Decoding the Mystery of Scar Endometriosis

Endometriosis, a perplexing condition where endometrial-like tissue is found outside the uterus, manifests in various forms. Among them is scar endometriosis, a rare yet distressing subtype that warrants heightened awareness and understanding. This is often a consequence of surgical procedures. Scar endometriosis can profoundly impact an individual’s quality of life, necessitating prompt diagnosis and effective management.

Introduction

Scar endometriosis, an extrapelvic manifestation of endometriosis, is characterized by the growth of endometrial-like tissue within or around a surgical scar. While its incidence is relatively low, ranging from 0.03% to 1.08% of endometriosis cases, the symptoms can be just as debilitating and the diagnosis challenging. This article delves into the intricacies of scar endometriosis, shedding light on its causes, symptoms, diagnosis, and treatment options, empowering individuals to navigate this intricate condition with knowledge and confidence.

Etiology: Unveiling the Root Causes

The precise etiology of scar endometriosis remains a subject of ongoing research and debate. However, several theories have been proposed to explain its development:

1. Iatrogenic Transplantation: This widely accepted theory suggests that during surgical procedures, endometriosis cells inadvertently become implanted within the surgical incision or scar tissue. This phenomenon is particularly common in obstetric and gynecological surgeries, such as cesarean sections, hysterectomies, and laparoscopic procedures.
2. Lymphatic or Vascular Dissemination: Similar to other forms of endometriosis found in the body,  these cells may travel through lymphatic or vascular channels, eventually seeding and proliferating within surgical scars or distant sites.
3. Metaplastic Transformation: This theory proposes that specialized cells within the surgical scar undergo metaplastic changes, transforming into endometrial-like cells under the influence of specific hormonal or environmental factors.

While these theories provide plausible explanations, the exact mechanisms underlying scar endometriosis remain elusive, underscoring the need for further research to unravel the complexities of this condition.

Clinical Manifestations: Recognizing the Signs

The clinical manifestations of scar endometriosis can vary, making early recognition a challenge. However, certain symptoms may raise suspicion and prompt further investigation:

• Cyclical Pain: One of the hallmark symptoms is cyclical pain or discomfort at the surgical scar site, often coinciding with menstrual periods. This pain can range from mild to severe and may radiate to adjacent areas.
• Swelling or Lump: Many people with scar endometriosis report the presence of a palpable lump or swelling at the scar site. This lump may fluctuate in size and tenderness throughout the menstrual cycle.
• Cyclical Bleeding: In some cases, patients may experience cyclical bleeding or discharge from the surgical scar, further indicating the presence of endometriosis.
• Dysmenorrhea and Pelvic Pain: Scar endometriosis can coexist with pelvic endometriosis, leading to additional symptoms such as dysmenorrhea (painful periods) and chronic pelvic pain, especially if endometriosis has been left untreated.

It is crucial to note that the absence of cyclical symptoms does not necessarily exclude the possibility of scar endometriosis, as some cases may present with non-cyclical pain or discomfort.

Diagnostic Approach: Piecing Together the Puzzle

Diagnosing scar endometriosis can be challenging due to its non-specific symptoms and the need for a multidisciplinary approach. The diagnostic process typically involves the following steps:

1. Medical History and Physical Examination: A thorough medical history, including details of previous surgeries, menstrual patterns, and associated symptoms, is essential. During the physical examination, healthcare professionals may palpate the surgical scar site for any palpable masses, nodules, or tenderness.
2. Imaging Modalities: Various imaging techniques can aid in the diagnosis and assessment of scar endometriosis:
   • Ultrasonography: Ultrasound is often the initial imaging modality employed, as it can detect hypoechoic or heterogeneous lesions with irregular borders at the scar site.
   • Magnetic Resonance Imaging (MRI): MRI provides detailed information about the extent and depth of the lesion, aiding in surgical planning.
   • Computed Tomography (CT) Scan: While less commonly used, CT scans can help differentiate scar endometriosis from other conditions, such as hernias or malignancies.
3. Biopsy and Histopathological Examination: Ultimately, a definitive diagnosis requires a biopsy or surgical excision of the lesion, followed by histopathological examination. The presence of endometrial glands and stroma within the scar tissue confirms the diagnosis of scar endometriosis.

It is essential to note that a multidisciplinary team including gynecologists, radiologists, and pathologists may be necessary to establish an accurate diagnosis and develop an appropriate treatment plan.

Treatment Strategies: Alleviating the Burden

The management of scar endometriosis aims to alleviate symptoms, prevent recurrence, and preserve fertility when desired. The treatment approach is multifaceted and tailored to each individual’s unique circumstances:

1. Surgical Intervention: Wide surgical excision with clear margins is the ideal treatment for scar endometriosis. This procedure involves the complete removal of the endometriosis lesion(s), including any affected surrounding tissue or muscle layers. In cases of extensive involvement, abdominal wall reconstruction with mesh reinforcement may be recommended.
2. Hormonal Therapy: While not a definitive treatment, hormonal therapies such as oral contraceptives, progestins, or gonadotropin-releasing hormone (GnRH) agonists can provide temporary symptom relief, and some research shows that these therapies may suppress the growth of lesions. However, these medications may have side effects and do not address the underlying lesion.
3. Combined Approach: In some cases, a combined approach involving surgical excision followed by adjuvant hormonal therapy may be recommended and may reduce the risk of recurrence.
4. Pain Management: Effective pain management strategies, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics, may be necessary to alleviate discomfort associated with scar endometriosis.

