Table of ContentsView AllTable of ContentsWhat Is It?CausesSymptomsDiagnosisColonoscopyMisdiagnosisSurgerySurgical PrepRecoveryLifestyle Changes
Table of ContentsView All
View All
Table of Contents
What Is It?
Causes
Symptoms
Diagnosis
Colonoscopy
Misdiagnosis
Surgery
Surgical Prep
Recovery
Lifestyle Changes
About 10% of people assigned female at birth have endometriosis, and 5% to 12% of those with endometriosis have bowel endometriosis.People with bowel endometriosis have lesions growing on their bowels but may also have endometriosis lesions elsewhere in their bodies.
You don’t have to have endometriosis lesions growing directly on your bowels to havegastrointestinal symptomsfrom the disease.
In this article, learn more about bowel endometriosis.
FatCamera
What Is Bowel Endometriosis?
“Bowel endometriosis” is a term used to describe whenendometriosis, an inflammatory tissue similar to the tissue that lines the uterus, grows on or into the bowels.
Other bowel endometriosis locations include:
What Causes Bowel Endometriosis?
As with other types of endometriosis, the exactcause of bowel endometriosisis unknown. However, there are multiple theories on why endometriosis occurs.
Mullerianosis of embryogenic originis one of the leading theories on the cause of endometriosis. Mullerianosis is a type of lesion, and “embryogenic origin” means originating through cell division. This theory proposes that developmental abnormalities lead to cells left in the body that later turn into endometriosis.
Bowel Endometriosis Symptoms
If you have unexplained gastrointestinal symptoms, you may wonder if you have endometriosis growing on your bowels. However, it is not necessary to have endometriosis directly on the bowels to experience these symptoms.
Anyone with endometriosis can have bowel symptoms. One study of 109 people with endometriosis and 65 people without endometriosis found that those with endometriosis were significantly more likely to have severe gastrointestinal symptoms.
The location of the lesions did not affect the types of gastrointestinal symptoms experienced either, except for significant nausea and vomiting, which were more prominent in people with bowel lesions.
Bowel Symptoms vs. Bowel Endometriosis
Most people with endometriosis (85%) report bowel symptoms, yet only a minority (5% to 12%) have endometriosis growing on the bowels.The inflammatory nature of endometriosis lesions may explain this.
GI-Related Symptoms
According to the research, gastrointestinal symptoms don’t always indicate bowel endometriosis. One exception that could signify endometriosis growing on the bowels is significant nausea and vomiting.
In particular, painful bowel movements or rectal bleeding may indicate endometriosis on or around the rectum, specifically in therectovaginalspace (the area separating the rectum and vagina).
Gastrointestinal symptoms of endometriosiscan include:
Non-Bowel Symptoms
People with endometriosis can also experience non-bowel symptoms. Historically (and inaccurately), endometriosis has been viewed as a “period disease.” The severity and frequency of gastrointestinal effects associated with the condition have only been recognized in recent decades.
Non-bowelendometriosis symptomsinclude:
Endometriosis Back Pain: Causes and Treatments
How to Diagnose Bowel Endometriosis
As with other forms of endometriosis, the gold standard for diagnosing bowel endometriosis ishistopathology(examining suspected endometriosis tissue under a microscope) after alaparoscopic excision surgery(a surgery in which the suspected tissue is cut out).
Other forms of testing or surgery are not sufficient to diagnose endometriosis.
Does Colonoscopy Diagnose Bowel Endometriosis?
Colonoscopy should not be used as a diagnostic tool for bowel endometriosis.This is because endometriosis grows on the outside of the bowel walls. Colonoscopy looks at the inside of the bowels. Only the most advanced, deeply infiltrating endometriosis would be visible upon colonoscopy.
One study found that among patients with a current diagnosis of deeply infiltrating endometriosis, colonoscopy missed 92.1% of cases.This figure does not account for superficial endometriosis, representing 80% of endometriosis cases and resulting in similarly severe symptoms to deep endometriosis.
