Bowel endometriosis is seen in less than 1% of all patients with symptomatic endometriosis. The term ’bowel‘ generally refers to the large colon. The majority of the changes seen involve the rectum, which lies in closest proximity to the uterus. It is less common to have the appendix involved, and rare for the small bowel to be directly infiltrated by endometriosis.
Bowel endometriosis is invariably associated with other significant endometriosis (eg endometrioma/chocolate cysts, or adenomyosis). Bowel endometriosis tends to slowly and progressively worsen in women who are pre-menopausal. It is rare for the bowel to be obstructed by endometriosis.
When the bowel is involved, there is generally a range of symptoms that a patient may experience; in particular, a cyclic change in bowel habit (diarrhoea, constipation or both) or cyclic bowel pain, always worst when the period is due. Women with bowel-related endometriosis will almost invariably have reduced fertility. Sometimes it is necessary to correct the pelvic and bowel endometriosis before a woman can conceive naturally. It is usual for patients with documented bowel endometriosis to experience back pain, sex pain and ovulation pain.
Investigating bowel pain by pelvic ultrasound scan or MRI scan is always a good starting point. The scan must be very specific, by an ultrasonologist or radiologist trained in recognising features of bowel involvement. This is very useful information in planning possible surgery.
The #1 question from patients and partners regarding the possibility of bowel surgery is “Will I have to wear a stoma/colostomy bag after surgery?” In more than 500 bowel procedures over 20 years, none of Dr Gordon’s patients have had a stoma following surgery where the bowel has been involved.
There are a range of possibilities for surgery when bowel involvement is suspected or even proven by a prior laparoscopy. These are best discussed in consultation with Dr Gordon.