It is crucial to engage in shared decision-making with healthcare professionals, weighing the risks and benefits of each treatment option to determine the most appropriate course of action.

Preventive Measures: Minimizing the Risk

While the complete prevention of scar endometriosis may not be feasible in all cases, certain measures can be taken to reduce the risk of its development:

1. Meticulous Surgical Technique: During surgical procedures, particularly those involving the uterus or pelvic region, strict adherence to meticulous surgical techniques is paramount. This includes minimizing the risk of cell seeding, proper handling of surgical specimens, and thorough irrigation of the surgical site.
2. Containment of Tissue Biopsies: The use of endo-bags or containment devices during laparoscopic procedures can help prevent the inadvertent dissemination of endometriosis cells into the surgical field.
3. Careful Wound Closure: Ensuring proper closure of the peritoneum and fascial layers during abdominal surgeries can help minimize the risk of endometriosis cell implantation within the surgical site.
4. Postoperative Monitoring: Regular follow-up and vigilance for any signs or symptoms of scar endometriosis in the postoperative period can aid in early detection and prompt management.

While these preventive measures cannot guarantee the complete elimination of scar endometriosis, they can contribute to reducing the risk and promoting better outcomes for patients undergoing surgical procedures.

Psychological Impact and Support

Scar endometriosis can have a profound impact on an individual’s psychological well-being, often leading to feelings of frustration, anxiety, and diminished self-esteem. The chronic pain, discomfort, and potential impact on fertility can take a toll on mental health, underscoring the importance of holistic care and support.

Healthcare professionals should be attuned to the psychological needs of patients with scar endometriosis and provide access to counseling, support groups, or mental health resources as needed. Building a strong support system and fostering open communication can empower an individual to cope with the challenges of this condition more effectively.

Fertility Considerations

For individuals desiring fertility,  the impact of scar endometriosis on fertility is a significant concern. While the condition itself may not directly affect fertility, the presence of pelvic endometriosis or the surgical interventions required for treatment can potentially impact fertility outcomes.

In such cases, a multidisciplinary approach involving reproductive endocrinologists and fertility specialists may be necessary. Fertility preservation techniques, such as egg or embryo freezing, may be considered for people undergoing extensive surgical procedures. Ongoing monitoring and tailored treatment plans can help optimize fertility outcomes for those affected by scar endometriosis.

Emerging Treatments and Research Frontiers

While current treatment modalities for scar endometriosis have shown promising results, ongoing research efforts aim to further enhance our understanding and management of this condition. Some emerging areas of interest include:

1. Targeted Therapies: The development of targeted therapies that selectively inhibit the growth or proliferation of endometriosis could potentially offer more effective and less invasive treatment options.
2. Stem Cell Therapy: Preliminary research explores the potential of stem cell therapy in regenerating or repairing damaged tissue, potentially reducing the need for extensive surgical interventions.
3. Genetic and Molecular Studies: Investigating the genetic and molecular mechanisms underlying scar endometriosis could provide insights into its pathogenesis and pave the way for personalized treatment strategies.
4. Improved Diagnostic Techniques: Ongoing efforts to refine imaging modalities and develop novel biomarkers could enhance the accuracy and timeliness of scar endometriosis diagnosis.

As research continues to advance, the future holds promise for more effective, personalized, and minimally invasive approaches to managing scar endometriosis.

Multidisciplinary Care: A Collaborative Approach

Scar endometriosis often requires a multidisciplinary approach involving various healthcare professionals, each contributing their expertise to ensure comprehensive care. This collaborative team may include:

• Gynecologists: Gynecologists play a pivotal role in diagnosing, treating, and managing scar endometriosis, as well as addressing any associated pelvic endometriosis or fertility concerns.
• Radiologists: Radiologists are essential in interpreting imaging studies and guiding the diagnostic process, particularly in cases where surgical intervention is being considered.
• Pathologists: Pathologists provide crucial insights by examining tissue samples and confirming the diagnosis of scar endometriosis through histopathological analysis.
• Surgeons: Surgical specialists, such as general surgeons or plastic surgeons, may be involved in the surgical management of scar endometriosis, particularly in cases requiring complex reconstructive procedures or mesh reinforcement.
• Pain Management Specialists: Chronic pain associated with scar endometriosis may necessitate the involvement of pain management specialists to develop effective pain control strategies.
• Mental Health Professionals: Psychologists, counselors, or therapists can provide invaluable support in addressing the psychological impact of scar endometriosis and promoting overall well-being.

