Table of ContentsView AllTable of ContentsBowel SymptomsPainCausesDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Bowel Symptoms
Pain
Causes
Diagnosis
Treatment
Frequently Asked Questions
Endometriosisis a full-body inflammatory disease in which tissue similar to the lining of the uterus grows outside the uterus. Historically, it has been a misunderstood disease thought to affect mainly reproductive organs. However, endometriosis lesions have been found on every organ, including the bowels.
According to research from 2020, 10% to 12% of people assigned female at birth have endometriosis, and 5% to 12% of those people havebowel involvement.You don’t need to have endometrial lesions growing on your bowels to experience bowel symptoms, such as constipation, diarrhea, pain with bowel movements, and more.
In this article, learn more about bowel endometriosis and bowel-related endometriosis symptoms.
Kannika Paison / Getty Images
Bowel Symptoms of Endometriosis
Endometriosis is generally thought of as a disease that causesinfertilityand painful periods.While these are both symptoms of endometriosis, they do not fully and accurately portray the disease’s symptoms.
Endometriosis can affect any organ, leading topainful sex, pain unrelated to menstruation,painful urination, bowel symptoms, and more. This, in turn, may contribute to the notabledelay in diagnosisthat most people with endometriosis experience.
Gastrointestinal symptoms are fairly common in endometriosis and should not be overlooked.
Some bowel symptoms of endometriosis include:
Everything You Should Know About Endometriosis Flare-Ups
Lesion Location and Associated Symptoms
You do not need to haveendometriosis lesionsgrowing directly on your bowels to experience bowel symptoms.
One study found that, compared to participants without endometriosis, people with endometriosis had significantly more severe gastrointestinal symptoms unrelated to the location of endometriosis lesions. The one exception was that people with bowel endometriosis lesions were more likely to have nausea and vomiting.
Another study found thatirritable bowel syndrome(IBS) is more commonly diagnosed among people with endometriosis than among the general public, regardless of endometrial lesion location.
Nature of Bowel Endometriosis Pain
Endometriosis can cause significant pelvic and abdominalpain. However, the pain pattern, location, intensity, and duration differ significantly from person to person.
Sensation
The sensation of endometriosis pain may feel like:
Frequency
The frequency of endometriosis pain differs from person to person.
In one 2021 study, these four patterns of endometriosis pain were found:
Location and Depth
Endometriosis lesions are found on the rectum and sigmoid colon in about 90% of bowel endometriosis cases.Bowel endometriosis lesions can be located on the following:
Bowel endometriosis lesions often present as one single nodule with a diameter greater than 1 centimeter (cm).However, endometriosis lesions can be any size, depth, and color.
Endometriosis is a complex disease, and there are multiple causes for bowel symptoms, including the following:
How Do Endometriosis Symptoms Feel?
Diagnosing Bowel Endometriosis
The only definitive way to diagnose endometriosis is through abiopsy. When performing a biopsy, your provider takes a sample of the affected tissue and sends it to a lab for a specialist called apathologistto examine under a microscope and provide a diagnosis.
Hysterectomy May Not Treat EndometriosisWhile once considered the most effective treatment for endometriosis, ahysterectomy(surgical removal of the uterus) may not be the best treatment for endometriosis, especially in cases of endometrial tissue growth outside of the uterus. Hysterectomy can help with heavy menstrual bleeding and painful periods in some people, but it is not right for everyone. If your surgeon recommends a hysterectomy for endometriosis, seek a second opinion.
Hysterectomy May Not Treat Endometriosis
While once considered the most effective treatment for endometriosis, ahysterectomy(surgical removal of the uterus) may not be the best treatment for endometriosis, especially in cases of endometrial tissue growth outside of the uterus. Hysterectomy can help with heavy menstrual bleeding and painful periods in some people, but it is not right for everyone. If your surgeon recommends a hysterectomy for endometriosis, seek a second opinion.
Supplementary Testing
If your provider suspects bowel endometriosis, they may recommend various supplementary tests before surgery to assist in surgical planning. These tests might include:
Imaging Can Miss Endometriosis
Complications During Surgery
Generalgynecologistsmay leave bowel endometriosis untouched duringexcision surgery(surgery to remove endometrial lesions and surrounding tissues) to avoid complications. An endometriosis specialist who uses the excision technique should perform the surgery, especially with the prospect of bowel involvement. A colorectal surgeon may often present in cases where bowel involvement is highly suspected.
Complications can happen during any surgery, including surgery for endometriosis on the bowels. Complications can include the following:
Your surgeon should inform you of possible complications and also provide their complication rates based on previous surgeries.
