Bowel and bladder endometriosis are two of the most commonly misdiagnosed forms of endometriosis. This is because many of their respective symptoms seem nearly identical to those of several other conditions, including acute appendicitis, inflammatory bowel disease, irritable bowel syndrome, interstitial cystitis, and celiac disease, just to name a few. Complicating matters further is the fact that these other conditions can co-exist with endometriosis. To help provide clarity amidst such clinical confusion, we’ve compiled the following summary to help you recognize what may be symptoms of bladder and/or bowel endometriosis from those of other disorders.
1. WHAT ARE THE SIGNS AND SYMPTOMS OF BOWEL ENDOMETRIOSIS?
Bowel endometriosis causes many different symptoms. Most commonly, patients complain of pain with bowel movements and pain with intercourse. Other symptoms include pelvic pain associated with menses, constipation, diarrhea, abdominal cramping, and difficulty with completely evacuating the bowels (called dyschezia). When endometriosis affects the ileum, which is part of the small intestine, it can cause pain on the right side of the abdomen that mimics acute appendicitis, life-threatening bowel obstructions, or other equally serious disorders. Because of this, unfortunately women with endometriosis have a higher rate of undergoing unnecessary emergency laparotomies when they present to the emergency room with these symptoms.
In severe cases patients can have rectal pain and bleeding, or a medically urgent bowel obstruction which can cause constipation lasting weeks. And, although rare, occurring in fewer than ~3% of cases, endometriosis can cause irreversible damage to parts of the bowel, which requires more extensive surgery to treat.
2. HOW IS BOWEL ENDOMETRIOSIS DIAGNOSED?
Bowel endometriosis is usually diagnosed by laparoscopy and proctoscopy (a procedure in which a camera is placed in the rectum). If you are having symptoms of constipation alternating with watery diarrhea, then your physician may order a CT scan of your abdomen to rule out an obstruction of the bowel that can be caused by endometriosis or another type of abnormal mass.
If you are having any rectal bleeding, then a gastrointestinal specialist should evaluate you to rule out the possibility of colon cancer. In fact, all patients age 50 years or older should be screened for colon cancer regardless of symptoms, as bowel cancer is the 3rd most common cancer in the U.S.
As mentioned, symptoms of bowel endometriosis are similar to other gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, and even appendicitis. Sometimes patients have these diseases along with bowel endometriosis. Therefore, a thorough workup is required by both your gynecologic surgeon and a gastrointestinal specialist to make the diagnosis of these disorders.
3. HOW IS BOWEL ENDOMETRIOSIS TREATED?
Bowel endometriosis is treated by removing the lesion from the bowel. The most common site of bowel endometriosis is the rectum, followed by the sigmoid colon. Most often bowel endometriosis involves the surface of the bowel, but severe cases can involve the full thickness of the bowel and invade into the wall and inside of the bowel. This type of bowel endometriosis should be treated by excising a portion of the affected bowel.
4. CAN BOWEL ENDOMETRIOSIS BE TREATED BY MINIMALLY INVASIVE TECHNIQUES?
Yes, but only by an extremely experienced surgeon. Operating on or near the bowels can be very dangerous and only those surgeons highly skilled at video-assisted laparoscopy and robotic-assisted laparoscopy should be treating bowel endometriosis. In terms of experience and advanced skill, you’ve definitely come to the right place because Dr. Camran Nezhat and his brothers, Drs. Farr and Ceana Nezhat, were actually the ones who first performed these advanced minimally invasive surgeries for the treatment of all forms of endometriosis, including bowel endometriosis. They achieved this revolutionary change to surgery nearly 3 decades ago, in the days when others were still derisively dismissing minimally invasive surgery as barbaric. (Click here for the full story of how some initially considered these advanced surgeries so utterly impossible that they began unfairly calling into question the validity of Dr. Nezhat’s unprecedented work).
Because of their extensive experience, Dr. Camran Nezhat and his brothers have found that the more conservative procedure called disc excision of the bowel is better for the patient. A disc excision of bowel endometriosis is where a circular portion around the endometriotic lesion is removed and the bowel is then repaired with sutures and staples. Utilizing this conservative approach means that an entire portion of the bowel does not need to be removed, which reduces the risk of any potential complications. Only in selective cases where there is severe stricture of the bowel or conservative management has failed, is a complete bowel resection needed.
You might remember from anatomy class that the bowel is a very long organ, approximately 22 feet long, from stomach to anus.
Parts of the bowel extend toward your upper abdomen, a few inches above the belly button. The different areas of the bowel have their own names, including the small bowel, large bowel, ascending colon, descending colon, sigmoid colon, ileum, rectum, and anus.
In about 70% of cases endometriosis affects the sigmoid colon and rectum, which are parts of the large intestine. However, it can affect any part of the bowel, including the ileum, which causes right-side pain symptoms very similar to acute appendicitis.
A common symptom of bowel endometriosis is chronic constipation. In severe cases, constipation can last for weeks.
Other symptoms of bowel endometriosis include diarrhea; the antithesis of constipation.
With such disparate symptoms as these, this is why bowel endometriosis continues to be one of the most misdiagnosed forms of endometriosis.
Sadly, too, many patients don’t seek the care they need because they think their symptoms aren’t serious enough, that they just have a bad case of indigestion. Don’t sell yourself short! You deserve to live a life free from pain and other uncomfortable symptoms.
When endometriosis affects the part of the small intestine called the ileum (which empties bowel contents into the large intestines) it can cause right-side pain symptoms that are nearly identical to those of acute appendicitis.
Unfortunately, this means that women with endometriosis have some of the highest rates of unnecessary emergency laparotomies than any other population.
With dismal statistics like these, that’s why it’s especially important for women with endometriosis to ask questions, demand answers, and seek out second opinions as much as possible.