Effective communication and collaboration among this multidisciplinary team are essential to ensure comprehensive, coordinated care tailored to each patient’s unique needs.

Patient Education and Advocacy

Empowering patients through education and advocacy is crucial in addressing the challenges posed by scar endometriosis. Healthcare professionals should prioritize providing accurate and up-to-date information to patients, fostering a better understanding of the condition, its implications, and available treatment options.

Patient support groups and advocacy organizations play a vital role in raising awareness, promoting research, and advocating for improved access to care and resources. These platforms can also serve as a valuable source of support, allowing individuals with scar endometriosis to connect, share experiences, and gain strength from one another. By fostering a collaborative approach between healthcare professionals, patients, and advocacy groups, we can collectively work towards improving the quality of life for those affected by scar endometriosis and advancing our understanding of this complex condition.

Conclusion

Scar endometriosis, a rare and often overlooked manifestation of endometriosis, presents unique challenges in diagnosis and management. However, by raising awareness, promoting early recognition, and embracing a multidisciplinary approach, we can better support everyone affected by this condition.

Through meticulous surgical techniques, targeted therapies, and ongoing research, we can strive to alleviate the physical and emotional burdens associated with scar endometriosis. Additionally, fostering open dialogue, patient education, and advocacy efforts can empower an individual to navigate this journey with knowledge, support, and resilience. By unraveling the enigma of scar endometriosis, we can pave the way for more effective treatments, improved quality of life, and a deeper understanding of this intricate condition, ultimately providing hope and solace to those affected.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851454

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10024799

https://www.shreeivfclinic.com/endometriosis/scar-endometriosis

https://casereports.bmj.com/content/2014/bcr-2014-206693

https://www.mdpi.com/2296-3529/9/2/20

6 months ago Endometriosis , Endometriosis , Endometriosis Education No comment

Does Removing Endometriosis and Fibroid Tumor Increase the Chances of Pregnancy?

Table of contents

• Overview of Endometriosis and Fibroids
• Endometriosis and Infertility
• Fibroids and Fertility
• Endometriosis and Pregnancy Outcomes
• Fibroids and Pregnancy Outcomes
• Treatment Options for Fertility Preservation
  • Endometriosis Surgery 
  • Fibroid Removal
• Fertility Outcomes After Surgery
• Pregnancy Monitoring and Management
• Non-Surgical Treatment Options
  • Endometriosis:
  • Fibroids:
• Emerging Treatments and Future Directions
• Emotional and Psychological Support
• Conclusion

Overview of Endometriosis and Fibroids

Endometriosis and uterine fibroids are prevalent gynecological conditions that can profoundly impact a woman’s reproductive health and fertility. Endometriosis, affecting approximately 10% of individuals assigned female at birth (AFAB),  occurs when endometrial-like tissue is found outside of the uterus, primarily in the abdominopelvic cavity.  Fibroids, on the other hand, are non-cancerous growths made up of fibrous tissue and smooth muscle cells that develop in or around the uterus. They may also be called uterine myomas or leiomyomas and affect an estimated 20–40% of AFABs, often during their childbearing years.

While these conditions are distinct, they share some common characteristics, including the potential to cause infertility and pregnancy complications. This article aims to provide a comprehensive understanding of the effects of endometriosis and fibroids on pregnancy, as well as the various treatment options available to maintain fertility.

Endometriosis and Infertility

Endometriosis is a leading cause of infertility, responsible for approximately 50%  of infertility cases. The condition can impair fertility by obstructing the fallopian tubes, disrupting the hormonal milieu, causing inflammation, and altering endometrial development, thereby reducing the chances of successful embryo implantation.

However, it’s important to note that many individuals with endometriosis can still conceive naturally or with the assistance of fertility treatments. The impact of endometriosis on fertility may depend on the severity and location of the endometrial lesions.

Fibroids and Fertility

While fibroids are generally non-cancerous, their presence can affect fertility in several ways. Submucosal fibroids, which protrude into the uterine cavity, can significantly reduce the chances of successful embryo implantation and pregnancy rates during assisted reproductive technologies (ART) such as in vitro fertilization (IVF).

Intramural fibroids, which grow within the uterine muscle wall, can also impair fertility by distorting the uterine cavity and disrupting the hormonal environment necessary for successful implantation and placentation.

Endometriosis and Pregnancy Outcomes

People with endometriosis may face an increased risk of certain adverse pregnancy outcomes, including:

• Placental abnormalities (placenta previa, placental abruption)
• Preterm birth
• Pregnancy-induced hypertension/preeclampsia
• Cesarean delivery

The risk of these complications may be influenced by factors such as the severity of endometriosis, the presence of infertility, and the use of fertility treatments. However, many individuals with endometriosis can have successful, uncomplicated pregnancies.