How Endometriosis Is Diagnosed
Treatment Options for Relief
Excision surgeryis the gold standard for diagnosing and treating endometriosis. However, excision surgery is not recommended or accessible to everyone. Your provider may also recommend certain medications or physical therapy to relieve endometriosis symptoms.
Excision Surgery
Excision surgery to treat bowel endometriosis may involve one or more of these surgical techniques:
Other Treatments
Some healthcare providers may prescribe medications to manage symptoms, includingbirth controland pain medications. These medications do not slow the progression of endometriosis nor reduce the size of endometriosis nodules. However, they may help reduce pain or other symptoms and improve quality of life.
Your provider may recommendpelvic physical therapyto help reduce pelvic pain, treat pelvic floor dysfunction, and reduce pain with bowel movements. This treatment method can improve symptoms and quality of life but does not address the underlying cause of endometriosis lesions.
Endometriosis Treatment Options
Summary
Gastrointestinal symptoms are common with endometriosis, regardless of whether lesions are growing on the bowels. Excision surgery with an endometriosis specialist is the gold standard for diagnosing and treating bowel endometriosis. However, complications can occur, and you should receive full informed consent from your surgeon before deciding on the best treatment plan.
Learn MoreEndometriosis Excision Surgery: What Happens and Recovery
Endometriosis lesions can grow on the small intestine, large intestine, cecum, sigmoid, rectum, and appendix. It extends from the outer surface (serosa) toward the inner surface (mucosa). Superficial endometriosis may appear as a small lesion on the outer serosa; deeply infiltrating endometriosis can penetrate the mucosa and cause bowel obstructions.Learn MoreSmall Intestine Function and Anatomy
Endometriosis lesions can grow on the small intestine, large intestine, cecum, sigmoid, rectum, and appendix. It extends from the outer surface (serosa) toward the inner surface (mucosa). Superficial endometriosis may appear as a small lesion on the outer serosa; deeply infiltrating endometriosis can penetrate the mucosa and cause bowel obstructions.
Learn MoreSmall Intestine Function and Anatomy
Endometriosis and IBS have similar symptoms. IBS is diagnosed based on symptoms and exclusion; endometriosis is diagnosed based on surgery and pathology. Therefore, diagnostic laparoscopy is the only accurate way to differentiate between IBS and endometriosis.Learn MoreWhat You Need to Know About Irritable Bowel Syndrome (IBS)
Endometriosis and IBS have similar symptoms. IBS is diagnosed based on symptoms and exclusion; endometriosis is diagnosed based on surgery and pathology. Therefore, diagnostic laparoscopy is the only accurate way to differentiate between IBS and endometriosis.
Learn MoreWhat You Need to Know About Irritable Bowel Syndrome (IBS)
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Samani EN, Mamillapalli R, Li F, et al.Micrometastasis of endometriosis to distant organs in a murine model.Oncotarget. 2017;10(23):2282-2291. doi: 10.18632/oncotarget.16889Habib N, Centini G, Lazzeri L, et al.Bowel endometriosis: current perspectives on diagnosis and treatment.Int J Womens Health. 2020;12:35-47. doi: 10.2147/IJWH.S190326Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B.Gastrointestinal symptoms among endometriosis patients–A case-cohort study.BMC Womens Health. 2015;15:59. DOI: 10.1186/s12905-015-0213-2Kotowska M, Urbaniak J, Falęcki WJ, Łazarewicz P, Masiak M, Szymusik I.Awareness of endometriosis symptoms—a cross sectional survey among polish women.International Journal of Environmental Research and Public Health. 2021;18(18):9919. DOI: 10.3390/ijerph18189919Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A.Is endometriosis associated with irritable bowel syndrome? A cross-sectional study.Eur J Obstet Gynecol Reprod Biol. 2018;231:65-69. DOI: 10.1016/j.ejogrb.2018.10.023Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain.British Journal of Pain. 2021;15(3):345-356. doi: 10.1177/2049463720961413Brigham and Women’s Hospital.Deeply infiltrative endometriosis.Machairiotis N, Vasilakaki S, Thomakos N.Inflammatory mediators and pain in endometriosis: a systematic review.Biomedicines. 2021;9(1):54. doi: 10.3390/biomedicines9010054Raimondo D, Cocchi L, Raffone A, et al.Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis.Int J Gynaecol Obstet. 2022;159(2):505-512. doi:10.1002/ijgo.14088Johns Hopkins Medicine.Endometrial biopsy.Rizk B, Fischer AS, Lotfy HA, et al.Recurrence of endometriosis after hysterectomy.Facts Views Vis Obgyn. 2014;6(4):219-227.Center for Endometriosis Care.Endometriosis and bowel symptoms.Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A.Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team.World J Gastroenterol. 2014;20(42):15616-15623. doi: 10.3748/wjg.v20.i42.15616Chou D, Perera S, Condous G, et al.Shaving for bowel endometriosis.J Minim Invasive Gynecol. 2020;27(2):268-269. DOI: 10.1016/j.jmig.2019.11.012de Almeida A, Fernandes LF, Averbach M, Abrão MS.Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter.Surg Technol Int. 2014;24:243-248.Johns Hopkins Medicine.Endometrial ablation.Lee CE, Yong PJ, Williams C, Allaire C.Factors associated with severity of irritable bowel syndrome symptoms in patients with endometriosis.J Obstet Gynaecol Can. 2018;40(2):158-164. DOI: 10.1016/j.jogc.2017.06.025
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Samani EN, Mamillapalli R, Li F, et al.Micrometastasis of endometriosis to distant organs in a murine model.Oncotarget. 2017;10(23):2282-2291. doi: 10.18632/oncotarget.16889Habib N, Centini G, Lazzeri L, et al.Bowel endometriosis: current perspectives on diagnosis and treatment.Int J Womens Health. 2020;12:35-47. doi: 10.2147/IJWH.S190326Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B.Gastrointestinal symptoms among endometriosis patients–A case-cohort study.BMC Womens Health. 2015;15:59. DOI: 10.1186/s12905-015-0213-2Kotowska M, Urbaniak J, Falęcki WJ, Łazarewicz P, Masiak M, Szymusik I.Awareness of endometriosis symptoms—a cross sectional survey among polish women.International Journal of Environmental Research and Public Health. 2021;18(18):9919. DOI: 10.3390/ijerph18189919Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A.Is endometriosis associated with irritable bowel syndrome? A cross-sectional study.Eur J Obstet Gynecol Reprod Biol. 2018;231:65-69. DOI: 10.1016/j.ejogrb.2018.10.023Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain.British Journal of Pain. 2021;15(3):345-356. doi: 10.1177/2049463720961413Brigham and Women’s Hospital.Deeply infiltrative endometriosis.Machairiotis N, Vasilakaki S, Thomakos N.Inflammatory mediators and pain in endometriosis: a systematic review.Biomedicines. 2021;9(1):54. doi: 10.3390/biomedicines9010054Raimondo D, Cocchi L, Raffone A, et al.Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis.Int J Gynaecol Obstet. 2022;159(2):505-512. doi:10.1002/ijgo.14088Johns Hopkins Medicine.Endometrial biopsy.Rizk B, Fischer AS, Lotfy HA, et al.Recurrence of endometriosis after hysterectomy.Facts Views Vis Obgyn. 2014;6(4):219-227.Center for Endometriosis Care.Endometriosis and bowel symptoms.Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A.Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team.World J Gastroenterol. 2014;20(42):15616-15623. doi: 10.3748/wjg.v20.i42.15616Chou D, Perera S, Condous G, et al.Shaving for bowel endometriosis.J Minim Invasive Gynecol. 2020;27(2):268-269. DOI: 10.1016/j.jmig.2019.11.012de Almeida A, Fernandes LF, Averbach M, Abrão MS.Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter.Surg Technol Int. 2014;24:243-248.Johns Hopkins Medicine.Endometrial ablation.Lee CE, Yong PJ, Williams C, Allaire C.Factors associated with severity of irritable bowel syndrome symptoms in patients with endometriosis.J Obstet Gynaecol Can. 2018;40(2):158-164. DOI: 10.1016/j.jogc.2017.06.025
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Samani EN, Mamillapalli R, Li F, et al.Micrometastasis of endometriosis to distant organs in a murine model.Oncotarget. 2017;10(23):2282-2291. doi: 10.18632/oncotarget.16889Habib N, Centini G, Lazzeri L, et al.Bowel endometriosis: current perspectives on diagnosis and treatment.Int J Womens Health. 2020;12:35-47. doi: 10.2147/IJWH.S190326Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B.Gastrointestinal symptoms among endometriosis patients–A case-cohort study.BMC Womens Health. 2015;15:59. DOI: 10.1186/s12905-015-0213-2Kotowska M, Urbaniak J, Falęcki WJ, Łazarewicz P, Masiak M, Szymusik I.Awareness of endometriosis symptoms—a cross sectional survey among polish women.International Journal of Environmental Research and Public Health. 