Bowel endometriosis: Symptoms, diagnosis, and treatment
Bowel endometriosis involves the abnormal growth of endometrial tissue in the intestines.
In this article, learn more about the symptoms of bowel endometriosis, how doctors diagnose it, and what treatments are available.
What is bowel endometriosis?
Bowel endometriosis occurs when tissues similar to endometrial tissue grow on the bowel or intestine.
Endometrial tissue usually grows in the uterus to prepare the body for ovulation and possibly fertilization.
The tissue is made up of blood cells and connective and gland tissue. It thickens every month until it sheds during menstruation if fertilization does not occur.
When the tissue grows abnormally outside the uterus, such as on the bowel, the endometrial tissue still thickens in response to hormones. However, because this endometrial tissue cannot leave the body, it causes a variety of symptoms.
Doctors usually classify endometriosis as either superficial or deep. Superficial endometriosis grows on the surface of the bowel. If the tissue penetrates the bowel wall, it is called deep bowel endometriosis.
According to a 2018 review, after the genital organs, the bowel is the most common location for abnormal endometrial tissue to grow.
Symptoms
Symptoms of bowel endometriosis may include:
- deep pelvic pain
- pelvic pain during sexual intercourse
- constipation
- diarrhea
- painful bowel movements
- rectal bleeding (uncommon)
Abnormal endometrial tissue can grow on any segment of the bowel. But according to 2014 research, about 90 percent of the incidences of bowel endometriosis involve the rectum or sigmoid colon.
Symptoms of bowel endometriosis may vary between individuals and depend on a person’s menstrual cycle.
For example, symptoms may be worse in the days leading up to menstrual bleeding.
Symptoms of bowel endometriosis may decrease once a person enters menopause and estrogen levels decrease.
Doctors do not know exactly why some people develop endometriosis.
One theory is that during menstruation, the blood flows back into the fallopian tubes and the pelvis. Some pieces of this tissue may attach to the lining of the bowel.
It is also possible that past surgery involving the uterus may allow the endometrial cells to attach to the incision and eventually transfer to the bowel.
Some researchers think an imbalance of estrogen may also contribute to endometriosis.
There also appears to be a genetic link. People who have a close family member, such as a mother or sister, with the condition are at an increased risk of developing endometriosis.
Researchers still do not know why endometrial tissue grows outside the reproductive organs, such as on the bowel.
Diagnosis
Because symptoms of bowel endometriosis can mimic other intestinal problems, it is essential to rule out conditions, such as colitis, rectal tumors, and irritable bowel syndrome (IBS).
After a physical exam including a pelvic examination, a review of symptoms, and medical history, a doctor may order additional tests, including:
- an ultrasound
- a CT scan
- sigmoidoscopy to view the interior of the bowels
- laparoscopy, a surgical procedure to view the bowel and abdomen
There is no conclusive evidence that a specific diet can ease symptoms of bowel endometriosis.
Some studies suggest that eating fruits and vegetables has links to fewer endometriosis symptoms.
For example, a 2018 study looked at 70,835 premenopausal women. The results indicated that women who ate one or more servings of citrus fruits daily had a 22 percent lower risk of developing endometriosis than women who consumed fewer citrus fruits. The study did not look at bowel endometriosis specifically, however.
Another small study looked at women who had IBS as well as endometriosis with bowel symptoms that worsened during menstruation.
The study indicated that eating a low FODMAP diet might ease bowel symptoms possibly associated with endometriosis.
FODMAP is the acronym for fermentable oligo-di-monosaccharides polyols.[PF1]
FODMAP foods are carbohydrates that tend to trigger symptoms, such as stomach cramps, gas, and bloating.
Additional research is necessary to conclude whether a special diet can help reduce symptoms of bowel endometriosis.
Outlook
The outlook for people with bowel endometriosis depends on the severity of their symptoms and the effectiveness of treatment.
Although endometriosis is a chronic condition, there are treatments, such as hormone therapy and surgery, which can help to reduce symptoms.
In many cases, symptoms of bowel endometriosis ease when estrogen levels decline after menopause.
[PF1]HANNAH – not sure we need this?
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