Dr Tsaltas Explains Bowel/Colorectal Endometriosis

Endometriosis is a complex condition where the cells of the uterus lining live and grow outside the uterus.

Affecting 10-15% of the female population, endometriosis is just as common as diabetes and asthma, if not more so. However, it is still a poorly understood condition that often goes undiagnosed for many years.

The most common sites include:

• Ovaries
• Fallopian tubes
• Uterine muscle (known as adenomyosis)
• Uterosacral ligament
• Inside walls of the pelvis over the ureters
• Pelvic side walls
• Pouch of Douglas
• Surface of the rectum
• Muscle of rectum and other areas of the bowel
• Bladder surface
• Vagina

In some cases, endometriosis may also infiltrate into the bowel and deep into the bladder.

Classic symptoms of endometriosis include:

• Severe period pain
• Chronic pelvic pain
• Mid cycle (ovulation) pain
• Pain during intercourse
• Infertility

Diagnosing endometriosis is often very difficult, but it is typically based on the following:

• Patient symptoms: Many patients will have symptoms for many years which is why a thorough history is very important.
• Pelvis examination: Tenderness or the presence of a nodule (lump) through the vaginal tissues may suggest endometriosis.
• Ultrasound: You may need an ultrasound with a pre-ultrasound bowel preparation to diagnose deep infiltrative endometriosis.

The gold standard for a conclusive diagnosis is laparoscopy – otherwise known as ‘keyhole’ surgery. Laparoscopy allows tissue to be tested and removed safely.

This surgery is specialised and complex. I will therefore ensure you have a full understanding of the procedure and associated risks beforehand.

For most patients, a laparoscopy is all that’s needed to remove the endometriosis. In severe cases such as bowel endometriosis, however, a second procedure may be necessary. If this is your situation, I will conduct the surgery in collaboration with a highly skilled multidisciplinary team at either Epworth Freemasons or St Vincent’s Private.

As well as surgical treatment, you may require medication. This may include the following medications:

• Combined oral contraceptive pill
• Progesterone only pill
• Mirena IUD
• Implanon
• Zoladex
• Synarel
• Provera
• Visanne

I can advise which medications are right for you.

Yes. Even though endometriosis can be successfully treated, the underlying cause cannot be removed. The disease can therefore reoccur at any time during the reproductive years – which is why I encourage regular monitoring.

Endometriosis can also occur in the post-menopausal years when women are on HRT. It only very rarely occurs in post-menopausal women not on HRT.