Endometriosis Supportive Therapy: Can Endometriosis Be Treated Without Surgery?

Endometriosis is an extremely painful chronic condition, which often also leads to infertility or subfertility, that affects about ten percent of women worldwide. It is characterized by growth of endometrial-like tissue, which normally lines the inside of the uterus, outside of the uterus on pelvic organs, the abdomen, bowel, and beyond. This tissue is not the same as the endometrium, characterized by very different behavior and unique molecular profiles.  

Eventually, personalized “theranostic” (therapy and diagnostic) tools will exploit these unique molecular profiles and lead to far better diagnosis, therapy and monitoring approaches.  Research is accelerating in this area, which is already very pervasive in other diseases such as cancer and various immuno-inflammatory conditions.   Meanwhile, the only therapies that are available to actually treat endometriosis, not just masking of symptoms, are hormonal options and excisional surgery.  However, there are major limitations to the argument that hormonal therapies work very well to treat endo rather than simply reduce symptoms.  That leaves surgery.

So, in a word, “can endometriosis be treated without surgery?”, the answer is a resounding NO!  That is not to say that hormonal and other treatments, including anti-inflammatory and perhaps anti-histamine agents (e.g. Zyrtec), both mainstream and integrative-holistic, don’t help. They might.  Let’s unpack this a little bit to give you a roadmap of the options.  

Understanding Endometriosis

The exact cause of endometriosis is technically unknown, but we know it is influenced by genetic, genomic, hormonal, immunologic and environmental epigenetic factors.  In other words, it is “multi-factorial”. This means the reason you may have endo could be different from why your friend or even your sister does.  Endo can also behave very differently because different factors are probably in play in different people. This makes a “standard treatment” hard, if not impossible, to recommend to any given patient.  This is changing with the advent of endometriosis bio-molecular pathway research, which will lead to highly individualized targeted treatments. But this is not part of what is available today. 

Diagnosis of Endometriosis

Diagnosing endometriosis is very challenging, because the symptoms can mimic other conditions. This is part of the reason that diagnosis is often delayed by 5-10 years and intentional or inadvertent gaslighting is rampant, depending on which specialist was consulted.  The doctor may be looking at you through a general practice medical lens, or intestinal, urologic, neurologic or other lenses in forming their opinions.   

Rule # 1 is to listen to the patient.  This is almost never done to an appropriate extent.  Why? Because today’s medical system limitations often lead to five-to-ten-minute visits with a semi-interested and overworked provider who is likely under-informed regarding endometriosis.  

When rule #1 is broken, an appropriate evaluation and testing is not likely to be done. Ideally, a clinical suspicion leads to testing that may include ultrasound or MRI, various blood tests, testing for associated conditions and so on.  None of these will reliably lead to a diagnosis of endo but can lead to appropriate specialist referrals to get to the root cause of pain, such as endo. 

Rule #2 in medicine, in general, is to get a diagnosis before recommending treatment.  This is because treatments can be ineffective when treating the wrong condition or, worse, can lead to complications and side effects.  Unfortunately, in the author’s strong opinion, this is often violated specifically in endometriosis treatment.  A common standard is to offer hormonal therapy to patients to see if it might work because the diagnosis might be endometriosis and endo is, in part, fueled by hormones. This may or may not be reasonable depending upon individual circumstances and choices. 

This brings us to rule #3, that we’ll cover next, which proposes that patients should be offered treatment options to select from after informed consent about the potential risks vs the potential benefits based on the best possible scientific evidence.  This is not always done very well and certainly depends on the “trust factor” with your selected specialist(s), since scientific evidence is subject to interpretation.  Most patients do not realize this.    

Conventional Treatment of Endometriosis

Traditional treatment for endometriosis often involves medication or surgery. Medications can include anti-inflammatory pain relievers and hormonal therapies.  In the near future medications will include targeted biomolecular non-hormonal therapies, but they are not here yet.  Pain relievers are mainly a symptom reducing band-aid and are not intended to treat, so we will not discuss them here either.  They can certainly help in overall management, but we will focus on “treatment” in this article.  

Hormones aim to either shut down ovarian function (in other words, cut off estrogen) or at least regulate the menstrual cycle, and progesterone analogs, to potentially reduce the growth of endometriosis tissue. 

Surgery is used for definitive diagnosis of endo as well as treatment by removing any lesions or implants that are found.  In some cases, the two modalities can be used hand in hand, but the order in which they are used, and the nature of the proposed hormonal therapy are important considerations.  

Hormonal Treatment

International guidelines are very confusing and inconsistent regarding hormonal therapy for endometriosis. Because of this, recommendations can vary between practitioners.  We won’t delve into all these options here, but the following are excellent summary articles on this important topic. 

The important points to consider are as follows:

1. The ONLY way currently to definitively diagnose endometriosis is through biopsy, usually performed during surgery.
2. Starting treatment that can cause extreme side effects and potential long-term harm without first getting a definitive diagnosis seems imprudent.  So, if a practitioner offers hormones because they “think” you have endo based on history, examination and perhaps some scans, at least get a second opinion from an endometriosis specialist.  This approach is within international guidelines but can cause you a world of misery and potential harm if not managed in expert hands. 
3. Hormone therapy for endo boils down to either reducing estrogen levels or eliminating estrogen altogether or increasing progestational agent levels to try to medically eliminate endo lesions. Reducing estrogen levels is not possible since there are different types of estrogen, different sources of estrogen and endo lesions themselves can influence local production of estrogen. 
4. Endometriosis cells differ from endometrial cells that are found in the uterus by being relatively resistant to synthetic progestin or natural micronized progesterone therapy. 
5. Hormonal therapy is known to reduce pain when endometriosis is the cause. However, studies have shown that pain relief is possible but hormonal therapy fails to significantly retard the growth of endometriosis tissue when objectively tested in pathology laboratories.  Further, hormonal therapy cannot eliminate scar tissue or fibrosis caused by endo and this fibrosis by itself can be a cause for pain.
6. While unproven, under some circumstances it may be prudent to use less toxic hormonal therapy options to potentially reduce the risk of endo recurrence after surgery.  

Surgical Treatment 

When symptoms, history, physical exam, scans and laboratory evidence all point to endometriosis as a strong possibility to be the root cause of pain, and/or infertility, minimally invasive surgery should be considered to find out for sure.  If endo is diagnosed, then medical hormonal therapy may make sense as part of a highly individualized treatment plan under the guidance of an endo specialist. 

The caveat to considering endometriosis surgery is that there are, of course, potential risks and complications even though it is minimally invasive.  These risks can be minimized in the hands of an expert surgeon, but they should be considered in a risk-benefit discussion.  

More importantly, assuming you have identified an expert endo excision surgeon, surgery is the cornerstone to current effective treatment.  While incompletely proven, for many reasons, it appears that excision of endo lesions and scar tissue (fibrosis) rather than burning them away (fulguration) is a better and safer approach.  To discover more about surgical considerations, consider the following articles. 

Integrative Holistic View of Endometriosis

Since the cause of endo is incompletely understood, but highly multifactorial, and because the reason endo is present in any given individual may vary, either surgery or hormonal therapy or both may fail.  Failure is relative. In other words, failure may be defined as no immediate pain improvement, persistent subfertility, or it may mean recurrence years later.  These are very different scenarios, requiring different approaches.  Also, it’s important to consider whether or not associated conditions have been addressed, such as SIBO or other microbiome irregularities, other inflammatory immune-modulated disease and so on.  Finally, pelvic floor physical therapy is not just a symptom band-aid but a critical co-treatment for pelvic floor function before and after surgery. These topics are all beyond the scope of this article, but you can discover more by reading the following articles. 

If expert excision surgery and supportive hormonal therapy, when used, fails to alleviate pain then supportive pain management can still improve quality of life.  This can be mainstream pain and anti-inflammatory medications like non-steroidal anti-inflammatory (NSAID), nerve block injections, electrical stimulation modalities and/or more holistic approaches including acupuncture, acupressure, mind-body biofeedback approaches such as HeartMath, herbals, aromatherapy and more.  

Kicking it up a notch, here is something you do not see covered much other than in a very superficial manner.  It is not rocket science but is not simplistic at the potential treatment level either.  However, it is something you can implement in a proactive way at any point in your journey.  Specifically, this is the impact of nutrition and lifestyle choices, as well as well-selected and targeted supplements, but drilled down a lot further than simply eating right, exercising and de-stressing.

