Endo and the Bowel
It’s the pain that can absolutely blindside you in the morning when you need poop 💩
Or maybe one minute you’re constipated…next minute you’ve got explosive diarrhoea
It might even get worse around ovulation or your period…
You might have noticed “skinny” poops…
You might have even noticed some blood in your stool, maybe even around your period.
You might even have only one symptom…or none at all!
Could it be bowel endometriosis or is it IBS?
Symptoms can vary according to the location of the endometriosis
Rectal bleeding & severe rectal pain when moving the bowel - quite often a stabbing pain can indicate the lower area involvement.
Variable pain or even chronic pain on the right side of the pelvis could indicate endometriosis higher up on the bowel. Obstruction could also be big red flag.
Other Generalised Indications could be:
Diarrhoea
Constipation
Skinny stools or big hard lumpy ones
Abdominal cramps
Bloating
Even Infertility
It may effect 5-15% of all endometriosis cases requiring shaving or in some cases even resecting the bowel depending on severity. This involves a team of specialists such as colorectal surgeons. It can be found on the outside of the bowel, and even deep into the muscles of the intestine/bowel area.
Common sites are:
The rectum
The sigmoid colon
The appendix
The small bowel/intestines
The most common sites (up to 90%) of bowel endometriosis are between the rectum and sigmoid colon, however occasionally it can be found in the appendix, caecum and ileum areas. This may cause dysfunction of the ileum…a predisposing factor in small intestinal bowel overgrowth (SIBO).
It should be noted, however, that IBS is commonly diagnosed with endo, and may not relate to endometriosis on the bowel. It might be more to do with adhesions from endometriosis causing the intestines to become distorted. IBS symptoms may also be to do with dysbiosis of the large or small intestine or even food intolerances
Figure 2: Schematic representation of the female reproductive anatomy with the two regions of the cul de sac highlighted sourced from https://www.preventmiscarriage.com/laparoscopic-excision-of-visible-endometriosis-significantly-increases-your-chances-of-having-a-successful-pregnancy.html
Sometimes endometriosis is on the Cul de Sac area recto-vaginally (Space between the pelvis and rectum) causing pain with the stool passes through the colon. Additionally, up to 8% of endometriosis patients with bowel symptoms actually have Inflammatory Bowel Disease (IBD), or Crohn’s Disease and Ulcerative Colitis. Very different to IBS, which is a “syndrome’ and indicates dysfunction within the GI tract, as opposed to IBD “Disease” which is clear destruction of the bowel wall. Commonly IBD - Crohn’s disease may also experience mouth ulcers, fatigue, anaemia and haemorrhoids.
It’s important to get a colonoscopy to rule these things out.
When it comes to staging, bowel endometriosis is classified as stage IV, and commonly indicates there is endometriosis in other locations.
Diagnosing bowel endometriosis
Your first point of call is a gynecologist specialising in endometriosis. You may need to get a referral to one via your GP.
Upon examination the gynecologist may perform a transvaginal ultrasound, refer for a specialist MRI and physically examine the vaginal/rectum areas. Tenderness, or firmness in the area at the top of the vagina behind the cervix could indicate rectovaginal endometriosis in the cul de sac region. Occasionally rectal examination may be performed.
Surgery, however is the best way to determine bowel involvement of endometriosis at this point in time. A team of specialists are required to manage bowel endometriosis, such as a colorectal surgeon, who may refer for a sigmoidoscopy or colonoscopy before surgery. Endometriosis lesions that are less than 2-3cm may be excised (Cut) out of the bowel muscle (rectal shaving). Larger/deeper lesions may be removed via disk resection. Multiple areas impacted may lead to a bowel resection removing up to 15cms of the colon or removal of the impacted area i.e. appendectomy.
Recurrence is low for bowel removal, yet shaving has a higher recurrence rate.
How nutritional medicine can help bowel endometriosis
As a clinical nutritionist, I can help show you tips to manage bowel pain and symptoms associated with endometriosis
My priorities to help really depend on your most challenging symptoms.
Reducing the pressure on the colon by decreasing stool size/hardness. We want it to look like a banana, not rabbit pebbles. A few kiwi fruits per day, adequate water intake and fibre intake are important here.
Decreasing excess gas caused by fermentation, leading to pressure on the colon. Lower FODMAP veggies might be good for a time until this is corrected. Addressing any undiagnosed gut conditions is really important for addressing this such as SIBO, IBD, Diverticulitis etc
Increasing the “bulk” of the stool for diarrhoea symptoms. Adding safe fibres to the diet, think thinks like stewed apples, pears, bananas, oats, chia. Even 1 tablespoon per day of carob powder, or specific probiotics can help reduce transit time.
Decreasing excess inflammation in the gut caused by food allergies or intolerances. Achieved by removing from the diet and a gut inflammation protocol. This seems to commonly be diary, gluten and for some people, eggs. Food allergy testing can be important here.
Provide natural analgesics and anti inflammatory nutrients. This helps to directly decrease pain. I can direct you to specific brands of supplements that are high quality and highly therapeutic. These may involve curcumin, etc
Do you experience symptoms of IBS or bowel endometriosis?
For additional support, feel free to book a consult with me.
Bec ✨
xx
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