Fibroids and Pregnancy Outcomes

Fibroids can also impact pregnancy outcomes in various ways. Individuals with fibroids may be at an increased risk of:

• Placental abnormalities (placental abruption, placenta previa)
• Preterm labor and delivery
• Fetal malpresentation (breech presentation)
• Cesarean delivery
• Postpartum hemorrhage

The risk of these complications may be influenced by factors such as the size, number, and location of the fibroids. Large fibroids, or those located in the uterine cavity, may pose a greater risk to the pregnancy.

Treatment Options for Fertility Preservation

For individuals with endometriosis or fibroids who desire future fertility, surgery or removal of the endometriosis lesions and/or fibroid(s)  may be recommended to improve their chances of conception and reduce the risk of pregnancy complications.

Endometriosis Surgery 

While there is no one-size-fits all approach to addressing endometriosis, surgical excision or removal of the lesions is thought to be the ideal approach to addressing the lesions directly. This minimally invasive surgery aims to remove the lesions while preserving the uterus and ovaries, allowing for future fertility.

Fibroid Removal

For individuals with fibroids who wish to maintain their fertility, a myomectomy may be recommended. This surgical procedure involves the removal of fibroids while preserving the uterus. Depending on the size, number, and location of the fibroids, myomectomies can be performed through various approaches, including:

• Hysteroscopic myomectomy (for submucosal fibroids)
• Laparoscopic myomectomy (for intramural or subserosal fibroids)
• Abdominal myomectomy (for larger or multiple fibroids)

The choice of approach depends on factors such as the size and location of the fibroids, as well as the surgeon’s expertise and the patient’s preferences.

Fertility Outcomes After Surgery

Studies have shown that those who undergo endometriosis excision or myomectomy for fibroid removal can achieve pregnancy rates ranging from 50-60%. However, it’s important to note that these procedures do not guarantee fertility, and the success rates may vary depending on factors such as age, severity of the condition, and the presence of other infertility factors.

Pregnancy Monitoring and Management

For those with endometriosis or fibroids who become pregnant, close monitoring and specialized care may be recommended to mitigate potential risks and ensure the best possible outcomes for both the mother and the baby.

This may involve regular ultrasound examinations to monitor fetal growth and placental function, as well as close monitoring for signs of preterm labor or other complications. In some cases, additional interventions or precautions may be necessary, such as bed rest, medication, or early delivery.

Non-Surgical Treatment Options

While surgical tumor removal is often the preferred option for those seeking to preserve fertility, there are also non-surgical treatment options available for managing endometriosis and fibroids. These include:

Endometriosis:

• Hormonal therapies (e.g., birth control pills, GnRH agonists)
• Anti-inflammatory medications
• Complementary therapies (e.g., dietary modifications, exercise)

Fibroids:

• Gonadotropin-releasing hormone (GnRH) agonists
• Selective progesterone receptor modulators (SPRMs)
• Uterine artery embolization (UAE)
• Magnetic resonance-guided focused ultrasound (MRgFUS)

These non-surgical options may be used to manage symptoms, reduce tumor size, or provide temporary relief before pursuing fertility treatments or tumor removal surgery.

Emerging Treatments and Future Directions

Research is ongoing to develop new and improved treatment options for endometriosis and fibroids, with a particular focus on preserving fertility and minimizing the risk of adverse pregnancy outcomes.

Some areas of active research include:

• Novel hormonal therapies and targeted therapies for endometriosis
• Improved surgical techniques for myomectomy and endometriosis excision
• Non-invasive tumor removal methods (e.g., MRgFUS, UAE)
• Preventative strategies to reduce the risk of endometriosis and fibroid development

As our understanding of these conditions continues to evolve, it is hoped that more effective and less invasive treatment options will become available, improving the quality of life and reproductive outcomes for individuals affected by endometriosis and fibroids.

Emotional and Psychological Support

The journey through endometriosis, fibroids, and infertility can be emotionally and psychologically challenging for many. It’s essential to recognize and address the emotional impact of these conditions, as well as the stress and anxiety that can accompany fertility treatments and pregnancy complications.

Support groups, counseling, and mental health resources can be invaluable in helping individuals cope with the emotional and psychological aspects of their condition and treatment. Healthcare providers should be mindful of these needs and provide appropriate referrals and support services as needed.

Conclusion

Endometriosis and fibroids are common gynecological conditions that can have a significant impact on fertility and pregnancy outcomes. While these conditions can pose challenges, there are various surgical and non-surgical options and treatment strategies available to help individuals achieve their desired family size while mitigating potential risks.

By working closely with their healthcare providers, people with endometriosis or fibroids can develop personalized treatment plans that address their individual needs and preferences. With proper management and care, those suffering from these conditions can successfully navigate pregnancy and achieve their dreams of parenthood.

