I have endometriosis, including deep endometriosis on my rectum, and had surgery in 2023. I have really slow motility and constipation occurring everyday and heightened with my cycle. My recent MRI results say: ** FINDINGS: Impression Possible deep infiltrating endometriosis at the torus uterinus measuring approximately 0.5 × 1.1 x 1.1 cm and contacting a loop of small bowel. Mild T2 hypointense thickening, which may represent deep infiltrating endometriosis versus postsurgical changes with blood products/scarring at the bilateral uterosacral ligaments. I contacted my GI and OBGYN regarding my results to see if they thought scar tissue and/or endometriosis in the MRI could be contributing to my symptoms of significant slow motility and constipation. They stated that those aren’t symptoms of endometriosis, and they wouldn’t anticipate endometriosis, if present as indicated in the MRI, to impact those symptoms. I previously understood that endometriosis could significantly impact the GI system and contribute to IBS symptoms such as constipation. Is this true? Could endometriosis and/or scar tissue contacting the bowel contribute to my symptoms that are not helped by medication?
Endometriosis
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December 23, 2024
Thank you for your thoughtful and important question — and I’m sorry you’re going through this. What you’re experiencing is more common than many realize, and it deserves to be taken seriously.
Yes, endometriosis — especially deep infiltrating endometriosis (DIE) involving the rectum, uterosacral ligaments, or small bowel — can absolutely contribute to gastrointestinal symptoms, including constipation, bloating, slow motility, and pain related to the menstrual cycle. This has been well-documented in the literature and acknowledged in the 2022 ESHRE guidelines on endometriosis.
Key points based on the scientific evidence and consensus:
• Deep endometriosis can cause inflammatory and fibrotic changes around the bowel, even without full-thickness infiltration. These changes can disrupt motility, create partial mechanical obstruction, or induce neuromuscular dysfunction that leads to symptoms very similar to IBS.
• According to ESHRE (2022), GI symptoms such as constipation, bloating, diarrhea, tenesmus, and painful bowel movements are common in women with rectovaginal and posterior compartment endometriosis — especially when the uterosacral ligaments, torus uterinus, or rectum are affected.
• Post-surgical changes (e.g. fibrosis, adhesions, and scarring) can persist or worsen motility disorders, particularly when involving the rectosigmoid or pelvic nerves.
• There is significant overlap between endometriosis and IBS. Studies show women with endometriosis are 2–3 times more likely to meet criteria for IBS, even after surgical treatment — often because of residual disease or functional changes.
• While medications for constipation (laxatives, fiber, osmotics) can help, they often don’t fully resolve symptoms when structural or inflammatory causes are present, as in your case.
So, yes — both endometriosis and postoperative scar tissue can contribute to your current symptoms, especially considering the imaging findings and your surgical history.
You’re not imagining this, and your symptoms are real and valid.
If standard medications haven’t helped, you might consider:
• A multidisciplinary evaluation (pelvic floor physical therapy + GI motility specialist + experienced endometriosis surgeon)
• Pelvic MRI with diffusion-weighted imaging (DWI) if further clarification is needed
• Consideration of hormonal therapy if not already in use, as it may reduce inflammation and cyclical exacerbation
• Surgical re-evaluation only if symptoms are severe and disabling despite conservative management
Most importantly: your experience aligns with the current scientific understanding of endometriosis. If your care team dismisses this connection, consider seeking a second opinion from someone with specific expertise in endometriosis involving the bowel.