Endometriosis is a chronic inflammatory condition where tissue resembling the lining inside the uterus, known as the endometrium, grows outside its usual location. This misplaced tissue can develop on various organs, most commonly within the pelvic region, including the bowels, bladder, and ovaries. When this tissue affects the gastrointestinal tract, it is referred to as bowel endometriosis, leading to symptoms like mucus in bowel movements.
Understanding Bowel Endometriosis
Bowel endometriosis occurs when endometrial-like lesions grow on the outer surfaces of the intestines, frequently affecting the rectum, sigmoid colon, ileum, or appendix. These lesions respond to hormonal fluctuations throughout the menstrual cycle. This cyclical response causes the misplaced tissue to thicken, break down, and bleed, but unlike menstrual blood, it has no way to exit the body.
This trapped blood and tissue lead to localized inflammation, irritation, and the formation of scar tissue or adhesions around and within the bowel. The body’s inflammatory response can cause the bowel wall to thicken and alter normal bowel function. The irritation and inflammation prompt the bowel to produce excess mucus.
Recognizing Bowel Endometriosis Symptoms
Bowel endometriosis causes various gastrointestinal symptoms, including mucus in stool, often worsening during menstruation. This occurs due to the cyclical inflammation and irritation caused by the tissue. Other common symptoms include painful bowel movements and sometimes rectal bleeding.
Individuals may also experience changes in bowel habits, such as constipation or diarrhea, abdominal bloating, and generalized abdominal pain. The overlap of these symptoms with common gastrointestinal conditions like Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD) can make diagnosis challenging. For example, over 90% of endometriosis patients report some gastrointestinal symptoms, and women with endometriosis are two to three times more likely to be diagnosed with IBS.
Diagnosing Bowel Endometriosis
Diagnosing bowel endometriosis presents challenges because lesions grow on the outside of the bowel wall, making them difficult to detect with standard internal procedures. For instance, a colonoscopy, which examines the inner lining of the large intestine, often misses these external growths. Only in the most advanced cases, where the tissue has deeply infiltrated the bowel wall, might it be visible during a colonoscopy.
A comprehensive diagnostic approach begins with a thorough medical history and physical examination, where a doctor might palpate for unusual growths. Imaging techniques play a significant role, including transvaginal ultrasound (TVUS) and Magnetic Resonance Imaging (MRI), designed to better visualize lesions. CT scans may also be used. While imaging can help locate and assess the extent of deep infiltrating lesions, a definitive diagnosis requires diagnostic laparoscopy, considered the gold standard, allowing for direct visualization and biopsy of the tissue.
Treatment Options for Bowel Endometriosis
Treatment for bowel endometriosis is individualized, considering symptom severity, lesion location, and personal preferences, including fertility desires. Medical management involves hormonal therapies aimed at suppressing estrogen production, which can reduce the growth of lesions and associated inflammation. Common hormonal treatments include GnRH agonists, oral contraceptives, and progestins, which can help manage pain and improve symptoms. Pain management strategies, such as over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), are also used.
Surgical options range from minimally invasive laparoscopic procedures to more extensive bowel resection in severe cases. The goal of surgery is to excise the lesions while preserving bowel function. Procedures may include rectal shaving, where lesions are removed from the bowel surface, or segmental bowel resection, which involves removing the affected section of the bowel and rejoining the healthy portions.