REFERENCES:

https://www.uchicagomedicine.org/en/forefront/womens-health-articles/2022/august/fibroids-fertility-pregnancy

https://www.webmd.com/women/uterine-fibroids/what-if-i-have-uterine-fibroids-while-pregnant

https://www.acfs2000.com/fibroids-and-endometriosis.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608270

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9187594

6 months ago Endometriosis , Endometriosis , Endometriosis Education No comment

Navigating the Road to Recovery: A Comprehensive Guide to Endometriosis Surgery Aftercare

The journey towards relief from endometriosis often involves surgical intervention, but the road to recovery can be a winding one. While endometriosis surgery offers hope for alleviating debilitating symptoms, the post-operative phase demands patience, diligence, and a steadfast commitment to self-care. This comprehensive guide aims to equip you with the knowledge and strategies necessary to navigate the recovery process with confidence and ease.

Table of contents

• Understanding the Endometriosis Surgery Landscape
  • Laparoscopy: A Minimally Invasive Marvel
  • Robotic Surgery: A More Advanced Approach
  • Laparotomy: The Open Approach
• Preparing for the Post-Operative Journey
• The First Few Days: Taking It Slow
• The Weeks Ahead: Gradual Progress and Patience
• Returning to Normal Activities: Listening to Your Body
• Embracing a Holistic Approach to Recovery
• Addressing Potential Complications and Recurrence
• Fertility Considerations After Endometriosis Surgery
• Embracing a Positive Mindset and Self-Care
• Endometriosis Surgery Recovery: A Transformative Journey

Understanding the Endometriosis Surgery Landscape

Endometriosis, a chronic condition characterized by the growth of endometrial-like tissue outside the uterus, can wreak havoc on an individual’s quality of life. When medications and lifestyle modifications fail to provide adequate relief, surgical intervention may become a viable option. Minimally invasive approaches are now the go-to approaches for endometriosis surgery. 

Laparoscopy: A Minimally Invasive Marvel

Laparoscopy, a minimally invasive procedure, is the preferred approach for endometriosis surgery. This technique involves making small incisions in the abdomen and inserting a laparoscope—a slender camera—to visualize and remove endometrial lesions or scar tissue. Laparoscopy offers numerous advantages, including reduced recovery time, minimal scarring, and a lower risk of complications.

Robotic Surgery: A More Advanced Approach

While you may hear mixed opinions on whether robotic surgery is better or worse than a laparoscopic approach, it appears that robotics are the way of the future. Providers using a robotic approach have to undergo more extensive surgical training, but the outcomes may be superior. While the operative time, or time and anesthesia, can be longer than laparoscopic surgeries, the visualization is undoubtedly better. Endometriosis can present with some hard-to-see or hard-to-recognize lesion types, and using this approach may be a better way to visualize those hard-to-see lesions to remove them. 

Laparotomy: The Open Approach

This is an older approach that has been replaced with minimally invasive approaches, but you may still occasionally see someone undergo a laparotomy. In cases of extensive endometriosis or when laparoscopy is not feasible, laparotomy, an open surgical procedure, may be recommended. Laparotomy involves a larger incision in the abdomen, allowing for better visualization and access to deeply infiltrating endometriosis lesions. While more invasive, laparotomy may be necessary in certain circumstances.

Preparing for the Post-Operative Journey

Before embarking on the recovery path, it is crucial to lay the groundwork for a smooth transition. Your healthcare provider will provide specific instructions tailored to your unique situation, but here are some general guidelines:

• Arrange Transportation: Have a trusted friend or family member available to drive you home after the procedure, as you will be unable to operate a vehicle immediately following surgery.
• Stock Up on Essentials: Ensure your pantry and refrigerator are stocked with easily digestible foods, such as soups, broths, yogurt, and fruits, as well as plenty of fluids to stay hydrated.
• Prepare for Medication Management: Discuss any necessary medication adjustments with your healthcare provider, including pain relievers, antibiotics, and laxatives to aid in post-operative recovery.
• Create a Comfortable Environment: Arrange your living space to minimize unnecessary movement and exertion, ensuring easy access to essential items and a comfortable resting area.

The First Few Days: Taking It Slow

The initial days following endometriosis surgery are crucial for initiating the healing process. During this time, it is essential to prioritize rest and follow your healthcare provider’s instructions diligently:

• Manage Pain and Discomfort: Take prescribed pain medications as directed to alleviate discomfort and promote healing. Applying a heating pad or ice pack to the incision site can also provide relief.
• Stay Hydrated and Nourished: Consume plenty of fluids and easily digestible foods to support your body’s recovery efforts. Avoid heavy, greasy, or spicy meals that may cause digestive discomfort.
• Embrace Gentle Movement: While rest is essential, light movement, such as short walks around the house, can aid in circulation and prevent complications like blood clots.
• Monitor Incision Sites: Keep an eye on your incision sites for signs of infection, such as redness, swelling, or pus drainage. Follow your healthcare provider’s instructions for proper wound care.

