Bowel Endometriosis (Rectosigmoid): Symptoms, Diagnosis and Treatment
Bowel endometriosis occurs when endometriosis lesions affect the bowel wall. The rectosigmoid region, where the rectum meets the sigmoid colon, is the most commonly affected area.
Symptoms may become more noticeable around menstruation and can include painful bowel movements (dyschezia), bloating, gas, constipation or diarrhea. In more advanced cases, narrowing of the bowel (stenosis) may occur.
Possible symptoms of bowel endometriosis include:
Painful bowel movements that worsen during menstruation
Bloating and gas
Constipation or diarrhea
Rectal pain or discomfort
Rarely, rectal bleeding
A feeling of pressure or obstructive symptoms in more advanced cases
When should bowel endometriosis be considered?
If bowel symptoms become noticeably worse during menstruation, particularly when accompanied by pelvic pain or pain during sexual intercourse, evaluation for endometriosis may be considered.
Diagnosis
Clinical assessment and imaging techniques are used in the evaluation of suspected bowel endometriosis.
Transvaginal ultrasound (TVUS) with bowel preparation: May be used to assess the rectovaginal region and rectosigmoid involvement.
Magnetic resonance imaging (MRI): Can help assess the location and extent of lesions and evaluate possible involvement of adjacent structures such as the bowel, ureters or bladder.
Colonoscopy: Because endometriosis often affects the bowel from its outer layers, colonoscopy may appear normal. It may be useful when rectal bleeding is present or when other bowel conditions need to be excluded.
Treatment Options
Treatment is planned according to the patient's symptoms, the location and extent of the lesions, the presence of bowel narrowing and future pregnancy plans.
Medical treatment: Hormonal treatments may be used to manage endometriosis-related symptoms in some patients. Surgical evaluation may be required when significant bowel narrowing is present.
Surgical treatment: When surgery is indicated, the surgical approach is determined according to the characteristics of the lesions. Advanced bowel involvement may require assessment and collaboration across different surgical specialties.
Surgical approaches may include:
Shaving: Removal of more superficial endometriosis lesions from the bowel wall.
Disc resection: Removal of a limited area of the bowel wall affected by deeper disease.
Segmental resection: Removal of an affected segment of bowel when disease is more extensive or causes significant narrowing.
How Is the Surgical Approach Determined?
The choice of surgical technique is not based solely on lesion size. The depth and extent of bowel involvement, the presence of stenosis, the patient's symptoms and overall clinical condition are considered together.
Fertility and IVF
When endometriosis and fertility are evaluated together, factors such as age, ovarian reserve, extent of disease, symptoms and previous treatments are taken into consideration.
For some patients, surgical evaluation may be considered, while for others assisted reproductive treatment may be prioritized. The approach is determined individually according to the patient's clinical circumstances and reproductive plans.
After Surgery
Recovery following surgery varies depending on the extent of the procedure and the patient's clinical condition.
Changes in bowel habits, gas or constipation may occur during the early postoperative period. Progression of diet and physical activity is planned according to the type and extent of surgery.
Medical assessment is required in the event of high fever, increasing or severe abdominal pain, significant bleeding, or newly developed urinary or bowel problems.
Nutrition and Lifestyle
Dietary adjustments may help some patients manage bowel-related symptoms. Identifying foods that individually trigger symptoms and developing a balanced nutritional plan may be considered.
Dietary and lifestyle measures do not replace medical or surgical treatment.
Frequently Asked Questions
Why can a colonoscopy be normal?
Endometriosis lesions often affect the outer layers of the bowel wall, meaning that the inner surface of the bowel may appear normal during colonoscopy.
Will I need a stoma?
The need for a stoma in bowel endometriosis surgery depends on the extent of the disease and the type of surgery required. If this is a possibility, it is discussed with the patient before surgery.
When can I return to work?
Recovery and return-to-work times vary according to the extent of surgery and the individual's recovery.
Will constipation or diarrhea improve?
The course of bowel symptoms following surgery varies between individuals and depends on the characteristics of the disease and the extent of the surgical procedure.
How is bowel endometriosis managed during pregnancy?
Management during pregnancy depends on the patient's symptoms and clinical circumstances. When necessary, assessment may involve the obstetrician and other relevant specialties.
Note: There is currently no scientifically established herbal or alternative treatment that has been shown to treat endometriosis. Such approaches should not replace appropriate medical evaluation or treatment.