Painful Bowel Movements in Endometriosis and Adenomyosis

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Full transcript of the original video, lightly edited for readability.

I need to keep this video as clean as I possibly can, so, let's try to keep it as PG as possible. So today I wanted to talk about one of the most disturbing symptoms in the case of endometriosis, which is rectal pain. This can manifest such as pain with bowel movements, deep stabbing pain during your menstrual cycle, feeling like there's glass, knives, pressure, or an electric shock when you try to go to the bathroom. Sometimes you may even find blood in the stool.

And a lot of the. The things women are told is that either it's hemorrhoids, IVs, you're not eating enough fiber, you may be constipated. And, yes, while that sometimes can be true, that's not gonna be the case specifically if the pain is cyclical and it gets worse during your menstrual cycle or before it's. And specifically during ovulation. More so, you can attribute painful intercourse to this, because when we look, we are talking about the bowel, the. The compartments, near the uterus.

Because this anatomy is gonna lead to inflammation, fibrosis, and nerve signaling interacting in this area. You see, the rectum sits directly behind the uterus, and between those structures, there is the rectovaginal septum. Above that is the pouch of Douglas, also called the posterior cul de sac. And this is one of the classic areas where you might find deep infiltrating endometriosis. So when a woman says that it hurts her butt, her bowel movements, Hurt during her menstrual cycle or things like there's lightning pain in my rectum.

I feel like there's pressure, like something stuck. This actually makes complete sense, because the uterus, the rectum, the pelvic nerves, the bowel wall, and the inflammatory tissue. Tissue, they're all gonna be packed together. There's not that much empty space there. So when the inflammation happens in that region, everything around it is going to feel it. Now, why does it hurt so bad? Well, there's four major mechanisms right here. The first is direct tissue involvement. You see, deep infiltrating endometriosis can form firm nodules in that area.

It's like, for example, the rectovaginal septum, the uterosacral ligaments, pouch of Douglas, so on and so forth. In endometriosis, the disease often affects the outside of the muscular layer of the bowel before it ever reaches the inside lining. And that matters because the bowel is supposed to stretch, glide, and move. Peristaltic movement. But if endometriosis tethers it, stiffens it or pulls it with adhesions. And every bowel movement becomes mechanical stress. That's why it can feel like something is ripping, pulling, or tearing from the inside.

The second mechanism is fibrosis and adhesions. Endometriosis behaves like a wound that keeps reopening. So that's inflammation, repair, bleeding, fibrosis, and repeat. So tr. As we've spoken on the channel, over time, this creates stiff, scar like tissue. That rectum can become stuck in the back of the uterus, the ovaries, the pelvic side wall. So When the stools move through that bowel, the tissue may not move freely because of these adhesions, and it pulls against inflamed, scarred, nerve sensitive tissue. This is why it can feel like deep, sharp, mechanical pain.

It's not necessarily in your head. It's a mechanism going on. That's why adhesions and deep disease can feel like, you know, just that type of pain. A third mechanism we would like to talk about is endometriotic lesions are creating the inflammation. You see, they. They release inflammatory signaling, and they recruit immune cells. Now, when we discuss this, we're talking about cytokines like tumor necrosis factor alpha, and they're looking one, beta, and they're looking one, six, and they're looking eight. COX-2, prostaglandins, mast cells, the whole nine yards.

You see, this is also going to compound and create an oxidative stress. These chemicals are going to irritate the bowel and the surrounding nerve. So even if the lesion is not inside the bowel lining yet, the whole rectum's gonna feel. It is still gonna inflame the whole localized area. And in the pelvis, that neighborhood's tiny, so it can manifest into different locations. The fourth mechanism I wanna talk about is nerve sensitization. This is where rectal pain becomes brutal. The rectum and the pelvic floor are highly innervated.

So when they communicate through the, pudendal nerve. Sorry if I mispronounce that. It's been a while. The hypogastric nerve, the sacral nerve roots and the autonomic plexuses in The endometriosis can create a neuroinflammatory environment. Mast cells can release histamine tryptase, immune cells and lesions can increase nerve growth factor, prostaglandin, substance P. Again, the whole neurological inflammatory soup that's gonna literally ignite these on fire. So the nerves around the rectum become hyperreactive, they fire much too easily. The pressure becomes pain, the stretching becomes pain, and a normal bowel movement becomes a full body event.

Event. And suddenly you get but lightning, which is something that I've heard thrown around in the community, that sharp electrical rectal pain that makes you freeze. This can happen when the nerves are irritated, sensitized, and when the pelvic floor spasms in response to pain. So it's not just a bowel problem, it's a bowel, nerve, immune and muscular problem happening all together. So let's discuss the bloody stools too. If bloody stools always need to be taken seriously. It's not something to casually assume that it's endometriosis just because.

This is something that you wanna make sure that you kinda address, because hemorrhoids, fissures, inflammatory bowel disease, infection, polyps, and other serious bowel conditions can be of a concern. The majority of women with endometriosis, they're, they're gonna have perforating lesions in, in the, into the colon, into the bowel, which is, which is, is, I mean, personally, I, I've talked to a lot that have had that issue. There's a lot of, in the community, they say it's real, it's really rare. I, I, to me, it's Not, it's just, you know, based on my discussions, but you can actually see this in a colonoscopy?

You. You should be able to, especially if it's time during your menstrual cycle. When they look in there, they should be able to see a hemorrhaging lesion. And it cause, typically, you might not see it outside of your menstrual cycle. Outside when you're not ovulating, it's. It might not be there. So you need to make sure. If you approach this and you want to verify that this is endometriosis related, it is done when, you know you're. You're bleeding and there's discharge, because the deletion is also going to follow.

So where does this fit inside the denomyosis? Well, this also can all can manifest in a similar way. So even if you don't have lesions in these localized areas, it can still contribute to rectal pressure. Because, like, like we spoke about, it's a very tightly knitted organs. Like, there's not that much empty space. So an inflamed uterus is still gonna push onto these. These organs, and it's gonna create abnormal contractions. It can. It's gonna increase the prostaglandins, and it can trigger public floor guarding.

And because of uterus, the rectum, the lower back, and the pelvic share nerve pathways. The pain can refer backwards into the rectum. So with adenomyosis, rectal pain may come just from the pressure. And then when you stack inflammation and prostaglandins, it just pain sensitizing agents. You're gonna feel It the posterior compartment is is right there, so the symptoms can also become extreme.