The Weeks Ahead: Gradual Progress and Patience

As the days turn into weeks, your body will continue its healing journey. During this phase, it is important to strike a balance between rest and gentle activity, while adhering to your healthcare provider’s recommendations:

• Increase Activity Levels Gradually: After the initial recovery period, you can gradually increase your activity levels, starting with light exercises like walking or gentle stretching. Listen to your body and avoid overexertion.
• Manage Expectations: Recovery timelines can vary significantly based on the extent of the surgery, your overall health, and individual healing rates. Be patient and celebrate small victories along the way.
• Attend Follow-up Appointments: Keeping scheduled follow-up appointments with your healthcare provider is crucial for monitoring your progress and addressing any concerns or complications that may arise.
• Seek Support: The recovery process can be emotionally and physically taxing. Reach out to loved ones, support groups, or mental health professionals for encouragement and guidance during this journey.

Returning to Normal Activities: Listening to Your Body

As you continue to heal, the desire to resume your normal routine may become increasingly strong. However, it is essential to listen to your body and follow your healthcare provider’s advice regarding the appropriate timeline for returning to various activities:

• Work and School: Depending on the nature of your job or studies, you may be able to return to work or school within two weeks of the surgery. However, if your responsibilities involve physical labor or strenuous activity, a longer recovery period may be necessary.
• Exercise and Sports: Low-impact exercises like walking or light yoga can typically be resumed within a few weeks, but strenuous activities and high-impact sports should be avoided until your healthcare provider gives the green light.
• Intimate Relationships: It is generally recommended to abstain from sexual activity for at least six weeks after endometriosis surgery to allow for proper healing. Discuss any concerns with your healthcare provider.
• Travel and Vacations: While short trips may be possible within a few weeks, it is advisable to postpone extended travel or vacations until you have fully recovered, typically within 6-8 weeks after the surgery.

Embracing a Holistic Approach to Recovery

Recovery from endometriosis surgery extends beyond physical healing; it encompasses emotional and mental well-being as well. Embracing a holistic approach can enhance your overall recovery experience:

• Prioritize Stress Management: Chronic stress can hinder the healing process. Incorporate relaxation techniques like deep breathing exercises, meditation, or gentle yoga into your routine to promote a calm and peaceful mindset.
• Seek Emotional Support: Endometriosis can take a toll on mental health, and the recovery process can be emotionally taxing. Lean on your support system, join support groups, or consider seeking professional counseling to navigate the emotional challenges.
• Nourish Your Body: A balanced diet rich in whole foods, antioxidants, and anti-inflammatory nutrients can aid in the healing process and promote overall well-being. Consult with a nutritionist or dietitian for personalized dietary recommendations.
• Stay Positive and Patient: Recovery from endometriosis surgery is a journey, and setbacks or slower progress than anticipated can be disheartening. Maintain a positive mindset, celebrate small victories, and trust in the healing process.

Addressing Potential Complications and Recurrence

While endometriosis surgery aims to alleviate symptoms and improve quality of life, it is important to be aware of potential complications and the possibility of recurrence:

• Recognizing Signs of Complications: Be vigilant for signs of infection, excessive bleeding, or worsening pain, and promptly report any concerns to your healthcare provider. Especially around the incision sites, look for abnormal redness, swelling, heat, or pain. 
• Managing Recurrence Risk: Endometriosis can recur after surgery, even with the best surgery. However, the persistence of endometriosis can occur when not all lesions are removed. Discuss long-term management strategies with your healthcare provider.
• Exploring Alternative Treatments: If endometriosis symptoms persist or recur despite surgery, explore alternative treatment options such as hormonal therapy, pain management techniques, or complementary therapies in consultation with your healthcare provider.

Fertility Considerations After Endometriosis Surgery

For many individuals with endometriosis, preserving fertility is a significant concern. Endometriosis surgery can potentially improve fertility outcomes, but it is crucial to have an open dialogue with your healthcare provider about your goals and options:

• Timing for Conception: Depending on the extent of the surgery and your overall health, your healthcare provider may recommend waiting a specific period before attempting conception to allow for complete healing.
• Assisted Reproductive Technologies: In cases of moderate to severe endometriosis, assisted reproductive technologies (ART), such as in vitro fertilization (IVF), may be recommended to improve pregnancy chances.
• Fertility Preservation Options: If you are considering future fertility but are not ready for conception immediately after surgery, discuss fertility preservation options like egg freezing with your healthcare provider.

Embracing a Positive Mindset and Self-Care

The recovery journey after endometriosis surgery can be physically and emotionally challenging, but embracing a positive mindset and prioritizing self-care can make a significant difference:

• Celebrate Small Victories: Recovery is a process, and every milestone, no matter how small, deserves celebration. Acknowledge and appreciate your progress, even on days when it may seem insignificant.
• Practice Self-Compassion: Be kind and patient with yourself throughout the recovery process. Healing takes time, and setbacks are a natural part of the journey. Treat yourself with the same compassion you would extend to a loved one.
• Engage in Enjoyable Activities: While rest is essential, engaging in low-impact activities that bring you joy and relaxation can boost your mood and overall well-being. Read a book, listen to music, or indulge in a favorite hobby that doesn’t strain your recovery.
• Seek Professional Support: If you find yourself struggling with anxiety, depression, or other mental health concerns during the recovery process, don’t hesitate to seek professional support from a therapist or counselor.

