Bowel Endometriosis

Explore how endometriosis affects the bowel: symptoms like pain, bleeding, and constipation, how it's diagnosed, and evidence-based treatments, from medication to excision surgery, plus diet and flare-management tips.

Overview

Bowel endometriosis occurs when endometriosis infiltrates the bowel wall, most often the rectum or sigmoid. Hallmark features include cyclic painful bowel movements, constipation or diarrhea that worsen around periods, bloating, a sensation of incomplete emptying, and occasionally rectal bleeding with menses. Because symptoms overlap with IBS and IBD, pattern recognition and targeted testing matter. This form commonly falls under deep disease and may coexist with rectovaginal, uterosacral, or vaginal lesions, making coordinated care important and distinct from urinary issues covered under bladder involvement.

Accurate diagnosis relies on expert pelvic exam plus high-quality imaging such as transvaginal ultrasound with bowel prep and pelvic MRI to map size, depth, and length of involvement; colonoscopy often appears normal since lesions sit outside the bowel lining. Treatment ranges from hormonal suppression for symptom control to advanced excision by a gynecologic and colorectal team when pain persists, the bowel is narrowed, or fertility is a priority. Learn how imaging guides decisions, what to expect from medical therapy, and when techniques like shaving, discoid, or segmental resection are considered. Nutrition, pelvic floor therapy, and flare strategies complement care and are explored alongside related topics in Deep Infiltrating Endometriosis, Ultrasound, MRI, Excision Surgery, Gut Health, and Pain Relief.

What symptoms point to bowel endometriosis rather than IBS?

Symptoms that reliably worsen around periods—painful bowel movements, rectal pressure or stabbing pain, cyclical constipation or diarrhea, and bleeding from the rectum with menses—raise suspicion for bowel endometriosis. IBS typically fluctuates with stress and diet but is not strongly tied to the menstrual cycle. When the pattern is cyclic, targeted imaging helps distinguish causes; see IBS / IBD and Diagnostics & Imaging.

Can colonoscopy diagnose bowel endometriosis?

Often it cannot, because most lesions grow on the outer bowel wall or within deeper layers, leaving the inner lining normal. Colonoscopy is useful to rule out IBD or cancer if bleeding occurs, but mapping endometriosis relies on transvaginal or transrectal ultrasound with bowel prep and pelvic MRI; see Ultrasound and MRI.

Do medications help, and when is surgery recommended?

Hormonal therapies can reduce inflammation and pain but do not remove deep bowel nodules, so symptoms may return when medication stops. Surgery is considered for bowel narrowing, severe pain despite medical therapy, recurrent bleeding, or when optimizing fertility; coordinated planning with a colorectal partner improves safety and outcomes. For fertility decisions, see Fertility & Reproductive Health and options in Excision Surgery.

What surgical techniques are used and what are the risks?

Surgeons choose between superficial shaving, full‑thickness discoid excision, or segmental resection based on nodule size, depth, and length of bowel involved. Benefits include pain relief and restored bowel function; risks include leak, fistula, temporary ostomy, nerve injury, and altered bowel habits, which are discussed during planning. Recovery expectations and recurrence prevention are outlined in Surgery and Postoperative Recovery.

Which diet and self‑care strategies can ease bowel flares?

An anti‑inflammatory pattern with individualized fiber, short‑term low‑FODMAP trials, and attention to trigger foods can reduce bloating and pain. Partnering with a dietitian and supporting the microbiome with gradual changes may help, alongside heat, pacing, and pelvic floor therapy. Explore nutrition and self‑care in Gut Health, Anti-Inflammatory Diet, Meal Guides, and At-Home Remedies.