What is Rectal Endometriosis?

Rectal endometriosis is a form of endometriosis in which endometrial tissue — the normal lining of the uterus — grows outside the uterus and involves the rectum or other parts of the large intestine.

Endometriosis most commonly affects women of reproductive age, particularly those with a known history of pelvic endometriosis. When the disease involves the bowel, it most frequently affects the rectum and sigmoid colon due to their close proximity to the uterus.

What are the Symptoms of Rectal Endometriosis?

Symptoms may vary depending on the depth and location of involvement. Common symptoms include:

• Chronic pelvic pain
• Constipation
• Bloating
• Painful bowel movements
• Pain during sexual intercourse
• Rectal bleeding, especially during menstruation

Because many of these symptoms overlap with other gastrointestinal conditions, bowel endometriosis may initially be mistaken for irritable bowel syndrome, inflammatory bowel disease, or other colorectal disorders.

Symptoms often worsen during menstruation. Some patients already carry a diagnosis of endometriosis elsewhere in the pelvis.

How is Rectal Endometriosis Diagnosed?

Diagnosis typically involves a combination of:

• Detailed medical history
• Pelvic examination
• Colonoscopy (in selected cases)
• Imaging studies such as MRI, CT scan, or specialized pelvic ultrasound

Colonoscopy may occasionally detect abnormal tissue if the disease penetrates the bowel lining. However, many cases involve deeper layers of the bowel wall and are better evaluated with advanced imaging such as MRI.

What are the Treatment Options?

Treatment depends on symptom severity, extent of disease, and individual patient goals.

Medical Management may include:

• Hormonal therapy to suppress endometrial tissue growth
• Pain management strategies

Surgical Treatment may be recommended for patients with significant symptoms, bowel obstruction, bleeding, or failure of medical therapy. Surgical options include:

• Shaving of superficial endometriosis from the bowel surface
• Disc resection (removal of a localized portion of the bowel wall)
• Segmental resection (removal of a portion of the rectum or colon)

Most colorectal surgeons perform these procedures using minimally invasive techniques such as laparoscopy or robotic-assisted surgery, including the Da Vinci® robotic system, which may allow for enhanced precision and recovery.

What is POST-TREATMENT PROGNOSIS?

Many patients experience significant symptom relief following appropriate treatment. Prognosis depends on the extent of disease and the type of therapy performed.

A multidisciplinary approach involving a gynecologist and colorectal surgeon often provides optimal outcomes, particularly in complex or advanced cases.

If you experience pelvic pain, bowel changes, or rectal bleeding that worsens during menstruation, a specialized evaluation is recommended.