Endometriosis Surgery Recovery: A Transformative Journey

Recovering from endometriosis surgery is a transformative journey that requires patience, perseverance, and a commitment to self-care. While the road may be winding, embracing a positive mindset, following your healthcare provider’s guidance, and listening to your body’s needs can pave the way for a successful recovery and improved quality of life. Remember, every person’s journey is unique, and with the right support and strategies, you can navigate this path with resilience and emerge stronger on the other side.

REFERENCES:

https://my.clevelandclinic.org/health/treatments/4620-endometriosis-surgery

https://www.healthline.com/health/endotough/surgery-for-endometriosis

Postop Care – The next 6-12 weeks

After Your Laparoscopy

10 months ago Endometriosis , Endometriosis , Endometriosis Education No comment

Understanding Endometriosis and Stomach Cramps

Endometriosis is a medical condition that affects approximately 10% of women globally. Its symptoms can be debilitating and significantly impact the quality of life of those affected. One of the most commonly reported symptoms of endometriosis is stomach cramps. This article delves into the relationship between endometriosis and stomach cramps, unraveling the causes, symptoms, and available treatment options.

Table of contents

• What is Endometriosis?
• What is Endo Belly?
• Causes of Endo Belly
• Symptoms of Endo Belly
• How Endometriosis Causes Stomach Cramps
• Symptoms of Stomach Cramps Due to Endometriosis
• Treatment for Endometriosis and Stomach Cramps
• When to Consult a Doctor
• Conclusion

What is Endometriosis?

Endometriosis is a health disorder that occurs when tissue similar to the uterus’s endometrium begins to grow in areas outside the uterus. These areas may include the ovaries, fallopian tubes, the lining of the pelvic cavity, and, in some cases, the bowels and bladder.

What is Endo Belly?

One term that has gained popularity in endometriosis discussions is “endo belly.” This term refers to the painful abdominal bloating often associated with endometriosis. The bloating, which can be severe, results from inflammation, growths, gas, or other digestive issues related to endometriosis.

Causes of Endo Belly

The exact cause of endo belly still needs to be fully understood. However, several factors have impacted this symptom. The endometrial-like tissue behaves similarly to the endometrium: it thickens, breaks down, and bleeds with each menstrual cycle. However, since this tissue cannot exit the body, it becomes trapped, leading to inflammation and irritation. Over time, this can cause scar tissue to form, leading to various symptoms, including bloating and fluid retention.

Symptoms of Endo Belly

The primary symptom of endo belly is severe bloating, particularly during or just before the menstrual period. The abdomen may fill with air or gas, causing it to appear larger and feel stiff or tight to the touch. This bloating may last for a few hours to a few weeks. Other symptoms that may accompany endo belly include:

• Nausea and vomiting
• Gas pain
• Constipation or diarrhea
• Abdominal discomfort, pain, and pressure

How Endometriosis Causes Stomach Cramps

The stomach cramps associated with endometriosis are often severe and debilitating. These cramps are not merely due to the menstrual cycle but are a direct result of the endometrial-like tissue growing outside the uterus. This tissue resembles the endometrium, building up and breaking down each menstrual cycle. But because this tissue is outside the uterus and cannot exit the body, it gets trapped. This trapped tissue leads to inflammation and irritation, which can cause severe stomach cramps.

Symptoms of Stomach Cramps Due to Endometriosis

The main symptom associated with endometriosis-induced stomach cramps is severe pain, particularly during the menstrual period. This pain can be so intense that it disrupts daily activities and significantly impairs the individual’s quality of life. The pain often worsens throughout the day and can be so severe that the person may not be able to button their pants or may even appear as though they are pregnant.

Treatment for Endometriosis and Stomach Cramps

There are several treatment options available for managing endometriosis and its associated stomach cramps. Treatment choice often depends on the severity of the symptoms, the person’s age, and their future pregnancy plans. The treatment options include:

• Over-the-counter Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, may be recommended to manage inflammation and reduce pain.
• Prescription Hormonal Medications: Hormonal pills or devices may help to regulate symptoms.
• Endometriosis Surgery: In severe cases, surgery may be the best option for long-term pain relief. This surgery involves removing the endometriosis and scar tissue from the pelvic and abdominal organs.

When to Consult a Doctor

It’s essential to consult an endo specialist if you’re experiencing severe stomach cramps, mainly if they’re associated with your menstrual cycle. Early diagnosis and treatment can significantly improve your quality of life and prevent potential complications, such as infertility.

Conclusion

Endometriosis and stomach cramps are closely linked. The condition can lead to severe stomach cramps that can significantly impair the quality of life of those affected. However, you can manage the symptoms effectively with proper diagnosis and treatment. Suppose you’re experiencing severe stomach cramps, especially if they’re associated with your menstrual cycle. In that case, it’s essential to consult a healthcare provider for a proper diagnosis and treatment plan.