Endometriosis specialists have argued that colonoscopy, due to its invasive nature and inability to detect the vast majority of endometriosis, should not be used in the diagnosis process.
Bowel Endometriosis Is Often Misdiagnosed
Approximately 75% of people with endometriosis are misdiagnosed with another physical health condition, and 50% are misdiagnosed with a psychological condition.
In particular, people with endometriosis are more than twice as likely to be misdiagnosed withirritable bowel syndrome(IBS).
IBS shares many symptoms with endometriosis, such as constipation, diarrhea, bloating, and abdominal pain.However, IBS is a diagnosis of exclusion, which means it should only be diagnosed once all other explanations are ruled out, includingendometriosis.
Healthcare providers don’t always recommend endometriosis surgery before diagnosing someone with IBS. Misdiagnosis of IBS contributes to the average of seven- to nine-year diagnostic delay for endometriosis, mismanagement, and unnecessary testing.
Specialists You Might SeeMany people with undiagnosed endometriosis who experience bowel symptoms are referred to a gastroenterologist for an evaluation before seeing a gynecologist or endometriosis specialist.
Specialists You Might See
Many people with undiagnosed endometriosis who experience bowel symptoms are referred to a gastroenterologist for an evaluation before seeing a gynecologist or endometriosis specialist.
Bowel Surgery for Endometriosis
If an endometriosis specialist suspects you have bowel endometriosis, they may recommendexcision surgery, the most common procedure for diagnosing and treating endometriosis.If your endometriosis specialist suspects bowel endometriosis, they may have acolorectal surgeonon call.
During excision surgery, your surgeon will thoroughly examine your internal anatomy and identify any spots of suspected endometriosis. “Excision” means cutting out of your body, but the exact methods of removal can differ based on the type of endometriosis found, especially on the bowels.
Bowel Prep Instructions Before Endometriosis Surgery
Some endometriosis surgeons may request you do a bowel prep before endometriosis surgery, which involves removing some or all of the stool from your bowels.
Methods for bowel prep may include doing anenema, taking laxatives, or oral solutions. Your surgeon or their coordinator will discuss this with you at your pre-operation appointment.
Shaving
Shaving is one method of excising endometriosis from the bowels. Surgeons use this method for more superficial lesions of less than 7 millimeters (mm) deep and less than 3 centimeters (cm) in diameter.
Disc Excision
Disc excision is another method of removing endometriosis from the bowels, used for more invasive lesions of less than 3 cm in diameter and less than 60% of the bowel circumference.During disc excision, a part of the bowel wall is cut out, and the opening is stapled together.
Resection
Resectionis the third surgical method for addressing bowel endometriosis. This technique is reserved for the most invasive and advanced bowel endometriosis. During resection, a surgeon removes a segment of the bowel and then sutures the two new openings together to reseal the bowel.
Appendectomy
Endometriosis of the appendix (a small organ considered part of the bowels) is rare. Research shows it affects only about 2.6% of people with endometriosis. However, some specialists argue it is more common.
If an endometriosis surgeon notices signs of endometriosis in the appendix during surgery, they may perform anappendectomy(surgically remove the appendix).
Operations for Endometriosis
Recovering From Bowel Endometriosis
Although it can be done laparoscopically (with minor incisions), surgery for bowel endometriosis is invasive and requires a recovery period.
You may spend the night or a couple of days in the hospital. During your first week or more at home, you may have to take prescription pain relievers, be instructed to limit bending, lifting, and twisting, and wear an abdominal binder (a compression belt worn around the midsection).
Recovery time after that can take weeks to months and will vary based on the extent of your surgery, personal healing time, and your overall health. Discuss any concerns and what to expect with your surgeon.
Complications From Bowel Endometriosis Surgery
The bowels are delicate organs. If you need bowel endometriosis surgery, seek care from an endometriosis specialist with experience performing bowel endometriosis surgery.
