Bowel Endometriosis

Bowel endometriosis symptoms include painful and heavy periods and pain when moving the bowels and urinating. You can treat endometriosis in the bowel with hormone therapy or surgery. Painful symptoms can negatively affect mental health, so counseling can also help.

Endometriosis is a condition that causes tissues that look like the endometrium to grow outside the uterus. The endometrium is the tissue that lines the inside of the uterus. Endometriosis is most often seen around the ovaries and pelvic area but can, at times, appear in other areas, like the bowels.

Research has shown that endometriosis affects 10% to 12% of reproductive-aged women. Bowel endometriosis can affect anywhere between 5% to 12% of people with the condition. Read on to learn about bowel endometriosis, including symptoms, treatment, and more.

Types

Endometriosis causes tissue that resembles the kind that lines the inside of the uterus to grow outside of the uterus, including the bowels. There are two types of bowel endometriosis: superficial and deep. The type you have depends on how the conditions affect the bowel.

Superficial

Superficial bowel endometriosis means that lesions, or tissue growths, develop on the surface of the bowel. This type can become more aggressive over time and progress into deep bowel endometriosis.

Deep

Deep bowel endometriosis is one of the most aggressive types of the condition. This type means that lesions have passed through the wall of the bowel.

Bowel Endometriosis Symptoms

Some of the most common bowel endometriosis symptoms include:

• Abdominal cramps and pain
• Bloating, or "endo belly"
• Constipation
• Diarrhea
• Painful bowel movements
• Rectal bleeding

These symptoms can resemble digestive disorders like irritable bowel syndrome (IBS). This is one reason bowel endometriosis often takes a long time to recognize and diagnose. Bowel endometriosis symptoms typically include menstrual-related symptoms and worsen around your period.

Causes

Endometriosis causes tissue similar to the inner uterine lining to grow outside the uterus. This endometrial-like tissue typically grows around the ovaries, the fallopian tubes, and the tissue that lines the pelvis.

This tissue acts like the endometrium: It swells, breaks down, and bleeds roughly every 28 days. The tissue has nowhere to go, so it gets trapped inside the body and causes scar tissue and adhesions.

Bowel endometriosis happens when the endometrial-like tissue grows deeper into the pelvic cavity and forms adhesions on or around the bowel. It's unlikely that the tissue will grow on the bowel alone. Organs in the pelvic cavity—bladder and reproductive organs like the uterus, fallopian tubes, and ovaries—are tightly packed.

The invading tissue grows on reproductive organs and other organs in the pelvic cavity. The adhesions act like glue and can tether bits of the intestine to itself or other organs when the tissue grows on the bowel.

Risk Factors

It's not exactly clear what causes bowel endometriosis in some people. The condition generally tends to be most common in people in their 30s or 40s. Other risk factors might include:

• A family history of endometriosis
• An underlying condition that prevents the flow of menstrual blood from the body
• Menstrual cycles that are 27 days or shorter
• Never having children
• Periods that last more than seven days

Diagnosis

A gynecologist (who specializes in female reproductive health) can help diagnose bowel endometriosis. They'll ask about your health history and symptoms. A gynecologist will also perform a pelvic exam in which they'll insert two gloved fingers into the vagina. A pelvic exam helps the gynecologist check for any abnormalities.

Diagnostic tests can include:

• Barium enema: This type of X-ray examines the large intestine (colon). A healthcare provider will use a small tube to inject a mixture of barium and liquid into the rectum. They may use a balloon at the tip of the tube to pump air into and expand the large intestine.
• Laparoscopic surgery: This exploratory surgery is considered the "gold standard" for diagnosing endometriosis. A healthcare provider will make small incisions in the abdominal area to insert a slender tool with a camera (laparoscope). They will usually take a tissue sample to biopsy for confirmation.
• Magnetic resonance imaging (MRI): This imaging test uses a magnetic field and radio waves to create detailed images of your pelvic organs.
• Transvaginal ultrasound: This is a procedure during which an ultrasound probe is placed inside the vagina to take images of reproductive organs from within.

Bowel endometriosis can be tricky to diagnose. Many people with endometriosis generally wait an average of seven to nine years before getting a diagnosis. Some struggle to get a diagnosis because symptoms can look like digestive disorders. The medical community is also still learning about endometriosis as a disease.