Upcoming bio-molecular therapies will target specific biological pathways that we are now beginning to better understand.  Many pathways are already identified, many not.  The problem is that there are no mainstream medical therapies, yet which can target these pathways safely and effectively.  We know from other related genomically modulated inflammatory diseases, like cancer and auto-immune disorders, that these treatments take a while to develop and offer safely.  Meanwhile, many of the genomic, metabolic and epigenetic abnormalities that influence endo are known or at least partly known.  With few exceptions, while it is too early to safely use pharmaceutical agents to modulate these abnormalities, nutrients, specific exercise, toxin avoidance, and even state of mind can affect the same pathways abnormalities without risk.  

Nutrigenomics and Epigenetics

How do toxins or stress adversely affect your health, while healthy diet and exercise positively influence your health? In large part, relatively new sciences like metabolomics and genomics, and their derivatives, explain this.  You are born with your genes and, so far, you can’t alter that deck of cards.  Some genes may be “bad” and increase your risk of endo, as well as other diseases. However, not everyone with some bad genes develops disease.  The most famous examples are identical twins who inherited the exact same genetics yet might look a little different (e.g. eye or hair color) and often get different diseases.  Why? 

Anything and everything you eat, drink, get exposed to via skin or breathing, or even think about or emote, can affect your genes through epigenetics.  This means these substances and neurochemicals, good or bad, can turn genes on and off.  Of course, it is infinitely more complex than that and multiple genes affect one process in many cases. However, you can actively modulate your inflammatory and oxidative state.  Do we know what veggie or what thought or what toxin turns what specific gene on or off?  No.  But we do know how these gene-controlled pathways synergize and work together to create health or facilitate disease.    

Conclusion

Surgery is a cornerstone to definitive diagnosis of endo and serves as very important part of treatment.  The path to success is a correct diagnosis, attention to detail and a highly individualized treatment plan.  This can only be carried out in consultation with endometriosis specialists in medical and surgical management.  

Unfortunately, it is not easy to find someone or a team that can fit your needs, but it is a crucial step forward to seek out the best you can.  The more complex your situation (e.g. possible advanced disease or repeat surgery) the more you need an excision surgeon with master surgeon skills.  Ideally you want a specialist who is not only a surgeon but also capable of guiding you through any additional treatment options you may need, mainstream and holistic.  While a master excision surgeon and integrative endo specialist is hard to come by, many have a team that can fulfill your needs.

References:

Endometriosis: Etiology, pathobiology, and therapeutic prospects

Brassica Bioactives Could Ameliorate the Chronic Inflammatory Condition of Endometriosis

Diet and risk of  endometriosis in a population-based case–control study

Emerging Drug Targets for  Endometriosis

The effect of dietary interventions on pain and quality of life in women diagnosed with  endometriosis: a prospective study with control group

Updated Post: July 09, 2024

12 months ago Endometriosis , Endometriosis Education No comment

Can Endometriosis Grow Inside the Bladder

Endometriosis, a medical condition that affects many women worldwide, is often associated with the reproductive system. However, this disorder can manifest in other regions of the body, leading to a pertinent question.

Table of contents

• Can Endometriosis Grow Inside the Bladder?
• Understanding Endometriosis
• Bladder Endometriosis: An Overview
• Recognizing the Symptoms of Bladder Endometriosis
• Identifying the Root Causes of Bladder Endometriosis
• Diagnosing Bladder Endometriosis
• Bladder Endometriosis Treatment Options
  • Medication
  • Surgery
• Complications and Prognosis
• Final Thoughts

Can Endometriosis Grow Inside the Bladder?

Yes, endometriosis can indeed grow inside the bladder, although this is less common than other locations. This condition, known as bladder endometriosis, affects approximately 1-2% of women with endometriosis.

In this article, we will explore the nature of endometriosis, its ability to affect the bladder, the related symptoms, causes, diagnosis, and available treatment options.

Understanding Endometriosis

Endometriosis is a gynecological condition where cells similar to the ones lining the uterus, known as endometrial-like cells, grow outside of the womb. These cells can attach themselves to various organs such as the ovaries, fallopian tubes, and in rare instances, the bladder. This phenomenon is known as bladder endometriosis.

Bladder Endometriosis: An Overview

Bladder endometriosis is a specific form of endometriosis where endometrial-like cells grow inside or on the surface of the bladder. These cells respond similarly to hormones as the cells within the womb, causing them to build up, break down, and bleed. However, being outside of the uterus, these cells have no way of exiting the body, leading to inflammation, pain, and scar tissue.

Bladder endometriosis is considered a rare form of the disorder, affecting only about 1 to 2% of patients with endometriosis. However, for those suffering from deep endometriosis (DE), a severe form of the condition, the prevalence increases to nearly 50%.

There are two types of bladder endometriosis:

• Superficial Endometriosis: Endometrial-like cells are found on the outer surface of the bladder.
• Deep Endometriosis: Endometrial-like cells infiltrate the bladder lining or wall. This infiltration can cause a nodule, potentially affecting the ureter.

Recognizing the Symptoms of Bladder Endometriosis

The symptoms of bladder endometriosis can vary, often aligning with the menstrual cycle and intensifying during or just before a period. However, many women may remain asymptomatic until the disease has progressed significantly.

Common symptoms of bladder endometriosis include:

• Bladder irritation
• Urgency to urinate
• Pain when the bladder is full
• Occasional presence of blood in the urine during menstruation
• In some cases, pain in the area of the kidneys

Identifying the Root Causes of Bladder Endometriosis

The exact cause of bladder endometriosis remains unknown. However, several theories have been proposed, including:

• Early Cell Transformation: Cells leftover from embryonic development may transform into endometrial-like cells.
• Surgery: Endometrial cells may spread to the bladder during pelvic surgeries, like a cesarean delivery or hysterectomy.
• Hematogenous/Lymphatic Spread: Endometrial-like cells might travel through the blood or lymph system to the bladder.
• Genetic Factors: Endometriosis has been observed to run in families, indicating a possible genetic link.

Diagnosing Bladder Endometriosis

Bladder endometriosis is diagnosed through a comprehensive evaluation involving a physical examination, medical history, and various diagnostic tests. These tests may include:

• Vaginal examination
• Ultrasound
• Urine sample analysis
• Cystoscopy and Laparoscopy
• CT and/or MRI scan

Bladder Endometriosis Treatment Options

The primary aim of bladder endometriosis treatment is to control symptoms and inhibit the growth of endometrial-like cells. Treatment options include:

Medication

Hormone therapy can slow the growth of endometrial-like cells, relieve pain, and help preserve fertility.

Surgery

Surgery is typically required for bladder endometriosis. The surgical options can vary depending on the severity and area affected. The areas affected by endometriosis can be excised to remove them.

Complications and Prognosis

If left untreated, bladder endometriosis could lead to kidney damage. However, surgery can prevent this complication. The condition doesn’t directly affect fertility, but if endometriosis is present in other parts of the reproductive system, conceiving might be challenging.

Endometriosis, including its bladder variant, is a chronic condition that can impact daily life. Yet, it can be effectively managed with proper treatment and a supportive healthcare team.

Final Thoughts

So, to answer the question, Can endometriosis grow inside the bladder? — yes, it can. However, through increased awareness, early diagnosis, and effective treatment strategies, bladder endometriosis can be managed, improving the quality of life for those affected.

References:

https://www.endometriosis-uk.org/endometriosis-and-bladder

Bladder Endometriosis symptoms

Endometriosis Symptoms And Treatments

https://www.healthline.com/health/womens-health/bladder-endometriosis

https://consultqd.clevelandclinic.org/urinary-tract-endometriosis-has-serious-health-implications/

12 months ago Endometrioma , Endometriosis , Endometriosis Education No comment

Do Endometriomas Automatically Make You Stage 4?

Endometriosis, a complex and often painful condition, is characterized by the growth of endometrial-like tissue outside the uterus. This tissue, which differs molecularly and in behavior from the lining of the uterus, can cause severe discomfort and various health complications. One such complication is the formation of endometriomas, sometimes referred to as “chocolate cysts”, which predominantly affect the ovaries. They’re named for their dark, chocolate-like appearance, resulting from the accumulation of old blood within the cyst.

But does the presence of endometriomas automatically classify a patient as having stage 4 (also designated Stage IV) endometriosis? This primer delves into the stages of endometriosis, the nature of endometriomas, and the relationship between the two.

