What is Bowel Endometriosis: Causes, Symptoms, Treatment

What is Bowel Endometriosis?

Endometriosis is a pathological condition in which the endometrial tissues that line the uterus start growing in other areas of the body. Normally, it grows within the pelvic organs and the fallopian tubes but at times it may also start to grow in the bowel region. This is what is termed as bowel endometriosis. The function of the endometrial tissues is to make the uterus prepared for ovulation and possible pregnancy. These tissues are made up of blood cells and connective tissues. These tissues become thick over the course of the month and then lose their thickness once menstruation occurs if there is no fertilization.[1]

When there is growth of the endometrial tissues outside the uterus such as in the bowel, the thickening of the tissues still continues due to action of the hormones but since these tissues are not able to exit from the body they start causing a variety of symptoms. Endometriosis is either superficial or deep. Superficial endometriosis occurs when there is growth of the endometrial tissue on the surface of the bowel. If the tissue growth occurs within the bowel wall then it is termed as deep.[1]

What is Bowel Endometriosis?

Experts opine that after the genital organs it is the bowel that is the most common area for the endometriosis to occur.[1] The causes, symptoms, and treatment have been explained in detail below in the article.

What Causes Bowel Endometriosis?

The root cause of Bowel Endometriosis is not completely understood. There are various theories stated by various researchers. According to one theory, Bowel Endometriosis occurs when during menstruation there is backflow of the blood into the fallopian tubes and the pelvic areas. Due to this, some portion of the tissues sticks to the lining of the bowels. This is what causes Bowel Endometriosis.[2]

According to another theory, if there is a history of a surgical procedure in the uterus the endometrial cells attach to the incision and get into the bowel causing Bowel Endometriosis. Some experts believe that hormonal imbalance in the form of estrogen is one of the causes of Bowel Endometriosis.[2]

Genes also play a role in the development of Bowel Endometriosis. It has been observed that people with a direct family member with Bowel Endometriosis also are at risk for getting this condition. All these theories only suggest a possible cause but there is no surety as to why endometrial tissues start growing outside the uterus such as in the bowel wall.[2]

What are the Symptoms of Bowel Endometriosis?

The primary symptoms of Bowel Endometriosis include:

  • Pain in and around the pelvis area
  • Pain during sexual intercourse
  • Constipation alternating with diarrhea
  • Pain when passing bowels
  • Rarely, Bowel Endometriosis causes rectal bleeding

Even though endometriosis can occur in any area of the bowel; however, it is mostly seen in the rectum and the sigmoid colon. In fact, 90% of the cases of Bowel Endometriosis occur in these two mentioned areas according to a study. The severity of the symptoms of Bowel Endometriosis is variable and differs from individual to individual depending on the menstrual cycle.[2]

Normally, the symptoms tend to get worse a few days before the menstrual period starts. However, the severity of the symptoms decreases once the female attains menopause. This is due to the decrease in the levels of estrogen in the body.[2]

How to Diagnose Bowel Endometriosis?

Diagnosing Bowel Endometriosis is quite a tough ask. In many cases, it is misdiagnosed as irritable bowel syndrome. Experts believe that on an average it takes about 7 to 8 years for a confirmative diagnosis of Bowel Endometriosis to be made. This is because the symptoms of Bowel Endometriosis are quite similar to many other medical conditions.[1]

The diagnosis is made after ruling out similar conditions like colitis, irritable bowel syndrome, and even rectal tumors, with all of them having similar symptoms to that of Bowel Endometriosis. For diagnosis, a thorough history of the patient is taken followed by a detailed physical examination.[1]

Additional tests may then be ordered in the form of an ultrasound, CT scan of the abdomen and pelvis, sigmoidoscopy, and a laparoscopy. The results of all of these tests confirmatively diagnose Bowel Endometriosis.[1]

How is Bowel Endometriosis Treated?

As of now, there is no cure for Bowel Endometriosis but treatments are available to manage the symptoms of this condition. The treatment strategy is formulated based on the severity of the symptoms, the overall health status of the patient, and the desire of the patient to conceive. Treatments include.[2]

Pain Medication: This is given for cases where the patient has mild to moderate pain. The medication may be bought over the counter or the physician may prescribe them. Tylenol and ibuprofen are the main medications used for this purpose. The medications cannot stop the growth of the tissues but are very helpful in calming the symptoms of pain and discomfort as a result of Bowel Endometriosis.[2]

Hormone Therapy: Estrogen has a crucial role to play in the development of Bowel Endometriosis. Thus hormone therapy can be used to manage the symptoms of this condition. Birth control pills normally contain estrogen and progesterone which prevent the buildup of endometrial tissues and also decrease the growth of the bowels.[2]

In some instances, the physician may prescribe gonadotropin releasing hormone which is quite effective in in preventing ovulation and growth of endometrial tissues. However, once the patient stops taking the medication there is a high likelihood of the symptoms returning.[2]

Surgery: This is reserved as the last resort when all other conservative modes of treatment for bowel endometriosis are deemed ineffective of if the patient is desirous of becoming pregnant. The surgery to be performed will be decided based on whether the endometriosis is superficial or deep.[2]

In one procedure, the endometrial tissues are removed in their entirety but the intestines are left intact. In severe cases, the surgeon may remove portions of the intestines with the endometrial tissues and then reattach the remaining parts of the bowel. In cases where the Bowel Endometriosis is deep then the surgeon will remove the lesions and plug any holes that are present in the bowel.[2]

With regard to the prognosis of people with Bowel Endometriosis, the severity of the condition plays a crucial role. Additionally, how well the patients respond to treatment is also one of the factors that decide the overall prognosis.[2]

In most cases, the prognosis is quite good, especially if the condition is treated with hormone therapy or with surgery. In other cases, the symptoms of Bowel Endometriosis calm down when the female attains menopause and the estrogen levels in the body decline.[2]

References:

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