Treatments

There's no cure for endometriosis, so the goal of treatment is to manage symptoms. A healthcare provider may recommend hormone therapy or surgery. These treatments may alleviate pain for some time, but symptoms can return.

Pain Medication

You might be able to reduce pain with an over-the-counter (OTC) pain medication if you have mild symptoms. Pain medications include Advil (ibuprofen), Aleve (naproxen), and Tylenol (acetaminophen). These drugs don't reduce or prevent the growth of lesions but can alleviate pelvic pain.

Hormone Therapy

You can sometimes treat bowel endometriosis with birth control. The endometrial-like tissue typically swells, sheds, and bleeds during a period. Hormonal birth control, like an intrauterine device (IUD) or the pill, overrides the brain's signal to release the hormones that trigger a period. A healthcare provider may instruct you to skip the placebo if you take the pill to avoid getting a period.

A healthcare provider can also prescribe a gonadotropin-releasing hormone (GnRH) agonist. This medication stops the menstrual cycle and can manage endometriosis. A GnRH may cause the body to enter a temporary menopause, which causes symptoms like hot flashes. The menstrual cycle typically returns when you stop treatment.

Surgery

A healthcare provider may suggest surgery, especially if bowel endometriosis symptoms greatly impact your life. A laparoscopic surgery, similar to the one used to diagnose the condition, is used to cut out the invasive tissue and the scar tissue.

The serosal (outer layer of the bowel) can often be peeled off, leaving the muscularis (muscular portion) of the bowel undamaged. The surgery can alleviate endometriosis symptoms or make them much easier to manage.

Counseling

Bowel endometriosis symptoms, such as pelvic pain, can negatively affect your mental health. Research has shown that people with endometriosis are more likely to have anxiety and depression than others. Physical and mental symptoms can greatly impact your daily activities and relationships.

It might be helpful to see a mental health specialist if you have bowel endometriosis. They can help you develop coping skills and provide emotional support.

Prevention

You can't prevent endometriosis completely. There are steps you can take to reduce your risk, such as decrease estrogen levels. Estrogen is a hormone that thickens the inner uterine lining.

Here are some ways you might reduce estrogen levels:

• Avoid excess caffeine: Limit yourself to one caffeinated beverage per day. Drinks like coffee, green tea, and soda can raise estrogen levels.
• Limit alcohol: Drink no more than one alcoholic drink per day. Large amounts of alcohol can increase estrogen levels.
• Stay physically active: Exercise reduces body fat, which increases the amount of estrogen in the body. Aim for four hours of physical activity per week.
• Use hormonal birth control: Methods include the pill, as well as injections, patches, and rings.

Related Conditions

Bowel endometriosis can raise the risk of other health conditions, including:

• Anxiety and depression: Pelvic pain can negatively impact your mental health. Anxiety causes excess worry, while depression causes persistent feelings of sadness. Both mental health conditions can affect school, work, and relationships.
• Infertility: About one in every two people with endometriosis have difficulty getting pregnant. Lesions can block the fallopian tubes and ovaries or distort reproductive organs.
• Irritable bowel syndrome (IBS): People with endometriosis are generally three times more likely to have IBS. Lesions in the bowel may cause constipation, diarrhea, or both.
• Ovarian cancer: Endometriosis can slightly increase ovarian cancer risk. Lesions can cause oxidative stress, which damages cells.
• Surgery complications: Laparoscopic surgery, like other surgeries, comes with complications. Although rare, surgery may cause anastomotic leakage, pelvic abscesses, and rectovaginal fistula. Anastomotic leakage is a leak in the gut. A pelvic abscess is fluid build-up. A rectovaginal fistula is an opening that forms between the rectum and vagina.

Living With Bowel Endometriosis 

Bowel endometriosis is a chronic condition, but you can manage symptoms with hormone therapy, surgery, and counseling. People with endometriosis generally have fewer symptoms after menopause, or the natural end of periods.

Some people with bowel endometriosis may notice symptoms worsen if they have constipation. Here are some ways to prevent constipation and ease symptoms:

• Eat plenty of fiber
• Exercise regularly
• Stay hydrated
• Use a stool softener