If these endometrial lesions penetrate at least the outer wall of the bowel, it is referred to as deep infiltrating endometriosis with bowel involvement. This condition is observed in approximately 25% of all endometriosis cases [5]. Endometriosis of the rectovaginal septum can manifest with or without intestinal infiltration, and both forms can significantly impact a person’s fertility and overall quality of life. Affected individuals often report severe pain, particularly during sexual intercourse (dyspareunia) and defecation (dyschezia) [5].
Depending on the extent of the condition, the appropriate treatment and therapy require collaboration between specialized surgeons and urologists, working alongside gynecologists, to remove the affected tissue surgically.
In addition to the typical symptoms associated with endometriosis, rectovaginal endometriosis often presents with additional distinctive symptoms, such as infertility and intense pain during and outside menstruation [2].
The following symptoms may manifest:
The diagnosis of intestinal endometriosis can be challenging due to the wide range of symptoms associated with endometriosis.
A preliminary diagnosis is typically established based on symptom observation and pain assessment using a pain scale.
In the case of rectovaginal endometriosis, a critical diagnostic technique is a rectovaginal palpation. The physician simultaneously palpates the vagina and rectum during this examination using one finger each. This allows for a thorough evaluation of the area in between, often the site of rectovaginal endometriosis. An experienced examiner can often discern strong indications of rectovaginal endometriosis using this method.
Ultrasound imaging can also be a valuable diagnostic tool. Initially, the examination focuses on the uterus and ovaries. It is followed by an assessment of ovarian mobility and the “sliding sign,” which gauges the mobility of the uterus. Due to the rectovaginal adhesions, mobility may be restricted, and this limitation can be directly evaluated through ultrasound. Subsequently, a more comprehensive evaluation of involvement in the posterior and anterior compartments, including the bladder and intestine, is conducted [5]. Endosonography of the rectum can also provide valuable information in the diagnostic process.
Occasionally, a colonoscopy may be conducted, but since endometriosis typically forms on the external surface of the bowel and infiltrates inward, an unremarkable colonoscopy does not necessarily exclude the possibility of bowel endometriosis.
For precise information regarding the location of rectovaginal endometriosis, whether it is limited to the outer bowel wall or has breached it, surgical intervention via laparoscopy [3] is necessary. In certain instances, lesions may not be visible on ultrasound or endosonography, and the full extent of endometriosis becomes apparent only during laparoscopy. Consequently, decisions about potential bowel resection should also be made intraoperatively [3]. It is crucial to discuss the approach in cases of endometriosis near or on the bowel during pre-operative consultations to develop an “if-then” plan in collaboration with the surgeon.
The treatment and therapy of endometriosis with bowel involvement [5] necessitates careful consideration of several factors, including:
In cases where endometriosis of the rectum is an incidental finding without associated symptoms, surgical therapy may not be deemed essential according to clinical guidelines. However, in practice, rectovaginal endometriosis, in particular, often leads to problems and pain.
Given the involvement of organs like the intestine, it is advisable to conduct therapy in a specialized center to ensure the participation of other specialized departments, including intestinal surgeons.
Surgical removal of the endometriosis lesions is often the preferred treatment for symptomatic endometriosis with bowel involvement. Surgical therapy is the most effective means of achieving long-term pain relief and potentially improving fertility [4].
However, the treatment choice should always be discussed individually with the appropriate medical center.
In deep-infiltrating endometriosis involving the bowel wall, bowel resection may be a viable option. Surgery involving organs such as the bladder, ureters, and bowel demands a well-trained and experienced team comprising gynecologists, surgeons, and urologists to ensure that the patient emerges from anesthesia with minimal damage.
Surgery on the intestine, which may involve the removal of a section of the intestine, carries inherent risks. It is important to emphasize that a temporary artificial anus may be necessary based on the surgeon’s evaluation. This can later be reversed, so it is not a permanent alteration. However, since this procedure naturally affects the postoperative period, it should be thoroughly discussed with the doctor.
In the case of endometriosis within the intestine, a decision must be made whether to continue the operation immediately to remove all affected areas or to plan a second operation. The latter approach allows for a more detailed discussion of the extent and associated risks beforehand. This decision is highly individual, so seeking comprehensive information and perhaps considering it in advance is essential.
If the endometriosis is confined to the outer bowel and has not been breached, bowel resection is typically unnecessary. However, suppose a portion of the bowel had to be removed during the surgery. In that case, an artificial bowel outlet may be temporarily installed for a few weeks or months to allow the surgically treated areas to heal.
In numerous instances, resection can enhance fertility. According to a study, 44.6% of women of childbearing age could conceive after undergoing resection for deep infiltrating bowel endometriosis. Furthermore, laparoscopic colorectal resection for endometriosis has been linked to symptom relief and significantly improved the patient’s quality of life [1]. Following the surgery, patients receive individual counseling regarding potential drug therapy options, such as progestin. Additionally, they are advised to maintain a healthy diet tailored to endometriosis.
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Psychologist Teresa Götz (Endo-App) interviewed Dr. Cecilia Ng, who is doing research on endometriosis in…
Endo-App - kostenlos
Endometriose lindern
App auf Rezept