Table of contents

• Understanding Endometriosis and Its Stages
  • Stage I: Minimal Endometriosis
  • Stage II: Mild Endometriosis
  • Stage III: Moderate Endometriosis
  • Stage IV: Severe Endometriosis
• The Nature of Endometriomas
• Endometriomas and Stage 4 Endometriosis: The Connection
• Treatment Options for Stage 4 Endometriosis and Endometriomas

Understanding Endometriosis and Its Stages

Endometriosis is categorized into four stages according to the American Society of Reproductive Medicine (ASRM), with each stage reflecting the location, extent, and superficial vs deep endometriosis implants, presence and severity of adhesions, and the presence and size of ovarian endometriomas.  The current revised ASRM system (rASRM) was adopted in 1996 and remains the most common staging system.  Unfortunately, there is a lot of inter-observer variation, so reproducibility of the score is poor.  It also is limited because it mixes visual staging and actual biopsy proven staging.  So, one surgeon might call it one stage and another surgeon may arrive at a different stage.  In addition, rASRM stages do not correlate well with degree of pain and does not fully consider presence and location of deeply infiltrating endometriosis (DIE).  

For all of the above reasons, other staging systems have been introduced.  The ENZIAN system, which more robustly considers the location and depth of DIE, was intended to supplement the rASRM system but due to numerous misunderstandings it is not widely used.  The endometriosis fertility index (EFI) focused mainly on predicting pregnancy rates. The American Association of Gynecological Laparoscopists (AAGL) proposed a comprehensive system to try to address pain, infertility/subfertility, and surgical excision difficulty. However, it was only recently published in 2021, continues to have limitations of not addressing upper abdominal and extra-abdominal disease, and is not yet widely accepted.

So, we are left with the rASRM system in terms of best communicating surgical outcomes, treatment planning and comparing results.  The Stages are based on a numerical score and are as follows:

Stage I: Minimal Endometriosis

In stage I, there are only a few small clumps of endometriosis tissue, also known as implants. These may be found in the tissue lining the abdomen or pelvis. 

Stage II: Mild Endometriosis

In stage II, there are more implants than in stage I, which may be either superficial or deep, with mild adhesions. Stage II is typically characterized by more extensive endometriosis with deep implants present.

Stage III: Moderate Endometriosis

In stage III, deep implants of endometriosis tissue are present. Adhesions may be dense rather than filmy and thin. As a result, endometriosis at this stage is more widespread than in stage II.

Stage IV: Severe Endometriosis

Stage IV, or severe endometriosis, is typically associated with numerous deep endometriosis plaques, large endometriotic cysts on one or both ovaries and many dense adhesions. There is usually also extensive scar tissue in the abdomen and signs of intense inflammation and scarring or fibrosis.

Read More: Can Endometriosis Cause Bowel Issues?

The Nature of Endometriomas

Endometriomas are endometriosis cysts that primarily affect the ovaries. Endometriomas can occur on one ovary or both and affect between 20-40% of patients with endometriosis, many of whom also have stage III-IV disease. The origin of endometriomas is incompletely known, just like endometriosis in general, but likely multifactorial in principle. 

Endometriomas and Stage 4 Endometriosis: The Connection

The question is, “Do endometriomas automatically make you stage 4?” The answer is not straightforward. The presence of ovarian endometriosis or an endometrioma of course contributes to the staging of endometriosis. Each ovary can contribute between 1 and 20 points, varying based on tiny implants to endometriomas greater than three centimeters in size.   However, the presence of endometriomas alone does not automatically classify a patient as having stage 4 endometriosis, which requires 40 or more points.  In addition to ovarian endometrioma,  presence or absence of surrounding adhesions also contributes to the point total. Also, larger endometriomas are often associated with extensive deep pelvic disease.  So, in general, small endometriomas may not mean Stage 4.  But larger ones are quite likely to mean Stage 4 disease is present.  

Read More: What Does Bowel Endometriosis Feel Like? Understanding the Pain and Symptoms

Treatment Options for Stage 4 Endometriosis and Endometriomas

The treatment of stage 4 endometriosis and endometriomas is complex and highly individualized. It depends on various factors, including the patient’s symptoms, age, desire for pregnancy, and overall health.

Treatment options for stage 4 endometriosis can include a combination of hormonal therapy, pain management, and surgery. While hormonal therapy may help control pain it is highly unlikely to shrink endometriomas, let alone resolve them, or effectively treat endometriosis.  This is due to the relative resistance of endometriosis to progesterone and progestins and incomplete dependence on estrogen.  There are major potential health risks and this should be part of the discussion with your chosen endometriosis specialist.  Pain management strategies include over-the-counter and prescription medications, as well as physical modalities like pelvic floor therapy and transcutaneous electrical nerve stimulation (TENS) units.  While this can help manage chronic pain associated with the condition this does not treat the root cause, which is endometriosis and resulting fibrosis.

Minimally invasive surgery under the care of an extremely well trained surgeon is the cornerstone of advanced endometriosis treatment.   This is not surgery that should be undertaken by novices or most general gynecologists.  The reason is mainly due to the fact that anatomy can be severely distorted, making surgery very challenging in terms of achieving excision while limiting complications which can be life threatening or at least very morbid. 

Specifically regarding endometriomas, endometriomas require excision, not drainage.  Draining is very ineffective and the endometrioma can soon recur.  Ideally, any surgical spillage should be minimized because it is not just old blood but also potentially endo-related stromal stem cells, which can implant and grow elsewhere.  Overall, the planning and timing of surgery varies significantly.  Often decisions have to be made based on whether or not fertility is the main concern or pain, or both in equal degrees.  Surgical planning is complex and requires a master surgeon for optimal outcomes.  Especially for the management of Stage 4 endometriosis and endometriomas a highly trained and skilled endometriosis specialist and surgeon is mandatory for your success. 

Read More: Life After Endometriosis Surgery: A Comprehensive Guide

References:

Risk factors for coexisting deep endometriosis for patients with recurrent ovarian endometrioma

Diagnosis and management of endometriosis

12 months ago Endometriosis , Endometriosis Education , Endometriosis Fertility No comment

Endometriosis-Related Infertility – Minimal Causes

Endometriosis, a common gynecological condition, has been frequently associated with infertility. However, the question remains: can minimal endometriosis cause infertility? This comprehensive article aims to delve into the connection between endometriosis, particularly in its minimal stage, and fertility issues.

Table of contents

• Defining Endometriosis
  • Stages of Endometriosis
• The Connection Between Endometriosis and Infertility
• Exploring the Question: Can Minimal Endometriosis Cause Infertility?
• Diagnosing Endometriosis
• Evaluating Fertility
• Treatment Options for Endometriosis-Related Infertility
  • Surgical Treatment
  • Medical Treatment
  • Assisted Reproductive Technology (ART)
• Conclusion: Can Minimal Endometriosis Cause Infertility?

Defining Endometriosis

Endometriosis is a medical condition characterized by the growth of endometrium-like tissues outside the uterus. These tissues can adhere to various pelvic structures like the ovaries, fallopian tubes, and even the intestines and bladder, causing irritation, inflammation, and scar tissue formation.

Stages of Endometriosis

Endometriosis is categorized into four stages:

• Stage I (Minimal): Small endometriotic implants with no scar tissue.
• Stage II (Mild): More extensive implants, involving less than 2 inches of the abdomen, without scar tissue.
• Stage III (Moderate): Severe endometriosis with deep implants and possible formation of endometriotic cysts or ‘chocolate cysts’ in the ovaries.
• Stage IV (Severe): Numerous endometriotic implants, possibly large endometriotic cysts in the ovaries, and scar tissue formation around the reproductive organs.

Read More: Understanding How Endometriosis Can Cause

The Connection Between Endometriosis and Infertility

It’s estimated that 30% to 50% of women with endometriosis may experience infertility. Even in cases of minimal or mild endometriosis, the disease may still impact fertility in numerous ways, including:

• Distorted pelvic anatomy due to scar tissue and adhesions
• Inflammatory response causing a hostile environment for eggs, sperm, and embryos
• Altered immune system functionality
• Changes in the hormonal environment affecting egg quality and embryo implantation

However, it’s essential to note that endometriosis does not necessarily equate to infertility. Many women with endometriosis, even in severe stages, can conceive naturally or with fertility treatments.

Exploring the Question: Can Minimal Endometriosis Cause Infertility?

The impact of minimal endometriosis on fertility is a contentious subject. The disease, even at its earliest stage, can cause inflammation and subtle changes in the pelvic environment, potentially affecting fertility. However, many women with minimal endometriosis conceive without issues, leading some researchers to suspect that other factors, possibly genetic or immunological, might be at play in cases of endometriosis-associated infertility.