2021;18(18):9919. DOI: 10.3390/ijerph18189919Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A.Is endometriosis associated with irritable bowel syndrome? A cross-sectional study.Eur J Obstet Gynecol Reprod Biol. 2018;231:65-69. DOI: 10.1016/j.ejogrb.2018.10.023Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain.British Journal of Pain. 2021;15(3):345-356. doi: 10.1177/2049463720961413Brigham and Women’s Hospital.Deeply infiltrative endometriosis.Machairiotis N, Vasilakaki S, Thomakos N.Inflammatory mediators and pain in endometriosis: a systematic review.Biomedicines. 2021;9(1):54. doi: 10.3390/biomedicines9010054Raimondo D, Cocchi L, Raffone A, et al.Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis.Int J Gynaecol Obstet. 2022;159(2):505-512. doi:10.1002/ijgo.14088Johns Hopkins Medicine.Endometrial biopsy.Rizk B, Fischer AS, Lotfy HA, et al.Recurrence of endometriosis after hysterectomy.Facts Views Vis Obgyn. 2014;6(4):219-227.Center for Endometriosis Care.Endometriosis and bowel symptoms.Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A.Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team.World J Gastroenterol. 2014;20(42):15616-15623. doi: 10.3748/wjg.v20.i42.15616Chou D, Perera S, Condous G, et al.Shaving for bowel endometriosis.J Minim Invasive Gynecol. 2020;27(2):268-269. DOI: 10.1016/j.jmig.2019.11.012de Almeida A, Fernandes LF, Averbach M, Abrão MS.Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter.Surg Technol Int. 2014;24:243-248.Johns Hopkins Medicine.Endometrial ablation.Lee CE, Yong PJ, Williams C, Allaire C.Factors associated with severity of irritable bowel syndrome symptoms in patients with endometriosis.J Obstet Gynaecol Can. 2018;40(2):158-164. DOI: 10.1016/j.jogc.2017.06.025
Samani EN, Mamillapalli R, Li F, et al.Micrometastasis of endometriosis to distant organs in a murine model.Oncotarget. 2017;10(23):2282-2291. doi: 10.18632/oncotarget.16889
Habib N, Centini G, Lazzeri L, et al.Bowel endometriosis: current perspectives on diagnosis and treatment.Int J Womens Health. 2020;12:35-47. doi: 10.2147/IJWH.S190326
Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B.Gastrointestinal symptoms among endometriosis patients–A case-cohort study.BMC Womens Health. 2015;15:59. DOI: 10.1186/s12905-015-0213-2
Kotowska M, Urbaniak J, Falęcki WJ, Łazarewicz P, Masiak M, Szymusik I.Awareness of endometriosis symptoms—a cross sectional survey among polish women.International Journal of Environmental Research and Public Health. 2021;18(18):9919. DOI: 10.3390/ijerph18189919
Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A.Is endometriosis associated with irritable bowel syndrome? A cross-sectional study.Eur J Obstet Gynecol Reprod Biol. 2018;231:65-69. DOI: 10.1016/j.ejogrb.2018.10.023
Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain.British Journal of Pain. 2021;15(3):345-356. doi: 10.1177/2049463720961413
Brigham and Women’s Hospital.Deeply infiltrative endometriosis.
Machairiotis N, Vasilakaki S, Thomakos N.Inflammatory mediators and pain in endometriosis: a systematic review.Biomedicines. 2021;9(1):54. doi: 10.3390/biomedicines9010054
Raimondo D, Cocchi L, Raffone A, et al.Pelvic floor dysfunction at transperineal ultrasound and chronic constipation in women with endometriosis.Int J Gynaecol Obstet. 2022;159(2):505-512. doi:10.1002/ijgo.14088
Johns Hopkins Medicine.Endometrial biopsy.
Rizk B, Fischer AS, Lotfy HA, et al.Recurrence of endometriosis after hysterectomy.Facts Views Vis Obgyn. 2014;6(4):219-227.
Center for Endometriosis Care.Endometriosis and bowel symptoms.
Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A.Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team.World J Gastroenterol. 2014;20(42):15616-15623. doi: 10.3748/wjg.v20.i42.15616
Chou D, Perera S, Condous G, et al.Shaving for bowel endometriosis.J Minim Invasive Gynecol. 2020;27(2):268-269. DOI: 10.1016/j.jmig.2019.11.012
de Almeida A, Fernandes LF, Averbach M, Abrão MS.Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter.Surg Technol Int. 2014;24:243-248.
Johns Hopkins Medicine.Endometrial ablation.
Lee CE, Yong PJ, Williams C, Allaire C.Factors associated with severity of irritable bowel syndrome symptoms in patients with endometriosis.J Obstet Gynaecol Can. 2018;40(2):158-164. DOI: 10.1016/j.jogc.2017.06.025
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