Bowel Endometriosis

Endometriosis affecting the bowel is the most prevalent form of deep infiltrating endometriosis that extends beyond the reproductive organs. Often, its symptoms closely resemble those of gastrointestinal disorders, making diagnosis complex. However, specific symptoms can indicate a link to the menstrual cycle. Conversely, gastrointestinal symptoms alone do not definitively signal bowel-related endometriosis.

Beyond rectovaginal endometriosis, lesions can also manifest on the colon or appendix. More rarely, they may appear on the stomach or small bowel.

As always, treatment decisions hinge on an individual’s medical history and symptoms, necessitating a thorough discussion with an endometriosis center.

Key Points about Rectovaginal Endometriosis:

  • Prevalence: Approximately 25% of individuals with endometriosis experience rectovaginal involvement [1].
  • Location and Growth: Rectovaginal endometriosis refers to endometrial tissue growth between the rectum and the vagina, which can extend into the rectum itself.
  • Symptoms: Common symptoms encompass discomfort or pain during bowel movements, rectal bleeding, and nausea.
  • Treatment Options: Management approaches include medicinal and surgical interventions. Surgery often offers better symptom relief and improved fertility outcomes.

Key Points about Rectal Endometriosis:

  • Prevalence: Rectal endometriosis is the most prevalent type of intestinal endometriosis.
  • Symptoms: Common symptoms encompass pain and bleeding within the digestive tract.
  • Growth Patterns: Endometriosis growth can occur on the bowel’s surface, within it, or extend through its entire wall. Symptoms vary based on the growth location.
  • Treatment: Surgical removal of endometriosis lesions from the intestinal wall is frequently employed.

Key Points about Endometriosis on the Stomach:

  • Prevalence: Endometriosis occurring on the stomach is rare.
  • Symptoms: Symptom presentation often resembles that of other gastrointestinal disorders.

Bowel-Related Issues in Endometriosis Despite Absence of Bowel Involvement

Numerous patients report bowel-related problems despite the lack of endometriosis affecting the bowel directly. Endometriosis lesions can induce alterations in the intestinal mucosa and overall function, leading to bowel issues even without lesions in the area. Inflammatory processes apart from endometriosis foci can also elicit symptoms by irritating the intestine. Elevated inflammatory markers within the peritoneum contribute to organ irritation.

Bloating is a frequent complaint among endometriosis patients, even without intestinal endometriosis. The precise origin of this bloating remains uncertain. Inflammatory reactions within the abdomen are presumed to be a potential cause. However, similar to other symptoms, a thorough exploration is essential to ascertain whether other factors might contribute to abdominal air accumulation.

Constipation and diarrhea often exist among many female patients.

Changes in the microbiome are suspected of playing a role in diarrhea.

Physicians refer to the microorganisms inhabiting the intestine as intestinal microbiomes. These microbes can be either beneficial or harmful. The beneficial ones maintain a healthy intestinal flora and bolster the immune system [1]. However, in endometriosis cases, the composition of microbiomes can differ. Research has revealed heightened levels of Proteobacteria, Enterobacteriaceae, Streptococcus, and Escherichia coli [2]. This microbial imbalance may lead to symptoms like diarrhea.

An association between bacterial gut flora and endometriosis appears to exist, explaining why patients might experience gastrointestinal issues even without intestinal endometriosis. Nevertheless, additional studies are required to understand this correlation comprehensively.

Endometriosis on the Intestine Despite Absence of Symptoms

Conversely, the situation can unfold in the opposite direction. Some patients may exhibit no symptoms that suggest endometriosis involving the bowel. Nonetheless, endometriosis lesions on the bowel can be identified during laparoscopic procedures. Consequently, surgeons must address the possibility of bowel-related endometriosis during preoperative discussions. In some cases, these lesions can be removed directly. However, if extensive surgery on the bowel is anticipated, it might necessitate subsequent surgical interventions. The course of action should always be determined in consultation with the patient before the operation.

IMPORTANT: Intestinal complaints can occur independently of endometriosis.

It is crucial to remember that not all of your symptoms necessarily stem from endometriosis. Despite the prevalence of gastrointestinal symptoms among patients, it is essential not to disregard potential factors like food intolerances, allergies, or other inflammatory conditions. If laparoscopy does not reveal signs of intestinal endometriosis, seeking medical advice to investigate the underlying causes of your symptoms is recommended.


  1. Shapiro H, Thaiss CA, Levy M, Elinav E. The cross talk between microbiota and the immune system: metabolites take center stage. Curr Opin Immunol. 2014 Oct;30:54-62. doi: 10.1016/j.coi.2014.07.003. Epub 2014 Jul 26. PMID: 25064714.
  2. Leonardi M, Hicks C, El-Assaad F, El-Omar E, Condous G. Endometriosis and the microbiome: a systematic review. BJOG. 2020 Jan;127(2):239-249. doi: 10.1111/1471-0528.15916. Epub 2019 Sep 19. PMID: 31454452.
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