Diagnosing Endometriosis

Diagnosing endometriosis can be challenging, as many women with infertility migh experience no symptoms. The gold standard for diagnosis is a surgical procedure known as laparoscopy, allowing the doctor to visually inspect the pelvic organs for endometriotic lesions and scar tissue, and take samples for histopathology.

Read More: Life After Endometriosis Surgery: A Comprehensive Guide

Evaluating Fertility

Before initiating any fertility treatment, a comprehensive fertility evaluation is recommended. This includes hormonal and blood tests, an assessment of ovarian reserve, a sperm analysis for the male partner, and possibly a laparoscopy to confirm the presence and extent of endometriosis.

Read More: Pelvic Floor Physical Therapy: What you Need to Know

Treatment Options for Endometriosis-Related Infertility

The treatment approach for endometriosis-related infertility is multifaceted, depending on the stage of endometriosis, the woman’s age, and the presence of other fertility factors.

Surgical Treatment

For women with Stage I or II endometriosis, surgical removal of endometriotic tissue may improve pregnancy rates. However, for women aged 35 or older, other fertility treatments might be recommended in addition to surgery.

Medical Treatment

Medical treatments aim to suppress endometriosis growth by reducing estrogen levels. However, these treatments, including hormonal contraceptives and Gonadotropin-Releasing Hormone (GnRH) agonists, prevent pregnancy during use.

Assisted Reproductive Technology (ART)

In cases where pregnancy does not occur naturally or following surgery, ART methods such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF) may be recommended. The success rates of these treatments vary depending on the woman’s age, ovarian reserve, and specific fertility issues.

Conclusion: Can Minimal Endometriosis Cause Infertility?

While minimal endometriosis can potentially affect fertility, it does not guarantee infertility. A comprehensive evaluation and personalized treatment plan can help women with endometriosis, even at minimal stages, to conceive successfully. However, further research is needed to fully understand the complex relationship between endometriosis and fertility.

References:

https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/endometriosis/endometriosis-and-fertility

https://www.uptodate.com/contents/endometriosis-treatment-of-infertility-in-females

https://www.tommys.org/pregnancy-information/planning-a-pregnancy/fertility-and-causes-of-infertility/how-does-endometriosis-affect-fertility

https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/endometriosis-does-it-cause-infertility/

12 months ago Endometriosis , Endometriosis Education No comment

Diaphragmatic Endometriosis: An In-Depth Analysis

Diaphragmatic endometriosis is a chronic health condition that manifests when tissues akin to the endometrial lining start to grow outside the uterus. This exogenous growth of endometrial-like tissue can be found in various areas such as the ovaries, fallopian tubes, and bladder. However, endometriosis can also occur in less common areas like the diaphragm, organs in the upper abdomen, like the stomach, in the retroperitoneum like the lymph nodes and kidneys, and so on.  Of these uncommon findings, finding some amount of endo on the diaphragm is perhaps most common. 

Table of contents

• Understanding the Diaphragm
• What is Diaphragmatic Endometriosis ?
• Symptoms of Diaphragmatic Endometriosis
• Causes of Diaphragmatic Endometriosis
• Diagnosis of Diaphragmatic Endometriosis
• Treatment of Diaphragmatic Endometriosis
  • Complications of Diaphragmatic Endometriosis
• Conclusion
• References

Understanding the Diaphragm

The diaphragm is a large, dome-shaped muscle located beneath the lungs, responsible for the crucial function of respiration. Acting as a separation between the abdominal and thoracic (chest) cavities, its involuntary contraction and relaxation facilitate the breathing process. The diaphragm also has openings that allow important structures such as the esophagus and major blood vessels to pass through.

What is Diaphragmatic Endometriosis?

In most cases, diaphragmatic endometriosis affects the right side of the diaphragm. The endometrium-like tissue that builds up on the peritoneal surface of the diaphragm reacts to the menstrual cycle’s hormones in the same way it does in the uterus, which can cause a range of symptoms in the affected individuals.

Read More: Understanding How Endometriosis Can Cause

Symptoms of Diaphragmatic Endometriosis

The most common symptoms of diaphragmatic endometriosis include pain in the chest, upper abdomen, right shoulder, and arm. This pain typically occurs around the time of your period and may get worse when you take deep breaths or cough. In rare cases, if it grows through the diaphragm and involves the lungs, it can lead to a collapsed lung.  This is known as catamenial pneumothorax. However, diaphragmatic endometriosis can often be asymptomatic while only small superficial implants are present.  Hence, surgery usually involves at least looking at the diaphragms to document if there are any endo implants even if there are no symptoms in that area. 

Causes of Diaphragmatic Endometriosis

The exact causes of diaphragmatic or other types of endometriosis remain unknown.  However, it is plausible that endo cells from the pelvis can travel throughout the abdomen and up into the diaphragm. What makes them implant and grow there is unknown.  Alternatively, there are other possible etiologies, such as lymphatic or blood stream spread to this area or direct transformation of stem cells or growth of embryologic remnants into endometriosis implants.  This is all likely facilitated or repressed by genetic and genomic molecular signalling that is only now coming to be appreciated and unraveled.  

Read More: What Does Bowel Endometriosis Feel Like? Understanding the Pain and Symptoms

Diagnosis of Diaphragmatic Endometriosis

Diagnosing diaphragmatic endometriosis can be challenging. Diagnosis often involves a combination of medical history, physical examination, and imaging tests such as a CT (computed tomography) scan or MRI (magnetic resonance imaging).

The most reliable way to diagnose diaphragmatic endometriosis is via minimally invasive laparoscopic or robotic surgery. Ideally, the surgeon who is excising endo in the pelvis can also remove diaphragmatic implants or have a surgeon available as part of the team, who can do so. In the much rarer event that endo is suspected to be inside the chest and/or growing on or in the lungs, a thoracic surgeon should be consulted.

Treatment of Diaphragmatic Endometriosis

Surgery is the main treatment for diaphragmatic endometriosis and this can usually be accomplished using minimally invasive laparoscopic or robotic surgery.  Again, the excision surgeon or surgical team should be capable of removing endo from the diaphragms.  

In some cases, endo is not suspected to be growing on the diaphragm.  In that case, if the surgery cannot be safely accomplished by the surgeon or surgeons on the team, it is best to back out and not cause more harm than good.  The diaphragm is very thin and it is rather easy to enter the chest as part of the excision.  In expert hands, that is not a problem. However, going one step beyond diaphragmatic endo, if it is unclear whether or not the endo may be crossing into the chest cavity it is best to back out, re-evaluate with proper imaging and consultation and perform the surgery with a thoracic surgeon at a later date.  

Complications of Diaphragmatic Endometriosis

In relatively rare cases, endometriosis of the diaphragm can lead to defects or holes forming in the diaphragm. Endo can then grow into the chest cavity and possibly involve the lungs. This can lead to life-threatening complications such as a collapsed lung during your period (catamenial pneumothorax) or significant bleeding into the chest, also compressing the lung.  

Read More: Can Endometriosis on Ureter Cause Kidney Shooting Back Pain?

Conclusion

In conclusion, while it is relatively uncommon, endometriosis can indeed spread to your diaphragm. Under more rare circumstances it can even grow into the chest and lungs.  Expert endometriosis consultation and care is always prudent.  But if you are experiencing upper abdominal or chest symptoms as discussed this this article, it become crucial.  

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018178/

12 months ago Endometriosis , Endometriosis Education No comment

Can Ureteral Endometriosis Cause Kidney Shooting Back Pain?

Endometriosis is a common gynecological condition that affects many women during their reproductive years. While it typically manifests in the pelvic region, in some instances, it may invade other organs, including the urinary system. This article explores the question: Can endometriosis on the ureter cause kidney shooting back pain?

Table of contents

• About Endometriosis
• Understanding Ureteral Endometriosis
• The Kidney-Endometriosis Connection
• Symptoms of Kidney Endometriosis
• Diagnosis of Ureteral Endometriosis
• Treatment Options
• The Silent Threat of Kidney Failure
• Impact on Kidney Health
• Conclusion

About Endometriosis

Endometriosis is a chronic disease characterized by the presence of endometrial-like tissue outside the womb. This could include the ovaries, fallopian tubes, and the lining of the pelvic cavity. In some extreme cases, endometrial tissue may also affect organs outside the pelvic cavity, such as the bladder, bowel, or kidneys.

Read More: Understanding Endometriosis: Unveiling the Common Symptoms and Their Impact

Understanding Ureteral Endometriosis

Ureteral endometriosis is an uncommon manifestation of the disease, accounting for about 1% of all endometriosis cases. It involves the ureters, the tubes that transport urine from the kidneys to the bladder. This condition can lead to urinary tract obstruction, resulting in hydronephrosis, which is the swelling of a kidney due to a build-up of urine.

