- Painful menstruation
- Intestinal obstruction
- Blood in feces
- Mid-cycle spotting
- Lax vaginal discharge mid cycle
- Mucus in feces
Intestinal endometriosis is a pathological condition that progresses as a result of the hematogenous and lymphogenous spreading of endometrial cells from other affected organs. Usually the disease is diagnosed in women who have a history of endometriosis of the uterus. Most often, this disease affects the sigmoid and rectum, but the process may be localized in other parts of the large intestine.
As mentioned above, endometrial intestinal damage develops as a secondary disease, against the background of existing endometriosis of the uterus, ovaries and other organs of the female reproductive system. Therefore, when the patient is diagnosed with intestinal endometriosis, it only means that the gynecological process was started, because of which the disease has spread.
At the same time, the causes of the initial development of endometriosis are hormonal disorders occurring in a woman’s body. This may be a hormonal failure due to impaired hormone production by the pituitary gland, or in case of failure, which is triggered by a disruption in the normal functioning of the ovaries.
A hormonal failure in a woman’s body causes a disruption not only in the reproductive system, but also in the entire body. As a consequence, the uncontrolled growth of endometrial cells lining the female genital organs begins.
The second cause of endometriosis is a decrease in immunity. When the protective functions of the body are reduced, it is much easier for bacteria and viruses to get inside, including the intestine, causing inflammatory processes in it that affect the development of endometriosis. It is important to remember that endometriosis is quite a serious disease. And although the initially expanding endometrial cells are benign, without treatment, the process can lead to the development of cancer in the affected organs in the uterus and ovaries of the woman and in the intestine. And the treatment of the oncological process will require surgical removal of the affected organ, chemotherapy and hormone replacement therapy, which will reduce the patient’s quality of life, and the lifespan too.
Therefore, treatment of endometriosis, including the intestines, cannot be postponed until later, and as soon as the first symptoms appear, it is necessary to seek medical help.
With such a pathology as intestinal endometriosis, the symptoms may be completely absent in the initial stages of the development of the disease, and only when the disease begins to progress, do they appear. Symptoms of intestinal endometriosis:
- development of constipation or diarrhea,
- the presence of blood in the feces,
- the presence of mucus in the feces,
- pain that is associated with menstruation (it usually increases during the premenstrual period and during menstruation, and becomes unexpressed during the period after menstruation),
- menstrual dysfunction,
- abdominal distention, which also increases during menstruation,
- spotting blood from the genital tract of a woman between periods.
Sometimes the patient may have intestinal obstruction, which is quite a serious indication for an emergency operation.
Diagnosis and treatment
In 25% of patients, symptoms of intestinal endometriosis are absent, therefore, the diagnosis of pathology can be based on the presence of symptoms of gynecological endometriosis in the advanced stage. In this case, the patient is sent for additional examination in order to exclude the probability of the process spreading beyond the limits of the reproductive system.
If the above symptoms of intestinal endometriosis are present, additional diagnosis is still required to confirm the diagnosis and set the extent of the process. Common methods used by modern diagnostics are:
- irrigoscopy provides an opportunity to see the entire intestine and detect foci of endometriosis,
- Irigography involves radiographic examination of the affected organ with the introduction of a radiopaque substance,
- colonoscopy is a rather complicated diagnostic method, but its information content is very high,
- biopsy - is shown in case of neglected pathology in order to exclude or confirm the presence of an oncological process in the intestine
Treatment of the disease depends on the stage and the cause of it. If the patient has hormonal disorders, treatment involves their correction, for which certain hormonal drugs are prescribed. If there are foci of inflammation in the intestines, treatment should include antibacterial or antiviral medications. Also mandatory treatment should include taking medications that increase the patient's immunity.
In addition, physiotherapeutic treatment is carried out, which, in combination with drug therapy, gives good results. However, if the treatment for half a year did not have an effect, and the patient still complains of the symptoms of endometriosis, which is confirmed by diagnostic methods, then surgical removal of the affected areas is indicated.
