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Colonoscopy image: bowel endometriosis
Endometriosis is the presence of tissue similar to the lining of the womb in the wall of the bowel. It can cause pressure on the bowel from outside, narrowing or, rarely, changes on the inner surface.
It is not cancer. However, it can sometimes be mistaken for bowel tumours. Ultrasound, MRI and, when needed, other tests are done to make the diagnosis.
What is bowel endometriosis?
Endometriosis is the presence, outside the womb, of cells similar to the tissue that normally lines the inside of the womb.
These cells can sometimes settle on the surface or in the wall of the bowel. This is called bowel endometriosis (endometriosis of the colon).
It is seen most often in the last parts of the large bowel, particularly the rectum and the sigmoid colon.
It is not cancer. In some patients, however, it can cause hardening of the bowel wall, narrowing and difficulty opening the bowels.
Who gets it?
It is usually seen in women of childbearing age. The bowel may also be involved particularly in women who have painful periods, who have been diagnosed with endometriosis or who have difficulty getting pregnant.
What are the symptoms?
- Abdominal and groin pain that gets worse during periods
- Pain when opening the bowels
- Constipation, diarrhoea or bloating of the abdomen
- A feeling that the bowels have not emptied completely
- Rarely, bleeding from the back passage linked to periods
- In advanced cases, narrowing of the bowel and difficulty opening the bowels
Important: bowel complaints that get worse particularly during periods can be an important clue to endometriosis.
Why does it happen?
The exact cause of endometriosis is not yet fully known. Hormonal, immune-system and genetic factors are thought to play a part.
Over time, patches of endometriosis in the bowel can cause an inflammatory reaction and adhesions in the surrounding tissues.
How is it diagnosed?
The diagnosis is made by looking at the patient’s complaints, the gynaecological examination and imaging tests together.
In particular, ultrasound performed by a specialist and pelvic MRI can give important information.
Colonoscopy can be used to assess the inner surface of the bowel and to look for other diseases. However, because endometriosis is mostly found in the outer or deeper layers of the bowel wall, a normal colonoscopy does not rule out bowel endometriosis.
In some patients a surgical method called laparoscopy may be needed for diagnosis and treatment.
How is it treated?
Treatment is decided according to the patient’s complaints, the extent of the bowel involvement and plans for pregnancy.
- Medicines to reduce the pain
- Hormonal treatment in suitable patients
- Surgery if there is serious narrowing of the bowel, marked complaints or no response to treatment
Not every patient with bowel endometriosis needs an operation.
Treatment is usually planned with a specialist in gynaecology and obstetrics, assessing the patient together with gastroenterology and colorectal surgery specialists when needed.
When should you see a doctor?
You are advised to see a doctor if you have abdominal pain that gets worse particularly during periods, difficulty opening the bowels, constipation or bleeding from the back passage.
Severe abdominal pain, marked swelling of the abdomen, persistent vomiting, or being unable to pass wind or stool need urgent assessment.
Remember: bowel endometriosis is not cancer. However, it can spoil quality of life and in some patients can lead to serious bowel problems. With the right diagnosis and suitable treatment, the complaints can be brought under control.
Sources
- Prof. Ali Tüzün İnce, MD — personal endoscopy archive