The Kidney-Endometriosis Connection

The kidneys can be impacted when one or both of the ureters become affected by endometriosis. The section of the ureter that is usually affected sits below the pelvic area.

Symptoms of Kidney Endometriosis

Kidney endometriosis can be asymptomatic for several years. If a person who has undergone surgery to treat endometriosis has ongoing urinary problems such as pain and infections, it may suggest the presence of urinary tract or kidney endometriosis. Symptoms may include:

• Pain in the lower back that gets worse with a monthly menstrual cycle. That pain can also extend down through the legs.
• Blood in the urine that can co-occur with the menstrual cycle
• Difficulty urinating
• Recurrent urinary tract infections

Read More: Understanding How Endometriosis Can Cause

Diagnosis of Ureteral Endometriosis

The diagnosis of ureteral endometriosis relies heavily on clinical suspicion. As a result, they often misdiagnose patients with kidney cancer. This can lead to patients not receiving treatment on time, or receiving the wrong kind of treatment.

Read More: Life After Endometriosis Surgery: A Comprehensive Guide

Treatment Options

Kidney endometriosis can lead to kidney damage and even kidney failure if left untreated. However, the best approach is to treat the condition by removing endometriosis lesions with minimally invasive laparoscopic surgery.

The Silent Threat of Kidney Failure

One of the most concerning aspects of ureteral endometriosis is the silent threat of kidney failure. It is estimated that as many as 25% to 50% of nephrons are lost when there is evidence of ureteral endometriosis, and 30% of patients will have reduced kidney function at the time of diagnosis.

Impact on Kidney Health

The good news is that if one kidney isn’t functioning due to endometriosis, you can survive on the other kidney. So, if you find out you only have one fully-functioning kidney, it’s essential to take care of it.

Conclusion

In conclusion, while endometriosis is typically a pelvic condition, it can venture beyond and affect the urinary system, including the kidneys. This can lead to severe complications, including kidney failure. Therefore, it’s crucial for women with endometriosis to be aware of the potential symptoms and seek medical advice if they experience any signs of kidney problems. The early detection and treatment of ureteral endometriosis are crucial to preserving kidney function and overall health.

References:

https://drseckin.com/kidney-endometriosis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535807/

Endometriosis: Perilous impact on kidneys

https://endometriosis.net/clinical/silent-kidney-failure

12 months ago CEO Message , Chronic Care , Endometriosis , Endometriosis Education , Integrated Care No comment

iCareBetter Launches Center For Endometriosis Long-Term Care

Table Of Contents

iCareBetter Launches Center For Endometriosis Long-Term Care

“

Based on patients’ needs and considering the lack of appropriate endometriosis care, iCareBetter launches Endometriosis Centers for long-term care. The centers’ focus will be long-term endometriosis care before and after excision surgery. We will collaborate closely with excision surgeons, physical therapists, and other providers on iCareBetter to offer long-term multidisciplinary care to endometriosis patients. We believe that excision surgery is the gold standard of treatment for endometriosis, and we also believe that patients need an ongoing care plan and monitoring after excision surgery, even if the best surgeons in the world do it.

”

This is Dr. Saeid Gholami, the founder of iCareBetter. I have an important announcement to make today. But first, let me take you on a journey with me through the last three and a half years. 

Phase I – It Starts with Surgery

In my exposure to endometriosis patients as a medical student and then as a primary care doctor, I have always tried to find a solution to identify trusted resources for patients. A few years ago, right at the beginning of the pandemic, while the world was going upside down, I started working with a team of the best endometriosis surgeons and advocates to create a vetting system to find and introduce skilled excision surgeons. The vetting was based on a New England Journal of Medicine article and assessed surgical videos in a double-blind process.

This vetting made some people uncomfortable. However, the vetting confirmed the skills of the best surgeons in the world and introduced some new excision surgeons with a limited chance to prove themselves in a space where everyone claimed expertise without proof. This led to a transparent process that let patients make informed decisions about their excision surgeons. This innovation put us on the map and made us a significant platform in the endometriosis world. 

Phase II – Add Multiple Disciplines

After successfully launching video vetting for surgeons, we sought other opportunities to support endo patients. Our conversations with patients taught us that the community needs vetted physical therapists (PT) who understand endometriosis and its complex care requirements. Therefore, we introduced the iCareBetter Physical Therapy vetting and built a network of PTs. Our list of PTs kept growing, and after two years, many advocates and patients are using it daily and promoting the importance of physical therapy for endometriosis patients. The PT directory has been very helpful for patients, and we have over 120 physical therapists in almost all the US states. And thousands of patients have used iCareBetter to find a PT to help with their endometriosis.

Similarly, we added urologists, dietitians, and pain specialists so patients can use iCareBetter for most of their endo-related issues.

Phase III – Artificial Intelligence for Endometriosis

Right after the launch of Chat-GPT and the excitement around artificial intelligence (AI), we launched an AI-powered chat tool called endometriosis.AI. This created massive excitement, and many patients started using it. As a result, we ran out of server capacity within three days after launch and had to shut it down to avoid going into debt for server costs. As I am speaking with you, thousands of patients have used it and keep using it to acquire information about endometriosis. With the launch of endometriosis.ai, we made endometriosis the first disease community to have its specialized AI discussion. This was in sharp contrast with the history of endometriosis, which is always among the last diseases to be considered in other situations, such as surgical tools, medications, and others.

Moreover, we have published hundreds of articles and interviews to create an education hub for endometriosis.

We currently have over 200 providers in our network, and 30,000 patients use our services each month.

I am incredibly proud of what we have achieved.

 

Phase VI – Begins iCareBetter Centers for Long-Term Care.

One question that patients commonly asked us was, “Where can I go before surgery or after surgery for long-term care?” 

We searched the medical community for the right centers to help with this long-term care. Our non-negotiable criteria were simple: These centers should not dismiss patients and avoid putting endo patients on hormones as “the cure for endo.” 

To my frustration and shock, no center expressed interest in seeing more endometriosis patients. We even purchased the emails of ten thousand OBGYNs in the US and invited them to join our network and support endo patients. Not even one ObGyn responded positively to the invite to see more endometriosis patients. Except for our excision surgeons, no one wanted to deal with endometriosis patients in their practice. It was a heartbreaking realization for all of us.

From a patient’s perspective, they need a care team that is in their corner and does not get tired of them after four or five visits because the pain is still there. A team that sits and thinks with the patient and tries to problem-solve with the patients as a team member. This team should map out the options, what has been tried, and what is left to be tested. A team that patients can go to four weeks, four months, or four years after surgery to complain that the pain is back.” This team, instead, thoroughly evaluates patients for other pain generators or a recurrence of endometriosis. A care team that believes in patients and helps them connect with the right specialist for their gastrointestinal, urinary, neurological, and other symptoms. 

We tried several solutions to create this care team with other centers and groups, but there was a complete lack of interest and empathy, as it has always been with endometriosis. Therefore, we decided to build these centers ourselves. With that, I am proud to announce that we are launching the first iCareBetter Endometriosis Center in sunny California. It will be at 6621 Bay Laurel Place, Suite A, Avila Beach, CA 93424. We plan to open the next centers in CA and other states.

The centers’ focus will be long-term endometriosis care, so we will collaborate closely with excision surgeons, physical therapists, and other providers on iCareBetter to offer long-term multidisciplinary care to endometriosis patients. We believe that excision surgery is the gold standard of treatment for endometriosis, and we also believe that patients need an ongoing care plan and monitoring after excision surgery, even if the best surgeons in the world do it. iCareBetter centers will be the long-term care center for patients before and after excision surgery.

Our first center in Central California will be ready to see patients on February 20th, and we will offer in-person and virtual services. The next ones are being prepared, and we will announce their launch soon. If you want to ensure you secure your place before we run out of space, join the waitlist by filling out the form below. Also, if you want to be among the first ones to know about iCareBetter centers when we come to your area, please use the link below to add your name to the waitlist.

 

Join the Clinic

1 year ago Endometriosis , Endometriosis Education No comment

Understanding the Pain and Symptoms of Bowel Endometriosis

Endometriosis is a condition affecting roughly 11% of women worldwide, predominantly those of reproductive age. An even more specific form of this ailment is bowel endometriosis, which impacts around 5% to 12% of those diagnosed with endometriosis. In this comprehensive guide, we delve into the intricacies of bowel endometriosis, exploring what it feels like, the symptoms, causes, diagnosis, and treatment options.

