Endometriosis is a very painful condition that affects many women. The office on Women’s Health estimates that 11% of US women (more than 6.5 million) have endometriosis.

Endometriosis happens when endometrial-like tissue, the tissue that normally grows on the inside of your uterus, grows on the outside of the uterus. This tissue acts just as normal endometrial tissue acts and is controlled by a woman’s menstrual cycle – it builds up, breaks down, and bleeds during each cycle of a woman’s period. However, unlike the tissue that is found inside the uterus, the tissue on the outside of the uterus has nowhere to go and becomes trapped. The trapped tissue can cause many problems, such as:

• Scar tissue formation

• Development of cysts

• Painful periods/pelvic pain during your period

• More extreme period like symptoms during your cycle

• Extremely heavy periods, or bleeding in between cycles

• Pain during sex

• Pain when having a bowel movement or while urinating

• Problems becoming pregnant

• Fatigue

• Constipation

• Diarrhea

• Bloating

• Nausea

Patients with endometriosis can feel intense pain during their menstrual cycles, so much so that it may affect their daily lives. This pain typically happens before their period, and throughout their menstrual cycle, although pelvic pain and discomfort may be present throughout the month.

The tissues typically live on your ovaries, fallopian tubes, and the lining of your pelvis, However, endometriosis can sometimes spread to other parts of the body including the bowel.

What is Bowel Endometriosis?

Bowel endometriosis is when the endometrial tissue grows on the surface or inside of the intestines, on the rectum, or in other parts of the bowel. As many as one-third of patients who have endometriosis have bowel endometriosis.  These women usually also have the condition in more common sites around the pelvis.

Patients experiencing bowel endometriosis may have more extreme symptoms of constipation, bloating or gas, lower back pain, and extreme pain when having a bowel movement. These symptoms may be in addition to the common symptoms listed above.

How Do I Know If Endometriosis Is Causing My GI Problems?

Because some of the symptoms of endometriosis mirror that of other GI diseases, it’s easy for a misdiagnosis to occur.  In fact, many people with bowel endometriosis are misdiagnosed with irritable bowel syndrome (IBS).

However, a key difference between most GI conditions and endometriosis is that with endometriosis, pain and symptoms are much worse during a woman’s menstrual cycle. With IBS, a patient may experience symptoms several times a week over the course of the entire month.

When Should I Talk To My Doctor?

You should always discuss any pain associated with your bowel movements with your healthcare provider. And, if you’re experiencing pain with your bowel movements regularly during your periods, it’s important to let your doctor know, especially if they accompany some of the other symptoms of endometriosis above.

How Is Bowel Endometriosis Diagnosed?

Endometriosis is a hard condition to diagnose. Many women experience pain during their menstrual cycles that are normal, making it hard to distinguish if there is a problem or not. And, every patient is different, with some endometriosis patients experiencing only mild pain and others experiencing no symptoms. Many women only learn about their condition when it affects their fertility.

Your doctor will likely perform a physical exam, checking your vagina and rectum for any growths. This may include one or several tests, such as an ultrasound, MRI, colonoscopy, laparoscopy, or barium enema.  These are all different methods for using cameras, X-rays, sound waves, or radio waves to get a good picture of the inside of your body.

If you are experiencing signs of endometriosis, talk to your doctor and be as thorough as you can in your description of your symptoms. You know your body best, so if you feel like your concerns are being dismissed or brushed off, talk to a different doctor.

How is Bowel Endometriosis Treated?

If you find that you do have bowel endometriosis, there are several things your doctor may suggest to treat the condition. These treatments will vary depending on the severity of your condition.

Surgery

Surgery is the most common treatment for bowel endometriosis and can greatly relieve symptoms.  Your options will vary based on the extent of your endometriosis and where it is located.

• Segmental bowel resection.

  With this surgery, the part of the intestine with endometriosis is removed and the remaining two pieces are then reconnected. This type of surgery is typically used when there is a large area of endometriosis, and the condition is less likely to come back than with other procedures.

• Rectal shaving.

  This procedure literally “shaves” the endometriosis from the top of the bowel, without removing any portion of the intestines and is typically performed on smaller areas of endometriosis. Endometriosis is more likely to come back after this surgery.

• Disc resection.

  For cases where the endometriosis is smaller, but deep within the bowel wall, disc resection may be appropriate. This procedure involves cutting out a small disk where the endometriosis appears and removing the full thickness of the lesions, then closing the hole.

Medications that control hormones, such as birth control or progesterone injections may also be useful in controlling the symptoms of endometriosis.  Over-the-counter pain relievers may also help.

If you’re experiencing symptoms of endometriosis, don’t wait to talk to your doctor.