A patient’s story
Laura, 32, had lived with bloating, painful bowel motions and fatigue for years. She was repeatedly told it was IBS. Only when her symptoms worsened around her periods did further tests reveal bowel endometriosis, finally explaining both her pelvic and digestive pain.
How endometriosis affects the bowel
Endometriosis can involve the digestive system in two main ways:
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Superficial bowel endometriosis, affecting the outer surface of the bowel
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Deep bowel endometriosis, where tissue infiltrates the bowel wall
When the bowel is involved, symptoms often mimic IBS, but with a key difference: they worsen before and during menstruation.
Digestive symptoms of bowel endometriosis
Common symptoms include:
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Painful bowel movements
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Deep pelvic pain, especially during or after sex
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Bloating and altered bowel habits
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Rectal pain or pressure
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Rectal bleeding during periods
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Fatigue and low mood
Because symptoms overlap with functional gut disorders, bowel endometriosis is often misdiagnosed or delayed.
How endometriosis is diagnosed
Diagnosis may involve:
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Clinical and vaginal examination
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Pelvic ultrasound
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MRI or CT scanning, especially for suspected deep disease
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Diagnostic laparoscopy, sometimes combined with bowel assessment
Early diagnosis is key to preventing progression and long-term complications.
Treatment options for endometriosis
Treatment is tailored to symptoms, fertility goals and disease severity.
Medical management
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Pain relief
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Hormonal treatments to suppress disease activity
These can help control symptoms but do not remove endometriosis tissue.
Surgical treatment for bowel endometriosis
Surgery is often recommended when bowel involvement causes significant symptoms.
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Options include:
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Shaving or excision of superficial disease
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Disc resection for limited bowel wall involvement
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Segmental bowel resection with re-joining of the bowel for severe disease
Surgical decisions are highly individual and often require a multidisciplinary approach.
When to seek specialist advice
You should seek assessment if you have:
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IBS-type symptoms that worsen with your menstrual cycle
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Pelvic pain plus bowel symptoms
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Rectal bleeding linked to periods
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Digestive symptoms not responding to standard IBS treatment