Bowel and bladder endometriosis are two of the most commonly misdiagnosed forms of endometriosis. This is because many of their symptoms can mimic those of several other conditions, including acute appendicitis, inflammatory bowel disease, irritable bowel syndrome, painful bladder syndrome, and celiac disease, just to name a few. Complicating matters further, these other conditions can co-exist with endometriosis.
To help provide clarity among such clinical confusion, we’ve compiled the following summary to help you recognize what may be symptoms of bowel endometriosis from those of other disorders.
1. WHAT ARE THE SIGNS AND SYMPTOMS OF BOWEL ENDOMETRIOSIS?
Bowel endometriosis causes many different symptoms. Most commonly, patients complain of pain with bowel movements and pain with intercourse. Other symptoms include pelvic pain associated with menses, constipation, diarrhea, abdominal cramping, and difficulty with completely evacuating the bowels (called dyschezia). When endometriosis affects the ileum, which is part of the small intestine, it can cause pain on the right side of the abdomen that mimics acute appendicitis, life-threatening bowel obstructions, or other equally serious disorders. Because of this, unfortunately women with endometriosis have a higher rate of undergoing unnecessary emergency surgeries when they present to the emergency room with these symptoms.
2. HOW IS BOWEL ENDOMETRIOSIS DIAGNOSED?
Bowel endometriosis is usually diagnosed by laparoscopy and proctoscopy (a procedure in which a camera is placed in the rectum). If you are having symptoms of constipation alternating with watery diarrhea, then your physician may order a CT scan or MRI of your abdomen to rule out an obstruction of the bowel that can be caused by endometriosis or another type of abnormal mass.
If you are having any rectal bleeding, then a gastrointestinal specialist should evaluate you to rule out the possibility of colon cancer. In fact, all patients age 45 years or older should be screened for colon cancer regardless of symptoms, as bowel cancer is the 3rd most common cancer in the U.S.
Symptoms of bowel endometriosis can mimic those of other gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, and even appendicitis. Sometimes patients have these diseases along with bowel endometriosis. Therefore, a thorough workup is required by both an experienced gynecologic surgeon and a gastrointestinal specialist to make the diagnosis of these disorders.
3. HOW IS BOWEL ENDOMETRIOSIS TREATED?
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 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.
4. CAN BOWEL ENDOMETRIOSIS BE TREATED BY MINIMALLY INVASIVE TECHNIQUES?
Yes, but only by an extremely experienced surgeon. Operating on or near the bowels can be very dangerous and only those surgeons highly skilled at robotic-assisted surgical techniques should be treating bowel endometriosis. In terms of experience and advanced skill, you’ve definitely come to the right place because Dr. Azer with nearly two decades of using the da Vinci robot, has performed hundreds of these advanced surgeries using state-of-the art technologies.