Possible complications from bowel endometriosis surgery include:
Lifestyle Changes to Reduce Bowel Endometriosis Pain
Some people with bowel endometriosis find that certain foods or lifestyle challenges (like stress or irregular sleep) may trigger their symptoms. Consider keeping a journal for a few weeks to track your triggers.
Another possible trigger for bowel endometriosis pain is constipation, which can also be a symptom of bowel endometriosis. When you are constipated, the hard stool may put pressure on painful bowel endometriosis nodules, worsening pain and other symptoms.
Eating fiber, drinking water, exercising regularly, using stool softeners, or taking prescription medications for constipation may help prevent constipation with endometriosis.
Summary
Bowel endometriosis occurs when endometriosis, a tissue similar to the lining of the uterus, grows directly on the bowels. Only about 5% to 12% of people with endometriosis have bowel endometriosis. However, most people with endometriosis have bowel symptoms due to the inflammatory nature of the disease. The only way to correctly diagnose and treat bowel endometriosis is through excision surgery.
18 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.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.S190326Wolthuis 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%2Fwjg.v20.i42.15616Sourial S, Tempest N, Hapangama DK.Theories on the pathogenesis of endometriosis.Int J Reprod Med. 2014;2014:179515. doi: 10.1155%2F2014%2F179515Ek 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/s12905-015-0213-2Center for Endometriosis Care.Bowel endometriosis.Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health. 2013;5:753-763. doi: 10.2147%2FIJWH.S37846Kotowska 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/ijerph18189919Johns Hopkins Medicine.Endometriosis.McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. doi:10.3390/jpm12091519Milone M, Mollo A, Musella M, et al.Role of colonoscopy in the diagnostic work-up of bowel endometriosis.World J Gastroenterol. 2015;21(16):4997-5001. doi:10.3748%2Fwjg.v21.i16.4997International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Tschann P, Vitlarov N, Hufschmidt M, et al.Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome.European Journal of Medical Research. 2021;26(1):12. doi:10.1186/s40001-021-00484-zBontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: Results from an online national survey.Diagnosis. 2020;7(2):97-106. doi:10.1515/dx-2019-0020Chiaffarino F, Cipriani S, Ricci E, et al.Endometriosis and irritable bowel syndrome: A systematic review and meta-analysis.Arch Gynecol Obstet. 2021;303(1):17-25. doi:10.1007/s00404-020-05797-8Chou 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.Mabrouk M.Endometriosis of the appendix: when to predict and how to manage—A multivariate analysis of 1935 endometriosis cases.Journal of Minimally Invasive Gynecology. 2020;27(1):100-106. doi:10.1016/j.jmig.2019.02.015Wolthuis 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
18 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.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.S190326Wolthuis 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%2Fwjg.v20.i42.15616Sourial S, Tempest N, Hapangama DK.Theories on the pathogenesis of endometriosis.Int J Reprod Med. 2014;2014:179515. doi: 10.1155%2F2014%2F179515Ek 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/s12905-015-0213-2Center for Endometriosis Care.Bowel endometriosis.Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health. 2013;5:753-763. doi: 10.2147%2FIJWH.S37846Kotowska 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/ijerph18189919Johns Hopkins Medicine.Endometriosis.McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. doi:10.3390/jpm12091519Milone M, Mollo A, Musella M, et al.Role of colonoscopy in the diagnostic work-up of bowel endometriosis.World J Gastroenterol. 2015;21(16):4997-5001. doi:10.3748%2Fwjg.v21.i16.4997International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Tschann P, Vitlarov N, Hufschmidt M, et al.Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome.European Journal of Medical Research. 2021;26(1):12. doi:10.1186/s40001-021-00484-zBontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: Results from an online national survey.Diagnosis. 2020;7(2):97-106. doi:10.1515/dx-2019-0020Chiaffarino F, Cipriani S, Ricci E, et al.Endometriosis and irritable bowel syndrome: A systematic review and meta-analysis.Arch Gynecol Obstet. 2021;303(1):17-25. doi:10.1007/s00404-020-05797-8Chou 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.Mabrouk M.Endometriosis of the appendix: when to predict and how to manage—A multivariate analysis of 1935 endometriosis cases.Journal of Minimally Invasive Gynecology. 2020;27(1):100-106. doi:10.1016/j.jmig.2019.02.015Wolthuis 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
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.