Table of contents

• What is Bowel Endometriosis?
• Where Does Bowel Endometriosis Occur?
• Symptoms of Bowel Endometriosis
  • Common Symptoms
  • Non-Bowel Symptoms
• Causes of Bowel Endometriosis
• Diagnosis of Bowel Endometriosis
  • Misdiagnosis
  • The Role of Minimally Invasive Surgery
• Treatment of Bowel Endometriosis
  • Surgical Treatment
  • Lifestyle Changes
• Coping with Bowel Endometriosis

What is Bowel Endometriosis?

Bowel endometriosis occurs when endometrial-like tissue, which typically grows inside the uterus, begins to develop on or inside the bowel walls. This can lead to a range of gastrointestinal symptoms, often causing significant discomfort and negatively impacting the quality of life.

Read More: Understanding Bowel Endometriosis

Where Does Bowel Endometriosis Occur?

The condition predominantly affects the rectum and sigmoid colon, with approximately 90% of bowel endometriosis cases directly involving these regions. However, the appendix, small intestine, stomach, and other parts of the large intestine can also be affected.  In many cases, bowel symptoms occur because of the mere presence of intensely inflammatory endo lesions on the peritoneum in the pelvis and abdomen and not even involving the bowel directly with implants. 

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis often mimic common gastrointestinal disorders, including small intestinal bacterial overgrowth (SIBO), making it difficult to diagnose. They can range from mild to severe, and often fluctuate depending on the menstrual cycle. 

Common Symptoms

Common symptoms may include:

• Abdominal pain, particularly in the lower quadrants
• Bloating, often referred to as “endo belly”
• Changes in bowel movements, including constipation or diarrhea
• Nausea and vomiting
• Pain during bowel movements, which might increase during menstruation
• Rectal bleeding

Non-Bowel Symptoms

In addition to bowel symptoms, individuals with endometriosis might experience:

• Chronic pelvic pain
• Difficulties with fertility
• Painful sexual intercourse
• Pain during urination
• Pelvic heaviness
• Fatigue
• Impaired psychological well-being

Causes of Bowel Endometriosis

The exact cause of bowel endometriosis remains unknown. However, Mullerianosis of embryogenic origin and retrograde menstruation are two often-quoted theories. Mullerianosis of embryogenic origin suggests that developmental abnormalities lead to cells being present in atypical locations which later turn into endometriosis.  This includes potential genetic, genomic and immunologic influencing factors.  Retrograde menstruation proposes that period blood flows upward towards the Fallopian tubes and into the pelvis instead of out through the vagina, potentially leading to endometriosis. Given that most women experience retrograde menstruation, and only 10% or so experience endometriosis, this theory is antiquated and has been challenged because of this disconnect.  Far more likely, some combination of embryologic, molecular, immunologic and genetic factors are in play and this can vary between individuals.  

Read More: Can Endometriosis Cause Bowel Issues?

Diagnosis of Bowel Endometriosis

Diagnosing bowel endometriosis is a complex process. It often requires a combination of a good evaluation of symptoms history, physical examination, imaging techniques like ultrasound or MRI, and sometimes minimally invasive laparoscopic or robotic surgery. However, diagnosis could be delayed due to its symptom similarity with other gastrointestinal diseases.  Imaging can only help with diagnosis and potential mapping for surgery.  It is absolutely not reliable enough to exclude the diagnosis of endo. 

Misdiagnosis

Misdiagnosis is common in bowel endometriosis, with many patients being misdiagnosed with irritable bowel syndrome (IBS) or other gastrointestinal disorders. Therefore, a high index of suspicion is necessary for diagnosis, and any bowel symptoms correlated with the menstrual cycle should be critically evaluated.

The Role of Minimally Invasive Surgery

Surgery with biopsy is considered the “gold standard” in diagnosing endometriosis, including bowel endometriosis. It provides a more accurate diagnosis and gives healthcare providers an exact idea of how much scar tissue and endometrial-like tissue they’re dealing with. Ideally, the surgeon should be prepared to perform a therapeutic surgery at the same time as a diagnosis.  However, a bad surgery is worse than no surgery if the surgeon is unprepared and performs some variation of fulguration (burning) of endometriosis lesions as opposed to proper excision of the lesions or implants.  If diagnostic surgery uncovers a situation where the surgeon is unprepared to properly perform therapeutic excision it is better to back out and refer to an appropriate surgeon. 

Treatment of Bowel Endometriosis

Treatment for bowel endometriosis often involves surgery, as medical management has generally been deemed ineffective for these specific lesions. The chosen surgical method depends on the extent of the condition. In many cases, hormonal options may also be recommended after surgery to reduce recurrence risk.  The better the surgery the less likely this would be required but there are exceptions.   

Surgical Treatment

The surgical treatment of endo usually involves removing all of the peritoneal lesions by an excisional technique. In deeply infiltrating endometriosis, the approach may vary based on the involvement of the rectal wall or the mesentery, which is where the blood vessels to the rectum are located. The treatments for bowel endometriosis include shaving, nodulectomy, disc resection, and bowel resection.  The surgeon should be capable of performing any of these procedures as needed at the time.  In some cases this may be the main excision surgeon, if they have bowel surgery training and hospital prvileges, and in other cases, this may be another surgeon who is part of the backup team.   In the latter situation, it is best if the possibility of bowel surgery and options are addressed before surgery and not as an emergency during surgery, when appropriate surgeons may not be readily available.  

Lifestyle Changes

Alongside medical treatment, lifestyle changes can aid in managing bowel endometriosis symptoms. Some patients find that certain foods or lifestyle habits, such as stress or irregular sleep, may trigger their symptoms. Keeping a journal to track triggers and consulting with a healthcare provider or nutritionist when making dietary changes can be beneficial.

Read More: How to Treat Bowel Endometriosis: A Comprehensive Guide

Coping with Bowel Endometriosis

Living with bowel endometriosis can be challenging, but with the right diagnosis, treatment, and management, individuals can lead fulfilling lives. It’s essential to communicate openly with healthcare providers about symptoms and concerns, as this can aid in diagnosis and treatment planning.

In conclusion, bowel endometriosis is a painful and often misunderstood condition. Increased awareness and understanding of the disease can help in early diagnosis, effective treatment, and improved quality of life for those affected. If you suspect you might have bowel endometriosis or are experiencing any of the symptoms mentioned, do not hesitate to seek medical advice.

References:

Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis

1 year ago Endometriosis , Endometriosis Education No comment

How to Treat Bowel Endometriosis: A Comprehensive Guide

Bowel endometriosis, a complex and severe variant of endometriosis, is a condition best navigated with a deep understanding of its details. This guide aims to shed light on the various aspects of bowel endometriosis, from its origins to symptoms, diagnostic approaches, and treatment options, to empower those affected.

Table of contents

• What is Bowel Endometriosis?
• How Common is Bowel Endometriosis?
• Recognizing the Symptoms
• Diagnosing Bowel Endometriosis
• Treating Bowel Endometriosis: An Overview
• Surgical Treatment Options
• Understanding the Risks of Surgery
• Hormone Treatment Options
• Managing Symptoms and Quality of Life
• Conclusion

What is Bowel Endometriosis?

Endometriosis, a chronic health disorder predominantly affecting women in their reproductive years, is characterized by the growth of endometrial-like tissue, which usually lines the uterus in regions outside the uterus. This misplaced tissue prompts an inflammatory reaction, leading to distressing symptoms. When this aberrant tissue growth takes place on or inside the bowels, the condition is referred to as bowel endometriosis.

How Common is Bowel Endometriosis?

While the exact prevalence of bowel endometriosis remains uncertain, it’s estimated to occur in 5-15% of all endometriosis cases. Predominantly, it manifests on the rectum or sigmoid colon but can also affect the appendix or small intestine.

Read More: https://icarebetter.com/endometriosis-and-inflammatory-bowel-disease-distinguishing-the-differences/

Recognizing the Symptoms

Symptoms of bowel endometriosis may not always be apparent, especially in the early stages of the disease. However, as the condition progresses, women may experience discomfort associated with their menstrual cycle, sexual intercourse, bowel movements, and even infertility.

Symptoms commonly associated with bowel endometriosis include:

• Painful Bowel Movements: This is often accompanied by constipation or diarrhea.
• Rectal Bleeding: This symptom, which is more uncommon, usually occurs during menstruation.
• Infertility: Some women may experience difficulty conceiving.
• Pelvic Pain: Chronic pelvic pain is a common symptom associated with endometriosis, often more severe during menstruation or ovulation.
• Painful Intercourse: This is often due to the endometriosis lesion causing a distortion of the pelvic anatomy.

