Endometriosis is a condition of the female reproductive system that occurs when endometrium, the tissue that usually lines inside the uterus, starts to grow on other parts of the body internally. Endometriosis comes from the combination of endo, which means inside, and metrium, which refers to the uterus, the organ where babies are carried before being born. The most common place for the formation of lesions is the pelvic cavity, which include on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, and on the bowels or bladder.
Despite the fact there is currently no cure for endometriosis, researchers are focused on finding the causes for its development and improve the treatments available. The therapeutics prescribed for patients with endometriosis aim to address the symptoms, which are mainly pain and infertility, and range from pain medication to hormonal therapy and surgery. Research advancements in the field has led to greater understanding of the disease, and investigators have found that pain is not related to the size or location of the lesions as previously thought.
Evidence of Endometriosis in the Bowel
While pain and infertility are the two main symptoms of endometriosis, the disease manifests itself in other ways as well, including painful bowel movements and digestive or gastrointestinal symptoms similar to a bowel disorder. In addition to the pelvic cavity, endometriosis can affect the bowel in two forms. Superficial bowel endometriosis occurs on the surface of the bowel, while deep bowel endometriosis penetrates the bowel wall. It may also be the case that patients develop superficial recto-vaginal nodules that later progress and infiltrate the bowel wall. Bowel endometriosis and irritable bowel syndrome have similar symptoms, but in the case of the former, they experience alterations according to the menstrual cycle.
The primary symptoms of bowel endometriosis are dyschezia, which is consistent with pain on opening the bowels; dyspareunia, which is deep pelvic pain during sex; and rectal bleeding while menstruating. If a physician suspects the condition, diagnosis exams include vaginal examination, ultrasound, and CT or MRI scan. However, the only method to confirm the diagnosis is surgery using two procedures called laparoscopy and sigmoidoscopy that enables surgeons to observe the interior of the abdomen and bowel respectively.
Treatment for Endometriosis in the Bowel
After confirmation of the bowel endometriosis diagnosis, patients can be treated with different methods, taking into consideration determined factors, such as the patients’ age, severity of the symptoms and extent of the disease. If not treated, bowel endometriosis will continue to worsen over time and the symptoms may become more severe. Pain medication and hormonal therapy are options that may help, but won’t cure bowel endometriosis. Despite the fact that surgery does not cure it either, it is the most common type of treatment for the disease.
There are currently three types of surgery for the treatment of bowel endometriosis, and all of them can be performed laparoscopically (with small incisions in the abdomen) or through open surgery. Each surgical procedure is meant to address the individual needs of the patient. A re-anastomosis consists of the removal of the affected segment or section of bowel and re-connection of the bowel, while in the case of small areas affected by the disease, surgeons may opt to cut the disc of affected bowel and close the hole in the bowel. In addition, surgeons may shave off the affected areas or nodules, leaving the bowel intact, but this procedure may leave residual endometriosis.
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