Bowel endometriosis is when endometrial-like nodules grow on the surface of or inside the intestines. It can present with a single or multiple nodules of different sizes. Bowel endometriosis is estimated to be found in 5-12% of patients with endometriosis, with the rectum and sigmoid, which are the most distal parts of the large intestine, being involved in 90% of the cases. In cases where the lesions grow in the rectum and vagina, we call the condition rectovaginal endometriosis.
Bowel endometriosis can be asymptomatic but may also present with the following symptoms:
- Pain when passing a bowel movement
- Straining to pass a bowel movement
- Abdominal cramps and bloating
- Pain during sex
- Diarrhea or constipation
- Blood in stools
- Bowel obstruction which manifests as an inability to pass stools or flatus and could require hospital admission and surgical resection of the lesion
Diagnosis
During your visit to your gynecologist, they will perform a pelvic and abdominal exam on you and possibly get an ultrasound. When there is suspicion of bowel endometriosis, your doctor might also order an MRI to evaluate the extent of the disease or a colonoscopy to visualize lesions inside the bowels.
This work up is important to determine the treatment and the extent of surgery, if it were to be performed.
Management
Medical therapy with oral contraceptives could be attempted to control symptoms in patients with bowel endometriosis .
In patients with severe symptoms or bowel obstruction, surgery is the optimal approach. Surgery, done laparoscopically or robotically, removes all visible lesions and sometimes requires removal of a part of the wall of the bowel( discoid resection) or section of the Bowel (segmental resection) .
The technique and extent of surgery will be determined by your surgeon on an individualized basis. Ask your doctor about the best surgery for you.
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. Bowel endometriosis surgery is technically challenging and requires sometimes a multidisciplinary approach with a colorectal surgeon.
Choose your surgeon with the training and the experience to manage these complex conditions.
Dr. Moawad is a highly reputable leading expert in this domain.
