vagina. But then, gut endometriosis doesn’t usually happen alone. It mostly happens alongside a buildup in common sites within and around the pelvis. This often includes the bladder, ovaries, and Douglas pouch (the pouch between your rectum and cervix).

The major complication that comes with endometriosis is infertility (or impaired fertility). About half of the women who have endometriosis find it hard to get pregnant.

The tissue invasion might obstruct the fallopian tube. This prevents the sperm and egg from uniting. However, endometriosis might impair fertility in other less-direct ways. These include damaging the egg or sperm or egg.

But then, if your case is still mild or moderate, you can still get pregnant and carry it to full term. Many women that have mild or moderate endometriosis do. Doctors often counsel women who have endometriosis and wish to get pregnant to not delay because this condition usually worsens with time.


Symptoms of Bowel Endometriosis

The main symptom you would feel if you have any form of endometriosis is pelvic pain. The pain often becomes severe during menstrual periods.

Menstrual cramps are quite normal in women. But the pain that comes with this health issue is usually very severe. More so, the pain typically increases over time.

Here is the full list of common symptoms and signs:

  1. Painful menstruation: This usually involves cramping and pelvic pain. Sometimes the pain begins before the period starts and extends some days into the menstrual period. Some women also report having abdominal and lower back pain.
  2. Painful sex: If you have endometriosis, you might feel pain either during sex or afterward. This is a very common symptom.
  3. Pain while passing stool or urine: This is also a very likely symptom. It often becomes worse during your period.
  4. Excessive bleeding: Your menstrual periods might become very heavy sometimes. You might also bleed between periods.
  5. Impaired fertility: In many cases, a woman only finds out that she has endometriosis when she goes for infertility treatment.

Other symptoms and signs that might point to bowel endometriosis include digestive symptoms. They are as follows:

  • Diarrhea
  • Bloating
  • Constipation
  • Nausea

As with other symptoms, these symptoms also worsen during menstruation.

Note, however, that how severe your pain is doesn’t indicate how severe the condition is. Mild endometriosis might sometimes cause severe pain. And advanced endometriosis sometimes causes almost no pain at all.

Because of similar symptoms, bowel endometriosis can be mistaken for some other conditions. These include IBS (irritable bowel syndrome). This condition also causes constipation, abdominal cramping, and diarrhea.


What Are The Causes?

Doctors are still yet to know the exact cause(s) of endometriosis in all its forms, including bowel endometriosis. But generally, experts suspect retrograde menstruation as the possible cause.

While you are having your menstrual periods, blood should flow through your fallopian out of your body. Retrograde menstruation is when blood flows in the opposite direction (backward) and gets into your pelvis instead.

The endometrial cells can then implant in your intestine and cause endometriosis. Some other probable causes include:

  1. Transplantation – This is when endometrial cells are carried by blood or lymph system to other parts of the body, such as the bowels.
  2. Genetics – For reasons yet unknown, this condition runs in certain families. As such, experts agree that there might be some genetic factors.


Available Treatments

There is no cure for endometriosis in general. However, you can manage it with drugs and surgery. The kind of treatment you will get often depends on the severity of your condition. But if there are no serious symptoms, you may not need any form of treatment.

Generally, however, surgery is the ultimate way to treat bowel endometriosis. The surgeon would have to remove the tissue to relieve you of pain, as well as improve your health.

Hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) used to be the gold standard for treating all forms of endometriosis before. But experts are no longer keen to use this approach. Now, they focus on how they can carefully remove all errant tissue, while they save the uterus and ovaries.

If the surgeon removes your ovaries, that is sure going to cause menopause regardless of your age. More so, it doesn’t take care of the errant tissue. So endometriosis is still there. But since there are no ovarian hormones, there might be less pain.

More so, early menopause is very risky. It could cause blood vessel and heart diseases, metabolic problems, and even early death. Hysterectomy has similar long-term health effects too. So this former approach is no longer advisable.

Nowadays, surgeons perform procedures that target the removal of endometrial tissues from the bowels. There are many surgical approaches to doing this. Some common examples include:

  1. Rectal shaving: The surgeon won’t remove any part of your intestine. He will only shave off endometrial tissue from the surface of your bowels using a very sharp instrument. But then, with this method, it is likely for the condition to return after some years.
  2. Disc resection: Your surgeon might also use this approach. He will cut out any affected disc of tissue in your intestine and close up the hole.
  3. Segmental resection: While the other two methods above are quite conservative, this is not. That’s why it’s typically used when large areas are affected.

In this approach, the surgeon will cut out the affected segment of your intestine and join back the 2 pieces. Most women who undergo this procedure end up being able to conceive afterward. More so, it is highly unlikely for the condition to return.

A lot of studies are still ongoing on bowel endometriosis. Hopefully, with time, experts will come up with more conservative, non-surgical treatment options.


Bowel endometriosis