Symptoms of colon endometriosis
Symptoms of endometriosis of the colon are associated with the menstrual cycle - they appear no earlier than a week before the onset of menstruation (regular vaginal discharge of blood associated with endometrial detachment (uterine mucosa)) and continue during menstruation.
Sometimes the disease can be asymptomatic.
- Algomenorrhea (painful menstruation).
- Constant nagging pain in the lower abdomen, worse before and during menstruation.
- Tenesmus (painful urge to defecate (emptying the rectum)).
- Changes in stool frequency are constipation or diarrhea (frequent loose stools).
- The appearance of impurities of mucus or blood in the feces.
- Rapid defecation during menstruation (or a week before it starts).
- Pallor of the skin.
Allot 2 formsendometriosis of the colon.
- Genital (affecting genitals):
- interior (affecting the uterus, fallopian tubes (the part of the uterus connecting the uterus cavity to the abdominal cavity))
- outer (affecting other internal and external genitals).
- Extragenital (infecting the intestines, peritoneum (shell, lining the abdominal cavity), postoperative scars, etc.).
The reason The development of endometriosis of the colon is the implantation (implantation) of endometrial cells (uterine lining) in the tissue of the colon.
Among factors leading to the development of endometriosis, there are several.
- High levels of estrogen (female sex hormones) as a result of disruption of the ovaries (female genital glands), liver disease, obesity.
- Inflammatory diseases of the reproductive organs:
- salpingo-oophoritis (inflammation of the fallopian tubes (uterine processes in the form of a tube) and ovaries),
- endometritis (inflammation of the endometrium).
- Numerous artificial abortions (abortion).
- The presence of gynecological diseases in combination with chronic diseases of internal organs:
- hypertension (prolonged increase in blood pressure more than 140/90 mm Hg. Art.),
- diabetes mellitus (an increase in the level of glucose (sugar) in the blood as a result of a lack or malfunction of insulin (pancreatic hormone)).
- Sedentary lifestyle, psycho-emotional stress.
A gynecologist will help in the treatment of the disease
Treatment of colon endometriosis
Treatment of colon endometriosis can be conservative (non-surgical) and surgical.
Conservative treatment aimed at normalizing hormonal levels. The mechanisms of action of drugs used in the treatment of endometriosis are extremely complex and complex (multicomponent). As a rule, all of them have a contraceptive effect (prevention of unwanted pregnancy), however, the therapeutic effect consists precisely in the “non-essential” action - the woman’s hormonal background is getting closer to normal.
Most often used several groups of drugs:
- Oral hormonal contraceptives (drugs to eliminate unwanted pregnancy) - drugs in the form of tablets containing female sex hormones:
- estrogen (female sex hormone that contributes to the growth of the endometrium (uterine lining)),
- progesterone (a female sex hormone that helps sustain pregnancy).
- Progestin oral contraceptives (mini-drank) - drugs containing only progesterone, used to prevent unwanted pregnancy.
- Gonadotropin-releasing hormone agonists - drugs that have an effect similar to that of gonadotropin-releasing hormone (a hormone produced by the hypothalamus (the brain that regulates the synthesis (production) of the pituitary hormones)). Gonadotropin-releasing hormone increases the production of gonadotropic (ovarian-stimulating) hormone by the pituitary gland).
- Gonadotropin-releasing hormone antagonists are drugs that reduce the production of gonadotropic hormone.
- Anti-estrogens - anticancer drugs (drugs for the treatment of malignant neoplasms (the cell type of which differs from the cell type of the organ from which they originated)), used in the treatment of estrogen-dependent tumors (the growth of a malignant formation is stimulated by estrogen (a female hormone promoting endometrial growth)) .
Surgery endometriosis of the colon should be applied only after 6 months of lack of effect from conservative treatment.
