ENDOMETRIOSIS
Bowel Endometriosis
Endometriosis can occur anywhere in the abdomen (and very rarely beyond). Because the bowel lies very close to the uterus (womb) and ovaries in the pelvis it is the most commonly affected other organ.
The symptoms of bowel endometriosis are similar to those of irritable bowel syndrome, however they can vary with the menstrual cycle, worsening in the days before and during a period. Symptoms may include pain on opening the bowels (dyschezia), deep pelvic pain during sex (dyspareunia) and sometimes rectal bleeding during a period. These symptoms can however be caused by many other conditions including haemorrhoids, IBS, inflammatory bowel disease and rarely cancer so should not be ignored.
Bowel endometriosis starts outside the bowel and may grow inwards. Most commonly it involves the outer layers of the bowel wall only and can therefore be shaved off without damaging the bowel. Occasionally though it may penetrate more deeply into the bowel wall and rarely all the way into the inside. Under these circumstances it will need a ‘full-thickness’ excision of bowel wall.
Types of surgery for bowel endometriosis:
- Bowel ‘shave’ – most commonly the endometriosis can be cut or peeled off without significant damage to the bowel
- Disc excision – excision of a small disc of bowel wall which is then sewn up again
- Bowel resection – sometimes the bowel is so severely affected that the only option is to remove a section of bowel. This represents a small percentage of cases and in the vast majority of these, the bowel can be rejoined without the need for a stoma (colostomy or ileostomy). Occasionally it may be necessary to bring the bowel to the skin as an ileostomy upstream of the bowel join (anastomosis) while it heals, particularly when the bowel join is very low in the pelvis. This can then be rejoined approximately 3 months later after the join has been checked with an X-Ray
- Colostomy – While it is possible that surgery for endometriosis could result in the need for a permanent colostomy it is exceedingly rare.
The vast majority of our surgery for endometriosis can be done laparoscopically (keyhole surgery). If a bowel resection is necessary, an additional small cut (approx. 5cm) low in the abdomen is necessary to remove the piece of bowel. It is also likely that the post-operative stay will be longer as they bowel may take a few days to work after such surgery.
Most bowel endometriosis affects the rectum and sigmoid colon in the pelvis. Very rarely, separate deposits of endometriosis may affect other, more distant, parts of the bowel and may present with different symptoms such as abdominal pain, vomiting or change in bowel habit.
