Newswise — Endometriosis occurs when the same tissue that lines the uterus is present in other areas of the body, such as the ovaries, the surface of the colon, or the lining of the abdomen.  It can behave similarly to the tissue lining the uterus, in that it can undergo identical changes with the menstrual cycle, in terms of changing with the menstrual cycle, growing in size, and bleeding. The areas where endometriosis is located is the primary reason why it can lead to symptoms of very intense deep pelvic pain, painful intercourse, infertility, as well as causing constipation. Initial treatment frequently involves using hormonal treatment, such as oral contraceptives or other types of hormones, to prevent new areas of endometriosis from growing and to slow the growth of existing areas.  If these treatments are unsuccessful, surgery is often recommended. There has been controversy as to which type of surgery is best.  Some surgeons advocate not removing affected bowel and only “shave off” endometriosis growths off the surface of the bowel.  There is little information from patients as to which type of surgery provides the best symptom relief.

In this month’s issue of Diseases of the Colon & Rectum, endometriosis experts from Denmark published their results of a large study of women who underwent laparoscopic colorectal resection for endometriosis not responding to hormonal treatment. Surgeons collected information on pelvic pain and quality of life before and after laparoscopic bowel resection for endometriosis. Of 175 women who completed preoperative surveys regarding pelvic pain and quality of life, 97% of women also completed these same surveys one year after surgery. There are few studies where such symptom data have been collected prospectively in patients, meaning both before and after surgery. The most common bowel site of endometriosis was in the upper rectum. Major findings of this study included a dramatic increase in the number of patients not on any hormonal or pain medication after surgery (19% of patients preoperatively vs. 44% postoperatively taking no hormone treatment and 6% of patients preoperatively vs. 38% postoperatively taking no pain medication), and a profound increase in quality of life. Women reported significant reductions in pain intensity associated with menstrual periods, between periods and less pain associated with bowel movements. In addition, women who had undergone laparoscopic bowel resection for endometriosis also reported significant improvements in general health, vitality, mental health, physical functioning and many other components of improved quality of life. This group has previously shown that laparoscopic bowel resection also results in less painful sex.

Lead author, Dr. Mads Riiskjær, noted: “We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment.”

Study Citation: Riiskjær M, Forman A, Kesmodel US, Andersen LM, Ljungmann K, Seyer-Hansen M. Pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. Dis Colon Rectum 2018;61:221-229.

In an accompanying editorial, Jean-Jacques Tuech of Rouen, France, highlights the frustration that many women have in establishing a diagnosis of endometriosis due to the variety of symptoms and their severity. He elegantly describes how rectal endometriosis causes the symptoms that it does, which include everything from diarrhea, the feeling that you have to go and can’t, constipation, bowel obstruction, as well as deep pelvic pain.

Dr. Tuech noted: “A patient-tailored approached is crucial, and the least radical option should be chosen.”

Study Citation: Tuech JJ, Roman H. Worrying about postoperative functional outcomes in young women with colorectal endometriosis: that's it! Dis Colon Rectum 2018;61:149-150.

A prepublication copy is available upon request. Please email Margaret Abby, Managing Editor, Diseases of the Colon and Rectum, at [email protected]

Journal Link: Diseases of the Colon & Rectum