Bowel Endometriosis Insights: Symptoms and Treatment

What is Bowel Endometriosis?

Bowel endometriosis is a complex condition where tissue similar to the lining inside the uterus, known as the endometrium, begins to grow outside it, specifically affecting the bowel region. 

“Endometriosis can grow in the lining of the abdomen (the peritoneum), the fallopian tubes, the ovaries (endometrioma cysts), the bowel or the bladder—or even within the uterine muscle itself, a condition called adenomyosis,” states Dr. Kelly Wright, associate professor of Obstetrics and Gynecology at Cedars-Sinai.

Unlike other forms of endometriosis that may attach to the pelvic lining, ovaries, or other abdominal organs, bowel endometriosis specifically involves the intestinal tract. This can include the surface or the inner layers of the bowel, often leading to significant discomfort and other gastrointestinal symptoms.

This form of endometriosis is particularly challenging because its symptoms can mimic those of common gastrointestinal disorders, making accurate diagnosis crucial. Bowel endometriosis differs from more typical pelvic endometriosis in its location and symptomatology.

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis can be quite varied, often depending on the extent and specific location of the endometrial growth within the bowel. 

General Symptoms

• Pelvic pain
• Menstrual cramps
• Pain during intercourse
• Pain with urination
• Excessive bleeding
• Infertility

Bowel-Specific Symptoms

• Painful Bowel Movements: Often intensifying during menstrual periods.
• Rectal Bleeding: This can occur during menstruation, not common but a significant indicator of rectal endometriosis.
• Changes in Bowel Habits: Including constipation or diarrhea, which might seem to fluctuate with the menstrual cycle.
• Abdominal Pain: Typically worsening during menstruation and can be mistaken for typical menstrual cramping.
• Bloating and Gas: These symptoms can vary in intensity but often increase during a menstrual period.

The connection between the menstrual cycle and bowel symptoms is a hallmark of bowel endometriosis. Unlike irritable bowel syndrome (IBS), which can exhibit somewhat similar symptoms, bowel endometriosis symptoms are cyclic and closely tied to the menstrual cycle.

This cyclical nature helps differentiate bowel endometriosis from other gastrointestinal issues, where symptoms might be more constant or not linked to menstrual cycles.

If you're experiencing these or similar symptoms and are concerned about the possibility of bowel endometriosis, Symptom Checker provides a useful tool to help identify possible signs of endometriosis. While this tool is not a substitute for professional medical advice, diagnosis, or treatment, it can be a helpful first step in understanding your symptoms.

Causes of Endometriosis

The exact causes of endometriosis are still unknown, but several potential links have been identified that may contribute to the development of this condition. Here are some of the key factors believed to play a role:

Potential Links:

• Retrograde Menstruation: One of the most widely accepted theories suggests that during menstruation, some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows.
• Genetic Factors: There may be a hereditary component to endometriosis. Women who have a family member with the condition are at higher risk of developing it themselves, indicating a possible genetic predisposition.
• Hormonal Influences: Estrogen, a hormone involved in thickening the lining of the uterus during the menstrual cycle, may promote the growth and maintenance of endometrial-like tissue outside the uterus.
• Immune System Dysfunction: Some scientists believe that a faulty immune system may fail to find and destroy endometrial-like tissue growing outside the uterus.

Treating and Diagnosing Endometriosis

Diagnosing

“Typically, a doctor will suspect endometriosis based on a detailed history, pelvic exam and pelvic ultrasound. To get diagnosed, patients undergo a laparoscopic procedure where a doctor looks inside the abdomen with a small camera to see if there are any spots that look like endometriosis outside of the uterus.” - says Dr. Wright.

Treatment options

Dr. Wright notes on the condition, "Endometriosis does not have a cure. After menopause, most patients find relief due to a lack of periods. However, if the endometriosis has never been adequately treated or removed, pain or other symptoms can persist."

However, there are various ways to manage and alleviate the symptoms associated with the condition. 

• Hormonal Therapies: These are commonly used to reduce estrogen levels, which can help shrink endometrial tissue and decrease menstrual bleeding and pain. Options include birth control pills, progestins, and GnRH agonists, which create a temporary menopause-like state.
• Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often recommended to help reduce menstrual pain and inflammation associated with endometriosis.

• Laparoscopy: A minimally invasive surgery used both for diagnosis and to remove endometriosis implants. It is often recommended when pain is severe or if there is a need to improve fertility.
• Hysterectomy: In cases where pain is extensive and other treatments have failed, removal of the uterus, and sometimes the ovaries, may be considered.

• Dietary Changes: Some women find relief from symptoms by adopting a diet that reduces inflammatory foods and increases intake of omega-3 fatty acids, fruits, and vegetables.
• Physical Therapy: Specialized pelvic floor physical therapy can help alleviate pain by relaxing pelvic muscles that are often tense with endometriosis.