Bowel Endometriosis

Medically Reviewed by Nivin Todd, MD on September 09, 2022
Written by Alyson Powell Key
4 min read

Endometriosis is an ongoing, painful condition in which tissue like the kind that lines your uterus (the endometrium) grows outside of your uterus.

When this condition affects your bowels, it appears in two forms:

  • Superficial (on the surface of your bowel)
  • Deep (passes through your bowel wall)

With this condition, doctors usually find a small mass of tissue (lesion) on your bowel wall. More rarely, a lesion can work its way into the muscular layer as well. These lesions grow slowly. They may get bigger, but it’s also not uncommon for them to shrink.

Scientists are still studying what causes these lesions, but research shows links to:

The symptoms of bowel endometriosis depend on where the lesion is located, its size, and how deep it is in your bowel wall. While some women with this condition won’t feel any symptoms, you’re likely to have:

Your symptoms could feel a lot like irritable bowel syndrome (IBS), but this is a different condition. With bowel endometriosis, you may notice that your symptoms get worse before and during your period.

Endometriosis impacts 10%-12% of women of childbearing age. Doctors tend to diagnose it in women who are in their 30s.

Your doctor will start by asking about your symptoms and medical history. Then they’ll examine your pelvic area. They may also suggest imaging tests for more information about the location and size of any cysts or tissue damage linked to endometriosis. These tests include:

  • Transvaginal or transrectal ultrasound. Your doctor or a technician will insert a wand-like device into your vagina or rectum, which releases sound waves that create images of your organs. This test can’t diagnose endometriosis, but it can locate lesions that may be caused by it once they’re large enough.
  • Magnetic resonance imaging (MRI). This test makes detailed images of your organs and tissues using a magnetic field and radio waves.
  • Laparoscopy. A surgeon will make a small cut near your bellybutton and insert a thin viewing tool called a laparoscope. It’s the same procedure sometimes used to remove any lesions.
  • Barium enema. Doctors use this type of X-ray to see changes or defects in your large intestine (colon). They’ll inject a liquid and barium mixture into your rectum through a small tube. Air pumped into your intestine expands the organ and improves image quality.

Your doctor will tailor your treatment to your symptoms and medical history. They’ll also consider things like your age and whether you want to have children. Treatments include:

Surgery. The goal of surgery is to remove as many lesions as possible while maintaining your organs and overall health. Doctors have three surgery options:

  • Remove the affected section of bowel and rejoin the healthy portions
  • Cut away the disk of the affected bowel and close the hole left behind
  • “Shave” the affected areas while leaving the bowel in place

If you need surgery, make sure it’s with an experienced medical team that’s familiar with the condition and will explore your options.

Hormone treatments. These medications control estrogen levels which can cause worsening of symptoms of bowel endometriosis. They could lower your risk of symptoms coming back. Along with hormone therapy, your doctor may also suggest pain medication.

Counseling. Bowel endometriosis is an ongoing condition that impacts your physical and your mental health. Studies show that women often have anxiety and depression about issues of relationships and sex, which can enhance feelings of physical pain. Your doctor may suggest counseling for support.

Since bowel endometriosis relies on estrogen, some women feel symptom relief during menopause or pregnancy when these hormone levels drop.

There’s no cure for endometriosis. Treatments like surgery and hormone therapy help you manage your symptoms. You may feel better, but your symptoms could return, if you stop treatment, or they could return on their own, especially if you have deep lesions.

Many times, you’ll need to continue treatment over a long period. This may be until menopause or when you plan to have a baby. Your doctor may suggest that you plan a pregnancy around your surgery, since your endometriosis may return after surgery and cause infertility. Studies also show that pregnant women who have had endometriosis have a higher risk of: