BOWEL ADHESIOLYSIS

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.

What are the signs and symptoms of endometriosis on the bowel?

The symptoms of bowel endometriosis 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.
Bowel endometriosis symptoms include:

Pain on opening the bowels (dyschezia)

Deep pelvic pain during sex (dyspareunia)

In some cases, rectal bleeding during a period

If you experience these symptoms you can discuss them with your doctor who may choose to use several of the following techniques for diagnosis:

Vaginal examination

Ultrasound

Sigmoidoscopy and/or Laparoscopy - operations to look inside your bowel and abdomen respectively

CT and/or MRI scan – if deep endometriosis is suspected

What treatment is available for endometriosis on the bowel?

If diagnosed with bowel endometriosis you can control the symptoms with a combination of painkillers and hormone treatments depending on the severity of your symptoms. Should you choose not to have treatment for your bowel endometriosis, your symptoms are likely to continue and may worsen over time. Some women have found complementary treatments useful with controlling symptoms, though these are not scientifically proven treatments.

Surgery is the usual treatment for bowel endometriosis – the surgical options vary depending on the severity of the endometriosis and the areas affected. Surgeries can be performed via a laparsocopy or via open surgery and may take several hours and more than one surgery depending on the extent of the endometriosis.

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 endometriosis, 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.

Post operation you will be on painkillers and it is likely that you will need a urinary catheter for a few days after your operation. Recovery after any surgery varies depending on the individual, however, in general after laparoscopic bowel surgery you can expect to go home after 4 -7 days, and after open bowel surgery it is usual to leave after 8 – 12 days.

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.