- Resection (excision) of the endometrial focus in the large intestine - is used only for superficial lesions of the mucous membrane of the colon wall. The operation is performed under general anesthesia and consists in removing the surface layer of the colon together with the endometriotic focus without disturbing the integrity of the intestinal mucosa.
- Hysterectomy (removal of the uterus (affected by endometriosis)), removal of endometrial foci in other organs and resection of a part of the large intestine are used in the defeat of all layers of the intestinal wall. The operation is performed under general anesthesia: at one time (in one operation) the uterus is removed, all endometrial foci of other organs (or walls of the abdominal cavity) are excised and a section of the large intestine affected by endometriosis is “cut out”, followed by intestinal stitching.
After surgical treatment, it is necessary to conduct conservative treatment for 6-12 months.
Complications and consequences
- Adhesive disease - the development of adhesions (dense connective tissue strands (bridges, resembling ropes)) between the abdominal organs (for example, intestinal loops). Often leads to intestinal obstruction (disruption of the movement of the food lump in the intestine).
- Stenosis (narrowing) of the intestinal lumen.
- Rectal bleeding.
- Anemia (anemia).
- Cancer (a malignant neoplasm (whose cell type is different from the cell type of the organ from which it originated)) of the colon.
- Perforation (rupture) of the colon.
- Peritonitis (inflammation of the peritoneum (the membrane lining the abdominal cavity)).
Prevention of colon endometriosis
- Regular visits to the gynecologist (1 time in half a year).
- Timely diagnosis and adequate treatment of gynecological diseases.
- Compliance with a diet with a moderate content of carbohydrates and fats (excluding fatty and fried foods, flour, sweets) and sufficient protein content (meat and dairy products, legumes - peas, beans).
- Maintain a rolling lifestyle, regular exercise.
- Planning of pregnancy, timely preparation for it (first birth to 27 years, prevention of unwanted pregnancy). Reception of combined oral contraceptives (drugs that prevent the occurrence of unwanted pregnancy).
- Breastfeeding for at least six months after childbirth - this reduces the amount of estrogen (female sex hormones that contribute to the growth of the endometrium (mucous membrane) of the uterus) in the blood, thereby preventing the development of endometriosis. Also, breastfeeding is good for a woman’s hormonal balance.
- Regular sex life.
The large intestine consists of several sections (listed in the direction of travel from the small intestine to the anus):
- ascending colon (part of the colon, located in the right side of the abdomen),
- transverse colon (section of the colon, located horizontally - between the ascending and descending parts),
- descending colon (part of the colon, located in the left side of the abdomen),
- sigmoid colon (the section of the colon, located between the descending part of the colon and the rectum),
- rectum (section of the colon, located between the sigmoid colon and anus).
The sigmoid and rectum are often the site of development of endometrial foci.
INFORMATION FOR READING
Consultation with a doctor is necessary.
- "Gynecology - national leadership" ed. IN AND. Kulakova, G.M. Saveleva, I.B. Manukhina. -: “GEOTAR-Media”, 2009
- "Emergency care in obstetrics and gynecology: a brief guide" ed. V.N. Serov. - M: “GEOTAR-Media”, 2011.
What is intestinal endometriosis?
Intestinal endometriosis is a medical condition in which endometrial tissue develops in the small or large intestine, which in a healthy female body should grow exclusively in the uterus, where it prepares the body for ovulation and possible fertilization.
The endometrium consists of blood cells, as well as connective and glandular tissues. Every month it thickens until either the fertilization of the egg or menstruation, that is, the process during which the endometrium is rejected by the uterus and leaves the body through the vagina.
When this tissue grows outside the uterus, for example on the intestines, it also thickens under the influence of hormones. However, since the endometrium cannot leave the body, it causes a number of alarming symptoms.
Doctors usually divide endometriosis into superficial and deep. With surface endometriosis, implants develop on the intestinal surface. If they penetrate the intestinal wall, then the patient is diagnosed with deep endometriosis.
The symptoms of intestinal endometriosis include the following:
- pain deep in the pelvis
- pelvic pain during sexual penetration,
- pain during stool,
- bleeding from the rectum (this symptom is rarely observed).