It’s important to note that bowel endometriosis can sometimes mimic symptoms of other gastrointestinal conditions, like irritable bowel syndrome (IBS), making it challenging to diagnose.

Diagnosing Bowel Endometriosis

A comprehensive diagnosis of bowel endometriosis usually involves a combination of physical examination, medical history analysis, and advanced imaging techniques. The diagnostic process may include:

• Physical Examination: This includes a manual check for growths in the rectum or vagina.
• Imaging Tests: These can include ultrasound, MRI, colonoscopy, and barium enema.
• Laparoscopy: This surgical procedure is considered the gold standard for diagnosing endometriosis, as it allows for visual examination of the uterus, ovaries, and other pelvic structures. And surgeons can take samples for histopathology evaluations.

Read More: Understanding Bowel Endometriosis

Treating Bowel Endometriosis: An Overview

Treatment for bowel endometriosis is complex and multifaceted. It requires a personalized approach, taking into account the severity of the disease, the patient’s age, fertility goals, and personal preferences. The primary treatment options include:

• Hormonal Therapy: This involves medications that control estrogen levels, which can influence the progression of endometriosis. These medications can help manage pain and other symptoms.
• Pain Management: Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help alleviate pain.
• Surgery: Surgical interventions aim to remove as much endometrial tissue as possible while preserving organ function.

Surgical Treatment Options

Surgery is typically the primary treatment for bowel endometriosis, particularly for severe cases. The goal of surgery is to remove endometrial implants without compromising the functionality of the organs involved. There are three main surgical options:

• Segmental Bowel Resection: This involves removing the section of the bowel affected by endometriosis and reconnecting the healthy portions. This option is often recommended for larger areas of endometriosis.
• Rectal Shaving: This procedure involves shaving off the endometriosis from the top of the bowel without removing any portion of the intestines. It’s often used for smaller areas of endometriosis.
• Disc Resection: In this procedure, a surgeon cuts out a small disk where the endometriosis lesions appear and then closes the remaining hole.

Understanding the Risks of Surgery

Surgery for bowel endometriosis is a complex procedure associated with certain risks. These can include short-term complications such as infection, leakage of bowel content during the postoperative healing phase, peritonitis, and septicaemia. Long-term risks might include bowel dysfunction, characterized by frequency, urgency, and incontinence.

Read More: Finding an Excision Specialist: What you Need to Know

Hormone Treatment Options

Although hormonal treatments cannot halt the progression of endometriosis, they can help manage symptoms. Hormonal treatments for bowel endometriosis can include birth control pills, progestin injections, or, less favorably, gonadotropin-releasing hormone (GnRH) agonists.

Read more: What are the long-term side effects of Lupron?

Managing Symptoms and Quality of Life

Bowel endometriosis can significantly impact the quality of life of those affected. However, with appropriate treatment and management strategies, many women affected by this condition can lead fulfilling lives. Communication with your healthcare team, lifestyle modifications, and psychological support can all contribute to improving the quality of life.

Conclusion

Understanding how to treat bowel endometriosis is crucial for managing this complex and often painful condition. With the right approach, it’s possible to mitigate symptoms, improve fertility outcomes, and enhance the quality of life for those affected. If you suspect you have bowel endometriosis, it’s important to speak with a healthcare provider who can guide you through the diagnostic process and treatment options. With the right knowledge and resources, you can navigate this challenging condition and find a path to improved health and well-being.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/

https://weillcornell.org/news/what-is-bowel-endometriosis

https://www.webmd.com/women/endometriosis/bowel-endometriosis

https://www.healthline.com/health/womens-health/bowel-endometriosis

Bowel Endometriosis

1 year ago Bowel Endometriosis , Endometriosis , Endometriosis Education No comment

Can Endometriosis Cause Bowel Issues?

Endometriosis is a common but often under-recognized condition, primarily affecting women between 15-50. It results from the growth of tissue similar to the endometrium (the lining of the uterus) outside the uterus. This article explores the question: Can endometriosis cause bowel issues?

Table of contents

• Understanding Endometriosis
• Endometriosis and Bowel Involvement
• Causes of Endometriosis
• Symptoms of Bowel Endometriosis
• Diagnosing Bowel Endometriosis
• Misdiagnosis of Bowel Endometriosis
• Treatment for Bowel Endometriosis
• Coping with Bowel Endometriosis
• The Importance of Early Detection
• Conclusion
• Additional Information

Understanding Endometriosis

Endometriosis is a condition where tissue, similar to the kind that lines the uterus (the endometrium), grows outside the uterus. This condition usually affects the ovaries, fallopian tubes, and the tissue lining the pelvis. However, in some cases, it can also affect other organs, including the bowel.

Endometriosis and Bowel Involvement

When endometriosis affects the bowels, it typically occurs in two forms:

• Superficial: The endometriosis tissue is located on the surface of the bowel.
• Deep: The endometriosis tissue passes through the bowel wall.

In both cases, doctors usually find a small mass of tissue, known as a lesion, on the bowel wall. More rarely, these lesions can penetrate into the muscular layer of the bowel.

Read More: Endometriosis and Inflammatory Bowel Disease: Distinguishing the Differences

Causes of Endometriosis

While the definitive cause of endometriosis remains unknown, several contributing factors have been identified. These include hormonal imbalances, immune system problems, and genetic factors.

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis can vary, depending on the location and size of the lesion, and how deep it is within the bowel wall. These symptoms often mimic those of irritable bowel syndrome (IBS), but there are key differences.

Some of the common symptoms include:

• Trouble pooping or loose, watery stools (constipation or diarrhea)
• Pain during bowel movements
• Menstrual discomfort
• Painful sex
• Difficulty getting pregnant (infertility)
• Blocked bowel (this is a rare symptom)

Diagnosing Bowel Endometriosis

Diagnosing bowel endometriosis can be challenging due to its similarities with other conditions. However, if you have other endometriosis symptoms, such as painful periods, painful sex, lower back pain, or abdominal bloating and discomfort, it’s critical to talk to your doctor.

Read More: Understanding Bowel Endometriosis

Misdiagnosis of Bowel Endometriosis

Unfortunately, bowel endometriosis is often misdiagnosed as irritable bowel syndrome or other gastrointestinal diseases. This is because the symptoms of bowel endometriosis can mirror those of IBS, Crohn’s disease, and appendicitis.

Read More: Finding an Excision Specialist: What you Need to Know

Treatment for Bowel Endometriosis

Treatment for bowel endometriosis is usually tailored to the patient’s symptoms and medical history. The most common treatments include surgery, hormone treatments, and counseling.

Coping with Bowel Endometriosis

Bowel endometriosis is a challenging condition to live with. It not only affects your physical health but also your mental well-being. Many patients have found some symptom relief through lifestyle changes, including dietary adjustments and regular exercise.

The Importance of Early Detection

Given the potential complications of bowel endometriosis, early detection and treatment are crucial. If you experience bowel issues alongside painful menstruation, it’s essential to consult with a healthcare professional.

Conclusion

The question, “Can endometriosis cause bowel issues?” is undoubtedly answered with a resounding yes. However, with timely detection, appropriate treatment, and necessary lifestyle changes, it’s possible to manage the symptoms and lead a healthy life.

Additional Information

This article is a comprehensive exploration of how endometriosis can impact bowel health. It’s essential to remember that while this condition can cause significant discomfort and health issues, effective treatments are available. If you suspect you have endometriosis, don’t hesitate to reach out to a healthcare provider.

References:

https://www.webmd.com/women/endometriosis/bowel-endometriosis

https://www.endofound.org/gastrointestinal-distress

https://maidenlanemedical.com/endometriosis/endometriosis-and-constipation/

https://drseckin.com/bowel-endometriosis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604671/

1 year ago Endometriosis , Endometriosis Education , Gastrointestinal symptoms No comment

Endometriosis Diet: Low FODMAP, a Comprehensive Guide

Table of contents

• Understanding the Low FODMAP Endometriosis Diet
• What are FODMAPs?
  • Types of FODMAPs
• Exploring the Impacts of FODMAPs
  • High FODMAP Foods and Low FODMAP Alternatives
• Who Should Follow a Low FODMAP Endometriosis Diet?
• The Purpose of a Low FODMAP Endometriosis Diet
• How to Follow a Low FODMAP Diet
• The Effectiveness of Low FODMAP Endometriosis Diet Combined with Other Therapies

‍The Low FODMAP Diet, a revolutionary approach for managing symptoms associated with Irritable Bowel Syndrome (IBS), has gained substantial recognition and popularity in recent years. Developed by researchers at Monash University, this diet has offered hope to many individuals suffering from IBS, a common gastrointestinal disorder that affects the digestive system. So how can it help those with endometriosis? This article will focus on the diet itself, but a relatively recent systematic review of dietary approaches and endometriosis showed that the low FODMAP diet was most helpful in managing symptoms in those with endometriosis that complained of gastrointestinal symptoms and had good follow through in individuals who tried it. 

