![]() These lesions will typically cause pain with BMs mostly during or just before menses, and while it can be sharp pain, they don’t usually cause the kinking or strictures, thus they cause less of the bloating and “gut cramps”. Most endo lesions on the rectosigmoid are not as large or as deep as those described above and live mostly in the serosa and outer muscularis. There can also be nausea and vomiting during these episodes. Patients have described the pain during these episodes as feeling like “a steak knife” or “shards of glass”, along with severe “gut cramps” from intense contraction of the colon trying to push the stool through the narrowed length of colon. As is shown in the ultrasound image at right, the nodule almost always causes both narrowing of the lumen (stricture) as well as a sharp kink in the colon, both of which explain symptoms of increasing pain and bloating until the stool passes by the nodule, then relief that can be immediate. Symptoms of endo within the muscle layer of the rectosigmoid colon are usually sharp pain either during the actual bowel movement, or just before as the mostly solid stool is pushed through the segment of colon with the endo in it. Most (95%) endo of the colon does not infiltrate the mucosal lining, meaning it can’t be seen on colonoscopy, so it is rarely recognized by gastroenterologists. Ironically, while some patients can have minimal symptoms (“I just thought I had bad cramps”), most of the time these rectal nodules will cause significant pain with defecation as well as alternating constipation and diarrhea, hesitancy (being unconsciously afraid to have a BM), urgency (gotta go NOW!), and some patients will actually pass out after passing a stool. ![]() Endometriosis here is commonly associated with “stage IV” disease – where there are endometriomas in one or both ovaries, and the ovaries, colon, and cervix/uterus are all stuck together with endometriosis causing these adhesions. ![]() ![]() The most common site on the bowel is the rectosigmoid colon – the part of the colon that lies right behind the cervix and upper vagina, between the uterosacral ligaments. Intestinal endometriosis can cause a variety of symptoms depending on where on the bowel it is (small bowel, colon, appendix, etc). We don’t know the exact proportion of women with endo who have bowel disease, but in specialized practices it can be up to 30% of endometriosis patients. One of the most painful manifestations of Deeply Infiltrating Endometriosis is that involving the gastrointestinal tract, or the bowels. ![]()
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