Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus, often on the ovaries, fallopian tubes, and tissue around the uterus. When endometrial tissue grows on the bowels, it is called bowel endometriosis.
Bowel endometriosis affects between 5-12% of women with endometriosis. The most common locations are the rectum and sigmoid colon. Symptoms include painful bowel movements, diarrhea, constipation, bloating, and cramping during menstruation. Bowel endometriosis can be diagnosed through imaging tests like transvaginal ultrasound, MRI, or laparoscopy. Treatment options include pain medications, hormone therapy, and surgery to remove the endometrial lesions.
What Happens if Bowel Endometriosis is Left Untreated?
Leaving bowel endometriosis untreated allows the endometrial lesions to continue growing larger and more numerous over time. This can lead to several complications:
Worsening Pain and Bowel Symptoms
As the endometrial lesions expand, they can infiltrate deeper into the bowel tissue. This causes increasing inflammation, scar tissue formation, and bowel obstruction. Patients experience worsening cramping, abdominal bloating, painful bowel movements, constipation, diarrhea, and gastrointestinal discomfort that greatly impacts their quality of life.
Bowel Obstruction
Bowel endometriosis can cause partial or complete intestinal blockage as the lesions grow inward and constrict the bowel lumen. This prevents food and waste from passing through normally. Symptoms of bowel obstruction include severe cramping, nausea, vomiting, abdominal distension, constipation, and inability to pass gas or have bowel movements. Bowel obstruction is a medical emergency requiring hospitalization, IV fluids, pain control, and possibly surgery.
Bowel Perforation
In rare cases, the expanding endometrial lesions can erode through the bowel wall causing perforation or hole formation. This allows bowel contents to leak into the abdominal cavity leading to infection (peritonitis) and sepsis. Bowel perforation causes severe abdominal pain and requires emergency surgery to repair the hole in the intestine and clean out any contamination.
Nutrient Malabsorption and Deficiencies
Progressive bowel endometriosis can interfere with the intestine’s ability to absorb nutrients from food. This leads to nutritional deficiencies, weight loss, diarrhea, and symptoms of anemia over time if left untreated. Nutrient malabsorption is more common when the lesions involve the small intestine compared to the colon.
Infertility
Bowel endometriosis can distort the nearby ovaries, fallopian tubes, and pelvic anatomy. Scarring around the reproductive organs prevents normal functioning and can contribute to infertility. Laparoscopic surgery to remove bowel endometriosis has been shown to improve pregnancy rates by restoring normal anatomy.
Cancer Risk
Research shows the risk of certain cancers is higher in patients with untreated endometriosis, especially endometrioid and clear cell ovarian cancers. It is theorized that leaving endometrial lesions in place allows more time for atypical cells to develop mutations. Early diagnosis and treatment of bowel endometriosis is recommended to remove lesions before malignant changes occur.
Diagnosis of Bowel Endometriosis
The first step in treating bowel endometriosis is accurate diagnosis. Symptoms alone are not enough, as they may mimic other bowel diseases like IBS or IBD. Here are the main diagnostic tests used:
| Diagnostic Test | Description |
|---|---|
| Pelvic Exam | Feeling for tender nodules on the bowel, enlarged ovaries, and other signs of endometriosis. |
| Transvaginal Ultrasound | Imaging test to identify endometrial lesions on ovaries, bowel, and other pelvic structures. |
| MRI | Magnetic resonance imaging that gives a detailed view of bowel endometriosis lesions and their extent. |
| Laparoscopy | Minimally invasive keyhole surgery to visually inspect pelvic organs and take biopsies of lesions. |
Once bowel endometriosis is diagnosed, treatment can begin to prevent complications from worsening.
Medical Treatment Options
For mild to moderate bowel endometriosis, the first line treatment is usually hormonal medications to slow growth of lesions and reduce inflammation. Common options include:
Combined Oral Contraceptives
Birth control pills contain estrogen and progestin that prevent ovulation and thin the uterine lining. This causes endometrial lesions to shrink and become less active.
Progestin Therapy
Progestin-only preparations like pills, injections, or intrauterine devices thicken cervical mucus to prevent sperm from reaching the eggs. They also make the endometrium less hospitable for implantation and growth.
Gonadotropin-Releasing Hormone (GnRH) Agonists
GnRH agonists switch off ovarian function and halt estrogen production. This induces a temporary menopausal state to discourage endometrial lesions.
Side effects of hormonal therapy may include menopausal symptoms, bone loss, and others. Treatment is usually time-limited to avoid complications. Hormones do not eradicate lesions permanently and pain often returns when treatment stops. They may be used to shrink lesions before surgery or manage symptoms long-term if surgery is not an option.
Surgical Treatment Options
Surgery is usually necessary for more severe bowel endometriosis to remove lesions and improve fertility. This requires meticulous dissection of endometriosis from the bowel performed by an experienced surgeon. Types of surgery include:
Laparoscopic Excision
Most bowel endometriosis surgery is done by laparoscopy. The surgeon inserts instruments through tiny abdominal incisions to cut away lesions while preserving as much bowel tissue as possible.
Laparotomy and Bowel Resection
Large endometrial growths invading the intestinal muscle may require open abdominal surgery and segmental bowel resection. The damaged portions of intestine are removed and the healthy ends sewn back together.
Colorectal Surgery Techniques
Bowel endometriosis near the rectum or anus may need special surgical techniques like transanal endoscopic microsurgery or laparoscopic-assisted transanal resection.
Complications from bowel surgery may include infections, bleeding, bowel leaks, fistulas, and rarely loss of bowel control. Patients require close monitoring after surgery. Complete lesion removal offers the best chance for symptom relief and fertility improvement.
Alternative and Complementary Therapies
Some patients use natural therapies alongside or instead of medications and surgery:
Dietary Changes
Anti-inflammatory diets, eliminating caffeine, alcohol, red meat, dairy, and high-fat foods may help relieve some endometriosis symptoms.
Nutritional Supplements
Vitamins, omega-3 oils, melatonin, and herbal preparations like turmeric may help reduce inflammation and hormone imbalance.
Acupuncture
Acupuncture can relieve pelvic pain and regulate menstruation. More research is needed on using it specifically for bowel endometriosis.
Exercise
Low-impact activities like yoga, Pilates, and walking can improve endometriosis pain and quality of life based on some studies.
However, these complementary therapies have not been well-studied for bowel endometriosis treatment and are unproven. They should not replace medical therapy without a doctor’s supervision.
Conclusion
In summary, untreated bowel endometriosis allows lesions to progress, often leading to significant bowel symptoms and complications. This negatively impacts fertility and quality of life. Accurate diagnosis is the first step, followed by medical or surgical treatment to remove lesions before they cause permanent damage. With proper treatment, symptoms can be managed and fertility preserved. Support groups and counselling may also help patients cope with this chronic disease.
Treating bowel endometriosis as soon as it is identified gives the best chance of symptom relief and restoring bowel function. This coordinated care team approach can prevent complications and debilitating symptoms from advancing if bowel endometriosis remains unchecked.
