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.
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.
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.
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.
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