Endometriosis occurs when the endometrium, or the tissue lining the uterus starts, to grow in other areas. The most common place for the formation of these extrauterine growths is the pelvic cavity; lesions can form on or under the ovaries, on the fallopian tubes (the tubes connecting the ovaries to the uterus), behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder.
While chronic pelvic pain and infertility are the two main symptoms of endometriosis, the disease can manifest itself in other ways as well, leading to painful bowel movements and digestive or gastrointestinal symptoms similar to a bowel disorder.
Evidence of endometriosis in the bowel
Endometriosis can affect the bowel in two ways. Superficial bowel endometriosis occurs on the surface of the bowel, while deep bowel endometriosis penetrates the bowel wall. In some cases, superficial recto-vaginal nodules can progress and infiltrate the bowel wall.
The symptoms of bowel endometriosis can resemble those of irritable bowel syndrome and cause diarrhea, constipation, and painful cramping. However, in this disease, patients’ symptoms usually worsen during menstruation.
The primary symptoms of bowel endometriosis are pain upon opening the bowels, deep pelvic pain during intercourse, and possibly rectal bleeding while menstruating.
To diagnose endometriosis in the bowel, a physician conducts an examination that includes a vaginal examination, ultrasound, and a CT or MRI scan. However, the only way to confirm the diagnosis is surgery, using two procedures called laparoscopy and/or sigmoidoscopy that enable surgeons to observe the interior of the abdomen and bowel, respectively.
Treatment for endometriosis in the bowel
After a confirmation of endometriosis in the bowel, patients can begin treatment. If not treated, bowel endometriosis may continue to worsen over time with symptoms becoming more severe.
While pain relief medication and hormonal therapy are options that may help reduce the symptoms of bowel endometriosis, surgery is the most common type of treatment for the disease, where endometrial lesions or portions of bowel containing an endometrial lesion are removed.
There are several types of surgery that can be performed to remove endometriosis lesions in the bowel. For example, a portion of the bowel can be removed completely and the healthy ends reconnected, or a small piece of bowel can be removed or shaved away, and the slice or cut sealed surgically. The ultimate decision about what surgery will best treat the patient is typically made by the surgeon.
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