Living with colorectal endometriosis is like dealing with an unwelcome house guest who refuses to leave. It’s not just an inconvenience—it’s a downright life-altering condition. Picture this: intense pelvic pain, bloating, constipation one day, diarrhea the next, and even pain during bowel movements.
Yeah, it's not a painful period or intense PMS is it.
It’s enough to put a serious damper on anyone’s quality of life. Fortunately, there’s a couple of ways to deal with this unruly “guest.” Though we have had great success with ENDOLLS at tackling these key issues, for others, surgery may be an option that may fit their unique needs.
We will be breaking this down as we go through how surgery can help, how effective it is, the risks, and what it all entails.
How Do You Know If You Have Colorectal Endometriosis & How Does It Affect Your Quality of Life? What You Need To Know
Colorectal endometriosis happens when endometriotic cells (similar to the lining of your uterus) grows where it doesn’t belong, for this case, on your intestines. This can lead to bowel blockages, excruciating abdominal and pelvic pain, and even blood in your stool. Over time, these symptoms can chip away at your daily life. Eating, working, or even socializing can feel like monumental tasks. You may be familiar with the following:
-
Pain: Severe pelvic pain, painful bowel movements (dyschezia), and pain during intercourse (dyspareunia) are common, disrupting daily activities, work productivity, and intimate relationships.
-
Digestive Problems: Diarrhea, constipation, bloating, and nausea can be frequent and unpredictable, leading to dietary restrictions, social anxieties, and limitations on travel and leisure activities.
-
Infertility: Colorectal endometriosis can contribute to infertility, adding emotional stress and strain on relationships.
-
Psychological Impact: The chronic pain, fatigue, and social limitations associated with colorectal endometriosis can contribute to anxiety, depression, and feelings of isolation.
When these symptoms become too much to bear or other treatments don’t work, surgery might be the next step. Surgical treatment can significantly help reduce pain and digestive troubles while improving overall well-being. While you find a specialist, we do recommend trying our Advanced Duo in the meantime as it will provide real relief for these issues.
Surgical Options—What’s on the Table?
There are several different surgical techniques for addressing colorectal endometriosis, each suited to specific severities and locations of the condition. Here’s a breakdown of the most common options:
1. Rectal Shaving (Typically for lesions at the surface level)
This technique is like skimming the surface. Surgeons remove just the outer layer of endometriotic growth on the bowel wall, causing minimal disruption to intestinal function. It’s typically used for less invasive cases where the endometriosis hasn’t deeply or fully infiltrated the bowel.
- Risk Rate: The risk of complications, such as rectal perforation or nerve damage, is relatively low, estimated at around at less than 5%.
- What It Is: Think of it as a precision haircut for your bowel—it targets the "surface" growths without cutting too deep, reducing the risks of more severe side effects.
2. Disc Excision/Rouen Technique (Preferred for large bowel infiltration)
If the endometriotic cells create nodules on the bowel wall, the Disc Excision method (also known as the Rouen Technique) might come into play. This involves cutting out a small "disc" of the bowel wall where the nodules are located.
- Risk Rate: The risk of bowel leakage or fistula (a small, abnormal tunnel forming in the bowel) is around 7–10%.
- What It Is: Picture this like removing a small, stubborn stain from fabric. The surgeon excises the problematic tissue while preserving as much of the healthy bowel wall as possible.
3. Segmental Bowel Resection (Severe large bowel infiltration)
For severe cases where endometriosis deeply invades the bowel wall, a Segmental Bowel Resection is often the treatment of choice. This involves removing an entire portion of the affected bowel and reconnecting the healthy ends.
- Risk Rate: Risks are higher with this more complex surgery, including infections, bowel leakage, and nerve damage, with rates estimated around 15–20%.
- What It Is: This procedure is like replacing a faulty segment of pipe in your plumbing system. The diseased portion of the bowel is removed altogether, addressing the root of the issue.
The Risks of Surgery—Here’s the Honest Truth
Yes, surgery comes with risks—it’s impossible to sugarcoat that. Here are the most common complications associated with these procedures:
- Bowel Perforation (tear in the bowel): Occurs in around 5–10% of cases with rectal shaving and up to 15% with segmental resection.
- Postoperative Infection: The risk of infection is about 10–15%, but it can be managed with antibiotics.
- Scar Tissue Formation (Adhesions): Scar tissue from surgery could cause discomfort or bowel blockages over time.
- Fistula Formation (abnormal tunnel in hollow tubes like blood vessels): Rare but possible, occurring in about 7–10% of cases with disc excision or more invasive bowel surgeries.
Surgical Efficacy Rates—Does It Work? Why Haven't They Been Mentioned?
Surgery for colorectal endometriosis has shown some promising results. However, there are numerous cases where endometrial tissue regrows, leading to recurring symptoms. It's difficult to directly compare the following three surgical techniques for endometriosis (shaving, disc excision, and segmental bowel resection) because there are many factors that can influence the risk of complications and overall success rates.
Most studies focus on what procedures provide the least amount of risk since the efficacy rates vary due to the given statement above. The ones that do mention success rates, success rates can be between 30-80% of long-term benefit.
These factors include that surgeries of this magnitude and complexity require a multidisciplinary team involving gynecological and colorectal surgical expertise. For example a crucial component in success is the distance of the stapling anastomosis (a stapling technique used to attach two portions of the intestines) from the anal verge, vaginal opening. Lastly, the surgeon's experience this is were NOOKs come in. They would need a colorectal surgical expert as well.
If The Surgery Is A Success, How Long Do the Benefits Last?
Most patients can experience improvements that last for years. However, long-term outcomes vary depending on the surgical method, the extent of the disease, and whether additional treatments, like hormone therapy, are used post-surgery.
The Takeaway
Surgery for colorectal endometriosis can be a game-changer for. Whether it’s a minimally invasive rectal shaving or a more complex segmental bowel resection, the goal is the same—to reduce pain and restore your quality of life. While no treatment is without risks, the numbers can be on your side with the right team.
Deciding whether surgery is right for you comes down to the severity of your symptoms, the impact on your daily life, and the advice of your medical team.
If you’re tired of letting endometriosis rule your life, know that you’ve got options. For the time being, we can provide real hope while you find the surgical team that suits your needs.