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Endometriosis and Irritable Bowel Syndrome

Q: I have endometriosis and now after 5 years, I have IBS (Irritable Bowel Syndrome).  The doctor said I have some endometriosis on my bowel. How common is this for women?


Dr. Donnica:
Endometriosis is relatively common, but commonly misunderstood.  It affects one in 15 women, or 5 million Americans! Four in 10 of these women will have infertility as a result. While endometriosis is marked by severe cramping before and during menses, some women don't experience any symptoms. In most cases, women are not affected until they reach their twenties or thirties.

What causes endometriosis?  Simply put, some of the lining cells of the womb flow backward into the pelvis and implant on other tissues, such as the ovaries or fallopian tubes.  Being estrogen sensitive, these implants react cyclically. They can grow and cause pain, abnormal bleeding, and tubal blockage.  There are many things we still don't understand about endometriosis: what causes it, why the symptoms are not necessarily related to the size or location of the implants, or what can be done to prevent it.

Endometriosis is also difficult to diagnose conclusively without a surgical procedure called a laparoscopy. A laparoscopy allows your doctor to look into your abdomen and pelvis with a lit tube through a small incision beneath your belly button.

The key to diagnosing Irritable Bowel Syndrome (IBS) is a taking a thorough patient history focused on characteristic bowel patterns, time and character of pain, and exclusion of other diseases through physical examination and routine diagnostic tests.

IBS is even more common than endometriosis, but they have many features in common, including being commonly misdiagnosed. IBS is a relatively common syndrome of abdominal discomfort or pain, bloating and changes in bowel habits (constipation and/or diarrhea). The pain or cramping can be a dull ache over one or several areas of the abdomen.  For some women, it can be intolerable and without relief. 

Up to 20 percent of all U.S. adults are affected by IBS, which involves an abnormality of the muscular action that passes food along the colon, as well as an increased sensitivity of the nerves in the colon. IBS generally first appears in a person's 20s to 40s and women are roughly three times more likely than men to be affected. Women with IBS seem to have more symptoms during their periods, suggesting that reproductive hormones may play a role. IBS has other symptoms as well: constant fatigue or feeling tired, and even depression.

Because IBS and endometriosis are both marked by varying degrees of pain "down there," they are often mistaken for each other.  However, many women may have both.  Women with endometriosis frequently have abdominal and bowel symptoms and these symptoms may be attributed to IBS, a "spastic colon," or to actual intestinal involvement from endometriosis.

Endometriosis implants may be found on or in the bowel wall. How common is this?  Reports of the incidence of intestinal involvement of endometriosis range from 3 to 34%; conservative estimates range from 5 to 10%. The hallmark of the diagnosis of intestinal endometriosis is that a woman has significant GI symptoms that vary with her menstrual cycle. The symptoms may be present only at the time of the menstrual period or they may be present all month long and worsen at the time of the period. The most common symptoms include loss of appetite, nausea (vomiting is rare), diarrhea, increased gas, significant bloating, crampy abdominal pain, painful bowel movements, and sharp stabbing rectal pain. Many women also complain of constipation that seems to vary with the menstrual cycle. Unexplained iron-deficiency anemia may also be a clue to the presence of intestinal endometriosis.  Another clue is rectal bleeding that is associated with menstruation.

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With best regards,
Donnica L. Moore, MD
President, DrDonnica.com

Created: 7/30/2002  -  Donnica Moore, M.D.

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