Understanding the Low FODMAP Endometriosis Diet

FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are certain types of carbohydrates that are either poorly absorbed or not absorbed at all in your intestines and can trigger symptoms in individuals with IBS.

What are FODMAPs?

FODMAPs are naturally occurring sugars found in a wide range of foods and food additives. When consumed, these sugars move slowly through the small intestine, attracting water. As they reach the large intestine, they are fermented by gut bacteria, resulting in gas production. This extra gas and water cause the intestinal wall to stretch and expand, which can cause pain and discomfort, especially in people with IBS.

Types of FODMAPs

Here are the different types of FODMAPs and examples of foods where they can be found:

• Oligosaccharides: These include Fructans and Galacto-Oligosaccharides (GOS) found in foods such as wheat, rye, onions, garlic, and legumes.
• Disaccharides: Lactose is a disaccharide found in dairy products like milk, soft cheeses, and yogurts.
• Monosaccharides: Fructose is an example, found in honey, apples, and high fructose corn syrups.
• Polyols: These include Sorbitol and Mannitol, found in some fruits, vegetables, and used as artificial sweeteners.

Exploring the Impacts of FODMAPs

When FODMAPs are consumed, they move slowly through the small intestine, attracting water. As they reach the large intestine, gut bacteria use these FODMAPs as a fuel source, fermenting them and producing gas. This process is normal but can cause problems in people with IBS due to issues with motility (the speed at which contents move through the intestines) or a highly sensitive gut wall.

FODMAPs are found in a variety of foods, such as fruits, vegetables, bread, cereals, nuts, and legumes. It’s impossible to guess the FODMAP content of a food without careful laboratory analysis. Monash University has developed a mobile phone app, the Monash University FODMAP Diet App, which uses a simple traffic light system to indicate whether foods are low, moderate, or high in FODMAPs.

High FODMAP Foods and Low FODMAP Alternatives

Here’s a table showing some high FODMAP foods and their low FODMAP alternatives:

High FODMAP Foods	Low FODMAP Alternatives
Vegetables: Artichoke, Asparagus, Cauliflower, Garlic, Green Peas, Mushrooms, Onion, Sugar Snap Peas	Aubergine/Eggplant, Beans (Green), Bok Choy, Green Capsicum (Bell Pepper), Carrot, Cucumber, Lettuce, Potato, Zucchini
Fruits: Apples, Apple Juice, Cherries, Dried Fruit, Mango, Nectarines, Peaches, Pears, Plums, Watermelon	Cantaloupe, Kiwi Fruit (Green), Mandarin, Orange, Pineapple
Dairy & alternatives: Cow’s Milk, Custard, Evaporated Milk, Ice Cream, Soy Milk (Made from Whole Soybeans), Sweetened Condensed Milk, Yoghurt	Almond Milk, Brie/Camembert Cheese, Feta Cheese, Hard Cheeses, Lactose-Free Milk, Soy Milk (Made from Soy Protein)
Protein sources: Most Legumes/Pulses, Some Marinated Meats/Poultry/Seafood, Some Processed Meats	Eggs, Firm Tofu, Plain Cooked Meats/Poultry/Seafood, Tempeh
Breads & Cereals: Wheat/Rye/Barley Based Breads, Breakfast Cereals, Biscuits and Snack Products	Corn Flakes, Oats, Quinoa Flakes, Quinoa/Rice/Corn Pasta, Rice Cakes (Plain), Sourdough Spelt Bread, Wheat/Rye/Barley Free Breads
Sugars, Sweeteners & Confectionery: High Fructose Corn Syrup, Honey, Sugar Free Confectionery	Dark Chocolate, Maple Syrup, Rice Malt Syrup, Table Sugar
Nuts & Seeds: Cashews, Pistachios	Macadamias, Peanuts, Pumpkin Seeds/Pepitas, Walnuts

Who Should Follow a Low FODMAP Endometriosis Diet?

The Low FODMAP diet is specifically designed for individuals with medically diagnosed IBS. It is not recommended for people to self-diagnose and start this diet without the proper medical guidance. There are many conditions with symptoms similar to IBS, such as coeliac disease, inflammatory bowel disease, endometriosis, and bowel cancer. Therefore, it is crucial to get a clear diagnosis of IBS from a medical doctor before starting this diet.

The Purpose of a Low FODMAP Endometriosis Diet

The Low FODMAP diet is essentially a three-step diet used to manage symptoms of IBS, which can include abdominal pain, bloating, wind (farting) and changes in bowel habit (diarrhea, constipation, or both). The main goals of this diet are:

• Understand which foods and FODMAPs you tolerate and which ones trigger your IBS symptoms.
• Determine whether your IBS symptoms are sensitive to FODMAPs.
• Implement a less restrictive, more nutritionally balanced diet for the long term that only restricts foods that trigger your IBS symptoms.

How to Follow a Low FODMAP Diet

The Low FODMAP diet is a three-step diet, typically encompassing the following steps:

Step 1: Follow the Monash University Low FODMAP Diet by replacing high FODMAP foods in your diet with low FODMAP alternatives. This step usually lasts for 2-6 weeks.

Step 2: Continue your low FODMAP diet and complete a series of ‘FODMAP challenges’ to identify which FODMAPs you tolerate and which trigger symptoms.

Step 3: Relax dietary restrictions as much as possible, reintroduce well-tolerated foods and FODMAPs to your diet, and establish a ‘personalized FODMAP diet’ for the long term.

It is recommended to follow a Low FODMAP diet under the guidance of a dietitian who has specialty skills in managing IBS and using a FODMAP diet. Monash University’s FODMAP Dietitian Directory can be a useful resource to find such dietitians.

The Effectiveness of Low FODMAP Endometriosis Diet Combined with Other Therapies

The Low FODMAP diet has shown promising results in managing IBS symptoms. However, in some cases, the diet alone may not be sufficient, and other therapies may be required. One such therapy that has shown positive results in treating IBS is Gut Focused Hypnotherapy.

Understanding Gut Focused Hypnotherapy

Gut Focused Hypnotherapy is a type of treatment where patients are asked to visualize their gut as a perfectly slimy set of passages where all the digesting food slips through smoothly. This treatment has been proven to reduce symptoms of IBS by 70% in patients.

Combining Low FODMAP Diet and Gut Focused Hypnotherapy

Researchers at Monash University conducted a study combining the Low FODMAP diet and Gut Focused Hypnotherapy. The study resulted in a significant improvement in the overall and individual gut symptoms of the participants by the end of the six-week study.

Comparing the Low FODMAP Diet with Other IBS Diets

When comparing the Low FODMAP diet with other diets for IBS, it has been noted that the Low FODMAP diet seems to be superior to a gluten-free diet for patients with non-celiac gluten sensitivity. This is likely due to the comprehensive approach of the Low FODMAP diet, which considers all types of carbohydrates that could potentially trigger IBS symptoms.

The Low FODMAP diet has been shown to be effective in managing IBS symptoms, with studies showing improvement in pain, discomfort, bloating, and other GI symptoms. However, it is essential to follow this diet under the guidance of a trained dietitian and in conjunction with other therapies if necessary. As with any diet, the Low FODMAP diet should be personalized to fit the individual’s needs and tolerance levels.

If  you are suffering from IBS-like symptoms and you have endometriosis or are just starting in your journey for a diagnosis, it may be worth seeking out professional guidance to see if the low FODMAP diet may be helpful. As a reminder – it is not going to treat your endometriosis and is used primarily for symptom management. It does not replace seeking out the root cause of both endometriosis and your GI dysfunction. 

Disclaimer: This article is intended for informational purposes only and is not a substitute for professional medical advice. Always consult your doctor or a dietitian before making any changes to your diet.

References:

1. https://www.monashfodmap.com/about-fodmap-and-ibs/
2. https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/

Molina-Infante, J., Serra, J., Fernandez-Banares, F., & Mearin, F. (2016). The low-FODMAP diet for irritable bowel syndrome: Lights and shadows. Gastroenterol Hepatol, 39(2), 55-65. https://doi.org/10.1016/j.gastrohep.2015.07.009

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