Endometriosis is often thought of as a condition of the female reproductive organs, but it can also be found in other parts of the body. Bowel endometriosis is a type of deep infiltrating endometriosis (DIE) that affects from 3% to 37%1 of people with endo.
What’s the difference between bowel and other types of endometriosis, and how do you know the signs to watch for? Keep reading to find answers from Dr Amy Feng, a specialist gynaecologist at Epworth Geelong and the Julia Argyrou Endometriosis Centre at Epworth.
Dr Feng has additional training to manage bowel endometriosis, including a laparoscopic fellowship with the Australasian Gynaecological Endoscopy and Surgery Society (AGES) and a Master of Surgery in Advanced Gynaecological Surgery.
What is bowel endometriosis?
Endometriosis is when cells that are similar to the ones that line the uterus, grow in other parts of the body. These growths are known as endometriosis implants or lesions. Endometriosis most commonly affects the pelvic organs, such as the ovaries and fallopian tubes.
Bowel endometriosis is when endometriosis grows on the bowel.
“Typically, this causes the bowel to be pulled up, or stuck, to other structures, like the back of the uterus, ovaries, or the top of the vagina,” Dr Feng says. “It is a form of severe endometriosis.”
Symptoms and signs of bowel endometriosis
- Pain with bowel movement, especially during your period. Typically pressure type pain, sharp pain or cramping pain
- Cyclical bleeding from the anus or rectum, usually linked to the time of your period
- Bloating around the time of your period
- Changes to bowel movements, such as diarrhoea or constipation, around the time of your period
- Pain with sex.
Not all people with bowel endometriosis experience symptoms.
“For some patients, it is picked up during investigation for infertility, and the person may not have any related pain,” Dr Feng says.
If you are concerned about bowel endometriosis, Dr Feng encourages you to chat to a specialist gynaecologist.
“There is a lot we can do to help, so please don't feel alone.”
Looking for easy-to-understand information about endometriosis and symptoms? Order your free copy of the Epworth Endometriosis Patient Guide.
Gastrointestinal symptoms – does this mean you have bowel endometriosis?
While bloating, diarrhoea and constipation may be symptoms of bowel endometriosis, these symptoms can also be present with other conditions, including general endometriosis.
“Endometriosis can cause bloating and constipation even when it is not on the bowel. The bloating is believed to be due to inflammation from the endo,” Dr Feng says.
Other conditions such as irritable bowel syndrome (IBS) or certain medications can have similar symptoms. And, just to complicate it more, the body’s natural chemicals and hormones like progesterone and prostaglandin can cause changes too.
“In normal cycles, some women experience slight constipation in the second half of their cycle due to an increase in progesterone levels. Many women experience some loose stools just before their period or on the first day of their period, due to the release of prostaglandins,” Dr Feng says.
Diagnosis and treatment of bowel endometriosis – a snapshot
Bowel endometriosis is investigated in the same way as endometriosis, through imaging (ultrasound and MRI) and surgery (laparoscopy).
“It is typically seen on specialised ultrasound that is looking for deep infiltrating endometriosis, or through MRI,” Dr Feng says.
“Laparoscopy is used for the visual diagnosis and treatment of bowel endometriosis.”
Management of bowel endometriosis may include hormone therapy and surgery.
“Treatment options can include period suppression with the combined oral contraceptive pill, contraceptive implant, or some types of IUD (intra-uterine device),” Dr Feng says. “This helps to relieve the pain.”
“Surgery may be required if pain persists, or if there are issues with using your bowels,” Dr Feng says.
“Bowel surgery for endometriosis is very complex and nuanced, and the surgeon needs to have a thorough conversation to understand the patient's symptoms and goals of treatment. Together, the surgeon and the patient will make decisions as to how best to proceed.”
Who treats bowel endometriosis?
Dr Feng advises bowel endometriosis is best managed by a specialist gynaecologist with experience treating endometriosis.
“Surgery is typically performed by a skilled gynaecologist with advanced laparoscopic skills and a colorectal (bowel) surgeon,” Dr Feng says.
“These gynaecologists have often completed further training in surgery for endometriosis, such as an AGES fellowship.”
Have a question about endometriosis symptoms, diagnosis or treatment in Victoria, Australia?
Our dedicated Endometriosis Nurse Coordinator can help you find the right Epworth specialist for your needs – get in touch:
1. Sánchez Cifuentes, Á., Candel Arenas, M. F., & Albarracín Marín-Blázquez, A. (2016). Intestinal endometriosis. Our experience. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva, 108(8), 524–525. https://pubmed.ncbi.nlm.nih.gov/27022815/
21 February 2023