March is Endometriosis Awareness Month – its mission is to raise awareness and highlight the symptoms of this condition.
Endometriosis is a debilitating inflammatory condition which affects an estimated 176 million women worldwide. In the UK, around 1.5 million women are currently living with this condition. However many experts believe the real number to be much higher.
For those affected, endo can start from the age of puberty through to menopause and it doesn’t stop there, as the impact may be felt for life.
Understanding the symptoms is so important. Endometriosis can have a significant impact on a person’s physical and mental health in several ways, such as living with chronic pain, adjusting to coping with fatigue, depression/isolation, encountering problems with sex life which can impact relationships, an inability to conceive and also difficulty in fulfilling work and social commitments.
What is endometriosis?
The endometrial tissue or endometrial lining of the uterus or womb, grows outside of it. These growths most commonly occur in the ovaries and fallopian tubes. On rarer occasions the growth can around the bladder and rectum. Endometrial like tissue occurs in the colon and small bowel causing obstruction and requiring bowel resection and endometriosis can lead to a stoma.
How does endometriosis affect the bowel?
Endometriosis can affect the bowel in the abdomen and pelvis. Penetration of the endometriosis can vary within two forms:
- Superficial – endometriosis is found on the surface of the bowel.
- Deep – endometriosis penetrates the bowel wall.
- In some cases, recto-vaginal nodules can start as superficial endometriosis and progress to infiltrate the bowel wall.
Symptoms of endometriosis of the bowel
The symptoms of bowel endo 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.
If you suspect you have bowel endometriosis, keep note of your symptoms to look for a monthly pattern.
- bloating or gas
- severe pain in the pelvic area and/or lower back
- rectal bleeding during menstruating
- extreme pain during a bowel movement
- digestive or gastrointestinal pain
- pain during sex
Once a diagnosis of bowel endometriosis is made by your doctor and depending on the severity of your symptoms, you may be offered a combination of painkillers and hormone treatments to control it.
Moving forward with treatment is a wise choice as the symptoms are likely to continue and may worsen over time if treatment is not involved. Complementary treatments can also be useful in controlling your symptoms, although these are not scientifically proven treatments.
Treatment for endometriosis which is around or inside the bowel may involve removal of the affected area of the bowel. Some women may need to have surgery for a temporary colostomy to allow time for their bowel to heal.
The surgical options vary, depending on the severity of the endometriosis and the areas affected. Surgeries can be performed via a laparoscopy or via open surgery and may take several hours and more than one surgery depending on the extent of the endometriosis.
Types of bowel surgery
There are essentially three surgery options for bowel endometriosis, which will be tailored to an individual’s needs:
The affected segment or section of bowel is removed, and the bowel is re-joined (re-anastomosis).
For smaller areas of endo, the disc of affected bowel is cut away followed by the closure of the hole in the bowel.
Affected areas or nodules can be “shaved” off the bowel leaving the bowel intact. This option may leave residual endometriosis.
There is a possibility that a temporary colostomy will be needed. Some complications to consider are a leak in the bowel where the bowel is re-joined, high temperature, infection in the stitched and chest or urine infections.
Bowel function may be altered after surgery, particularly with a full resection (re-anastomosis). This does improve over time although watching your diet to see which food aggravate or improve the situation.
When to seek medical help for endometriosis
If you think you are suffering from symptoms of endo, you should speak to your healthcare provider.
Untreated endo can lead to chronic pain, bladder problems, ovarian cysts, and infertility. Many women don’t realise they have endo until they seek medical help for fertility problems.
There is plenty of valuable information and advice on the Endometriosis UK website.
Your Stoma Care Nurse will help guide you through any stoma related issues or questions.