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.S190326Wolthuis 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%2Fwjg.v20.i42.15616Sourial S, Tempest N, Hapangama DK.Theories on the pathogenesis of endometriosis.Int J Reprod Med. 2014;2014:179515. doi: 10.1155%2F2014%2F179515Ek 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/s12905-015-0213-2Center for Endometriosis Care.Bowel endometriosis.Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health. 2013;5:753-763. doi: 10.2147%2FIJWH.S37846Kotowska 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/ijerph18189919Johns Hopkins Medicine.Endometriosis.McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. doi:10.3390/jpm12091519Milone M, Mollo A, Musella M, et al.Role of colonoscopy in the diagnostic work-up of bowel endometriosis.World J Gastroenterol. 2015;21(16):4997-5001. doi:10.3748%2Fwjg.v21.i16.4997International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Tschann P, Vitlarov N, Hufschmidt M, et al.Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome.European Journal of Medical Research. 2021;26(1):12. doi:10.1186/s40001-021-00484-zBontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: Results from an online national survey.Diagnosis. 2020;7(2):97-106. doi:10.1515/dx-2019-0020Chiaffarino F, Cipriani S, Ricci E, et al.Endometriosis and irritable bowel syndrome: A systematic review and meta-analysis.Arch Gynecol Obstet. 2021;303(1):17-25. doi:10.1007/s00404-020-05797-8Chou 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.Mabrouk M.Endometriosis of the appendix: when to predict and how to manage—A multivariate analysis of 1935 endometriosis cases.Journal of Minimally Invasive Gynecology. 2020;27(1):100-106. doi:10.1016/j.jmig.2019.02.015Wolthuis 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
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
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%2Fwjg.v20.i42.15616
Sourial S, Tempest N, Hapangama DK.Theories on the pathogenesis of endometriosis.Int J Reprod Med. 2014;2014:179515. doi: 10.1155%2F2014%2F179515
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
Center for Endometriosis Care.Bowel endometriosis.
Moawad NS, Caplin A.Diagnosis, management, and long-term outcomes of rectovaginal endometriosis.Int J Womens Health. 2013;5:753-763. doi: 10.2147%2FIJWH.S37846
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
Johns Hopkins Medicine.Endometriosis.
McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. doi:10.3390/jpm12091519
Milone M, Mollo A, Musella M, et al.Role of colonoscopy in the diagnostic work-up of bowel endometriosis.World J Gastroenterol. 2015;21(16):4997-5001. doi:10.3748%2Fwjg.v21.i16.4997
International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.
Tschann P, Vitlarov N, Hufschmidt M, et al.Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome.European Journal of Medical Research. 2021;26(1):12. doi:10.1186/s40001-021-00484-z
Bontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: Results from an online national survey.Diagnosis. 2020;7(2):97-106. doi:10.1515/dx-2019-0020
Chiaffarino F, Cipriani S, Ricci E, et al.Endometriosis and irritable bowel syndrome: A systematic review and meta-analysis.Arch Gynecol Obstet. 2021;303(1):17-25. doi:10.1007/s00404-020-05797-8
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.
Mabrouk M.Endometriosis of the appendix: when to predict and how to manage—A multivariate analysis of 1935 endometriosis cases.Journal of Minimally Invasive Gynecology. 2020;27(1):100-106. doi:10.1016/j.jmig.2019.02.015
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
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