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Endometriosis of the bowels is a special entity which requires a high index of awareness and suspicion for correct diagnosis, and expertise for management. Many women who suffer from endometriosis may not realise that the disease can affect the bowels. This may be due to the fluctuating nature of symptoms, lack of awareness of the link between bowel symptoms and endometriosis and inadequate appreciation of the extent of the disease at laparoscopy The exact incidence is unclear but may occur in 5-15% of all cases of endometriosis. The sites where endometriosis occurs are the rectum, the sigmoid, the appendix and the small bowels. Bowel symptoms that can occur in endometriosis patients include:

  • Painful bowel movements (especially during periods)
  • Constipation
  • Diarrhea
  • Alternating constipation and diarrhea (Irritable bowel syndrome)
  • Intestinal cramping
  • Nausea and/or vomiting
  • Abdominal pain
  • Rectal pain
  • Rectal bleeding

Some patients will only have one of these symptoms, while others may have all of them. Often these symptoms are more problematic during their periods. Diagnosis of bowel endometriosis requires a careful history and thorough physical examination. The detection of tender nodule at the top of the vagina adjacent to the rectum should raise suspicion. Women found to have ovarian endometriotic cysts on ultrasound may have up to 30 per cent chance of having bowel endometriosis at the same time. Barium enema and colonoscopy, carried out to exclude inflammatory bowel diseases or to confirm full-thickness endometriosis bowel involvement, are often negative. Consequently, many women may be mistakenly diagnosed as having irritable bowel syndrome.

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 it 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. Some women may need a temporary colostomy for a couple of months to allow adequate healing of the resected bowel area.