Ectopic endometrial tissue can develop in any part of the intestine. However, according to a study conducted in 2014 by Belgian scientists, in 90% of cases implants are found in the rectum and sigmoid colon.
The symptoms of intestinal endometriosis are different in different women and usually depend on the period of the menstrual cycle. For example, they may worsen several days before the onset of menstruation.
Symptoms of intestinal endometriosis can subside as soon as a woman enters menopause, and the level of estrogen in her body decreases.
Doctors do not know exactly why some women develop endometriosis.
According to one theory, menstrual blood is able to go into the fallopian tubes and subsequently penetrate the pelvic cavity. Particles of this blood can be implanted in the intestinal mucosa.
Women who have mothers and sisters with endometriosis are more likely to develop this disease.
Some experts believe that as a result of previously performed operations on the uterus, endometrial tissue can attach to the incision site and ultimately penetrate the intestine.
In the scientific world, there is an opinion that estrogen imbalances also contribute to the development of endometriosis.
In addition, genetic factors may be associated with this condition. Women whose close relatives suffer from endometriosis are associated with an increased risk of developing this disease.
Researchers have not yet figured out why endometrial tissue appears in places remote from the organs of the reproductive system, such as the intestines. It is known that it can also affect the lungs, diaphragm and even the brain.
For mild symptoms, the doctor may recommend management of endometriosis with non-prescription or prescription painkillers. These include paracetamol and ibuprofen.
Drugs can not stop the growth of endometrial implants, but you can ease the pain and discomfort.
Since estrogen affects intestinal endometriosis, hormone therapy sometimes helps women fight this condition.
Hormone therapy involves taking birth control pills or using birth control patches. Such products contain estrogen, progesterone, or both hormones, thereby preventing the growth of endometrial tissue. They are also able to reduce the size of implants.
In some cases, doctors prescribe gonadotropin-releasing hormone to patients, which prevents ovulation and inhibits the development of ectopic endometrium.
After stopping medication, symptoms may return.
If hormone therapy does not help with the symptoms, the doctor may recommend surgery. Surgical intervention is also used in cases where infertility develops in women who want to give birth to a child due to endometriosis.
The type of operation proposed will depend on which endometriosis the doctor reveals on the intestine - deep or superficial.
One type of surgery involves removing particles of endometrial tissue and keeping the intestines intact.
With deep endometriosis, the surgeon removes endometrial implants and restores intestinal lesions.
In particularly severe cases, the doctor removes a small segment of the intestine affected by the endometrium, and then connects the remaining parts.
There is no convincing scientific evidence that specific diets help reduce the degree of symptoms of endometriosis, although some scientific work has shown that in this state it is good to eat fruits and vegetables.
In 2018, the authoritative journal Human Reproduction published the results of a study in which more than 70 thousand women of child-bearing age took part. It was found that the risk of endometriosis among those tested who consumed at least one serving of citrus fruits daily was 22% lower than among women who were less actively fed their diets with the indicated products. It should be noted that in the framework of this study, scientists considered any form of endometriosis, and not just intestinal endometriosis.
As part of another small study conducted in Australia, experts examined information about women suffering from irritable bowel syndrome and intestinal endometriosis with exacerbations during menstruation.
It was found that a diet low in FODMAP can alleviate bowel symptoms that may be associated with endometriosis.
FODMAP is an English acronym that in Russian stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
Foods high in FODMAP can provoke symptoms such as stomach cramps, gas and bloating.
Further research is needed to figure out a more accurate relationship between symptoms of intestinal endometriosis and diet.
Read more about diet for endometriosis here.
The prospects for women with endometriosis depend on the degree of symptoms and the effectiveness of treatment.
Endometriosis is a chronic medical condition, but its symptoms can be alleviated with medications or surgeries.
In many cases, the symptoms of intestinal endometriosis begin to appear less intense after the woman enters menopause.