When It’s Not IBS: A Guide to Intestinal Endometriosis
For years, have you been told your debilitating bloating, painful bowel movements, and alternating diarrhea and constipation are “just Irritable Bowel Syndrome (IBS)”? Have dietary changes and gut-focused remedies failed to provide relief? If your gut symptoms flare cyclically with your period, the problem may not be IBS at all—it could be intestinal endometriosis.
At Endometriosis Surgical Specialists International (ESSI), we know that a “pelvic” disease doesn’t just stay in the pelvis. We specialize in diagnosing and treating complex endometriosis, and that includes when it affects the bowel.
What is Intestinal Endometriosis?
Intestinal or bowel endometriosis is when endometrial-like tissue grows on the surface of or into the walls of the intestines. While it can affect the small intestine, it most commonly impacts the rectum and sigmoid colon—the final parts of the large intestine.
This tissue responds to your monthly hormonal cycle, bleeding and causing inflammation. This leads to a cascade of gastrointestinal symptoms that are easily mistaken for other conditions. The key difference is that the symptoms of bowel endometriosis are often cyclical, worsening significantly in the days before and during your period.
Symptoms include:
- Painful bowel movements (dyschezia), often described as sharp or stabbing.
- Severe abdominal bloating and distension, often called “endo belly.”
- Cyclical diarrhea, constipation, or both.
- Deep pelvic pain and rectal pain or pressure.
- Nausea.
- In some cases, rectal bleeding that occurs only during menstruation.
Frequently Asked Questions About Bowel Endometriosis
Q1: How is intestinal endometriosis diagnosed?
It can be difficult to diagnose. A colonoscopy may be normal unless the disease has grown all the way through to the inner lining of the bowel. The best non-invasive diagnostic tools are advanced imaging techniques like a specialized MRI or a transvaginal ultrasound performed by an expert who knows how to look for deep endometriosis. Often, a definitive diagnosis is made during surgery.
Q2: What does surgery for bowel endometriosis involve?
Surgery for intestinal endometriosis is complex and should only be performed by a highly skilled specialist, often working with a colorectal surgeon. The surgical approach depends on how deeply the disease has invaded the bowel:
- Shaving: For superficial disease, the lesions are carefully shaved off the surface of the bowel.
- Discoid Resection: If a nodule has grown deeper, the surgeon removes a small “disc” of the bowel wall and repairs the opening.
- Resection and Reanastomosis: For the most severe cases, the affected segment of the bowel is removed, and the two healthy ends are reconnected.
Q3: Will I need a colostomy bag?
This is a very common fear, but the risk is extremely low. In the hands of an expert surgical team, the need for a temporary or permanent colostomy bag is exceptionally rare. The goal of surgery is always to preserve and restore normal bowel function.
Expert Care for a Complex Condition
Dismissing cyclical bowel symptoms as IBS can lead to years of unnecessary suffering and allows the disease to potentially progress. If you suspect your gut issues are linked to your menstrual cycle, you deserve a thorough evaluation from an endometriosis specialist.
At ESSI, we have the multidisciplinary expertise required to safely and effectively perform complex bowel surgery, removing the disease and giving you back control over your life.
