Endometriosis occurs when the tissue that's growing inside the uterus penetrates the abdominal. In some cases, endometriosis can grow to the bowels.
The most common site for this condition is the rectosigmoid colon – the part of the colon that lies right behind the cervix and upper vagina, between the uterosacral ligaments. The other involve the appendix and ileum (final segment of the small intestine). Intestinal endometriosis can cause various symptoms depending on the location of the bowel. It is important to know anatomical positions of organs around vagina, uterus, rectum, bowel and etc.
This condition is usually linked to ‘’stage IV’’ disease, where the ovaries and the colon are stuck together with the uterus causing the adhesions. Although it can
cause minimal symptoms, most of the time, the rectal nodules can cause significant pain with defecation as well as alternating constipation and diarrhea and hesitancy.
While many individuals have bowel/gastrointestinal symptoms with endometriosis (like diarrhea, constipation, bloating, and pain with defecation), most will not have endometriosis directly on the bowel itself. For those that do, there are different approaches to its surgical management.
More than 90% endometriosis of the colon does not infiltrate the mucosal lining, meaning it can’t be seen on colonoscopy, so it is rarely recognized by gastroenterologists.
Symptoms: 3 Signs Are Crucial!
The symptoms are very important to be seen on time, of course always better early diagnose. But this disease has a lot of similar symptoms like other bowel irritations and inflammatory processes.
Some symptoms of bowel endometriosis are similar to those when the bowel is irritable, also they can vary with the menstrual cycle, worsening in the days before and during a period. If you suspect you have bowel endometriosis, keep note of your symptoms to look for a monthly pattern. Of course, there are people without any symptoms of this disease so it is hard to diagnose in early stages.
But we can point out 3 symptoms for this disease, very important for differential diagnosis:
- Dyschezia - is the term applied to difficult or painful defecation, which is most commonly observed with anorectal disorders. In bowel endometriosis this is very important sign that can guide for a colonoscopy test (exam used to detect changes or abnormalities in the large intestine (colon) and rectum) to exclude other conditions like polyps and hemorrhoids.
- Dyspareunia - is defined as persistent or recurrent genital pain that occurs only during intercourse, if we speak about bowel endometriosis only during in other conditions and diseases it can occurs before and after also. In general, there are entry dyspareunia and deep dyspareunia but most common in bowel endometriosis is deep pelvic pain during intercourse.
- Rectal bleeding during a period - Rectal bleeding is a symptom of many more conditions like hemorrhoids, anal fissures, inflammatory bowel disease (IBD), ulcers and colorectal cancer, but timing is of crucial importance when it is happening in period. Typically, you notice rectal bleeding on toilet paper, in the water of the toilet bowl or in your stool.
There are others symptoms which can be related with condition of bowel endometriosis like rectal pain, gas and bloating, diarrhea, constipation, nausea etc.
Diagnostic Options For Bowel Endometriosis?
The problem to get a diagnosis is partially because symptoms can look like several bowel problem conditions, but also there is space for improvement because the medical community is still learning about endometriosis as a disease and it is relatively new topic in health to speak about.
Diagnosis of bowel endometriosis requires a careful history and approach. The detection of tender nodule at the top of the vagina adjacent to the rectum should raise suspicion in any case. Women found to have ovarian endometriotic cysts on ultrasound may have bigger chances of having bowel endometriosis at the same time.
There are great diagnostic methodes for bowel endometriosis:
- Deep transvaginal pelvic ultrasound- Having a transvaginal ultrasound may feel a little bit uncomfortable, but it shouldn't hurt. Transvaginal ultrasound is an examination of the female pelvis. in specialised centre may help discover tender endometriotic nodule infiltrating into the rectal-sigmoid wall, co-existing ovarian endometriosis, bladder endometriosis or find
- Colonoscopy - Colonoscopy is a safe procedure. Colonoscopy or coloscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. With this diagnostic method may detect rectal -sigmoid stricture or rarely mucosal ulceration due to full-thickness endometriosis infultration into the bowel lumen. However, colonoscopy is often negative resulting in false diagnosis of irritable bowel syndrome.
- Laparoscopy- laparoscopic management of bowel endometriosis is safe and effective. With this diagnostic method we can see significant predictors of higher-stage disease that should prompt careful surgical planning. This remains the gold standard for assessment of endometriosis.
- MRI (Magnetic resonance imaging) - uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. MRI can help detect smaller sites of endometriosis, especially along the bowel and pelvic ligaments. For higher lesions on the sigmoid, and small bowel then MRI is more accurate. An MRI exam is necessary because deeper structures are difficult to see by ultrasound.
Best Treatments Possible For Bowel Endometriosis?
Treatment of intestinal endometriosis almost always involves surgery but there are many steps before that crucial step in treatment of this disease. This is important multidisciplinary care for this condition. Sometimes complementary treatments are useful with controlling symptoms, though these are not scientifically proven treatments. The treatments used for this disease are:
- Controling symptoms with medicaments - painkillers such as codeine that may be prescribed and helpful for handling pains caused by bowel endometriosis. Best option you may be referred to a specialist pain management team.
- Treatments with hormons - these treatments reduce or stop ovulation which is helpful. Medical treatments with progestogens or GnRH analogues can be included in this type of therapy. Hormone therapy can help relieve pain.
Removal of endometriosis (Surgical) - Surgical treatment for endometriosis of the bowel depends on the location. Size and place of endometrium tissue for further planning surgical procedures for it. For smaller areas of endometriosis are "shaved" off the bowel. For larger areas of endometriosis is more invasive procedure, the affected part of the bowel is removed. The bowel is then rejoined together. This is called a “bowel resection” and “anastomosis.”
After Surgery Care
Post operation care you must take seriously and in first days you will be on painkillers. It is not a phenomenon that you will need a urinary catheter for a few days after your operation.
Recovery after any surgery varies depending on the individual, however, in general after laparoscopic bowel surgery you can expect to go home after 7 days, and after open bowel surgery it is usual to leave after 10 days. You should aim to gradually increase your level of physical activity after you go home. Start with a short walk for about 10 minutes.
It's common to have diarrhea after a bowel resection. Because your large intestine is suddenly shorter so it is better to avoid fatty food rich. Your doctor may tell you to start with soft foods like cooked vegetables, bananas, avocados, mashed potatoes, and tender proteins.
After surgery bowel function may be altered, particularly with a full resection. This does improve over time although watching your diet to see which food aggravate or improve the situation. And after rehabilitation time it is possible to back on track for normal way life with predicated medical control.