References:

https://maidenmedical.com/endometriosis-belly

https://www.healthline.com/health/endo-belly

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

https://www.utphysicians.com/the-pain-of-endometriosis/

https://www.medicalnewstoday.com/articles/endo-belly

10 months ago CEO Message No comment

Video-Vetted Vs. Non-Video-Vetted Vs. Subjectivity

To the endometriosis community, 

Over the past several months, we have had some questions regarding iCarebetter and the legitimacy of our expert lists. We have seen several posts, comments, and threads sharing various information and questions about iCarebetter and the vetting platform. We thought it might be helpful to clear the air and provide answers in case anyone has been confused. Specifically, we are here to answer these questions:  

• Are all of the surgeons on iCareBetter video vetted?
• Do doctors have to pay iCarebetter to be added to the expert list on the website? 
• Is the vetting process for iCarebetter regulated?

We fully understand and appreciate the concerns about the quality of an excision surgeon and the complexity of assessing a surgeon’s skill for a patient. 

Before diving into the Video-Vetting and iCareBetter list, let’s review other options. There have been several recommendations, which include:

• Review the surgeon’s social media profile and their surgical videos
• Use Google to search for nearby doctors and their reviews
• Ask surgeons how many complex surgeries they have done
• Look at their publications
• Lists

While many of those with endometriosis have had to do this for many years, It is obvious that these solutions are not practical or helpful for many patients, and they lack objectivity.  

For example, reading in detail about someone’s experience can be helpful. However, reading a list of Google reviews will often be one-sided or only demonstrate extreme views—those with extremely positive or negative experiences.

Having scientific publications doesn’t mean a surgeon is good. Most people have been informed that funding sources, conflicts of interest, and the quality of research are important to understand. Without having a background in healthcare or research, this can be hard for patients to understand how to do or what to look for. There are also publications that say the right things, but their intentions are not in the right place and there may be secondary gain. Many surgeons in the endo space may demonstrate a good understanding of endo, but this does not always extend in their surgical skills.

Knowing the power dynamic between patients and surgeons, it is almost impossible to get a clear answer about how many endo surgeries a surgeon has performed. Logically, it makes sense that if a doctor is only performing a few surgeries per month compared to someone doing a few surgeries per week, the physician performing more has more practice. That being said, there are other considerations that are beyond the control of the physician. 

We can go on, but you get the idea. The bottom line is that everyone has their own subjective perspective, which is based on past experiences, their own research, and oftentimes others’ influence and experiences. And we all know each individual is different and what worked for me might not work for you.

In contrast to all these methodologies, iCareBetter has only applied objective processes. We have only examined evidence to see what works.

A study in the New England Journal of Medicine used actual data to show that video-based surgical skill scores were correlated with Complications. https://www.nejm.org/doi/full/10.1056/NEJMsa1300625

iCareBetter then applied this Journal Article methodology to endometriosis surgery. We created the list of Video-Vetted surgeons after vetting their surgeries. iCareBetter started by only listing surgeons who passed video vetting. This process requires surgeons to submit three videos with specific criteria, which are then peer-reviewed by other experts in this field. The entire process is double-blinded. 

As iCareBetter is relatively new to the endo space, it took some time to build up our resources. Unfortunately, the number of surgeons submitting videos and the number of surgeons who passed was very low.  Additionally, reviewing a surgeon’s videos is very long and usually takes three months on average. At the same time, 90% of patients who used iCareBetter could not find a surgeon based on their criteria and location. In order to serve the needs of those utilizing iCareBetter to find care, we had to make a change so patients could still find a doctor who could still provide some surgical care. Therefore, we made the decision to add a second group of surgeons who are non-video-vetted. These surgeons are added based on their peers’ recommendations and their personal interests. Patients can review them on their iCareBetter profile, and we publish the reviews without filters. 

We hope that these non-video-vetted surgeons will take the steps to pass the video-vetting in the future. Meanwhile, the Video-Vetted designation is explicitly stated on the profile of the Video-Vetted surgeon, there is no fine print.

In regards to the questions about surgeons paying to be on iCareBetter,  we did begin this process by charging doctors a subscription fee to be on iCareBetter. But since over a year ago, we have given the option for a 100% discount, and surgeons can choose to be on iCareBetter for zero subscription fee. To keep the lights on, we only charge doctors if we help them with promotion or management services such as training their staff to offer better care to patients and giving them marketing strategies, all of which are optional. That said, for video vetting, the only required fee for surgeons is a one-time review fee of $400 that pays for reviewers and the cost of the review.

Currently, we have 222 providers, including surgeons on iCareBetter, and we are seeing constant interest and growth. We will continue to do video-vetting and hope that more surgeons will become Video-Vetted. We continue Video-Vetting for patients’ interest and for the purpose of transparency. 

We would love to hear your thoughts and concerns here.

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 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 Bowel Endometriosis , Endometriosis , Endometriosis Education No comment

Understanding How Endometriosis Can Cause Bowel Problems

Endometriosis, a common health concern among women, can manifest itself in various ways, one of them being bowel problems. But how exactly can endometriosis cause bowel problems? This article will take you through the intricate connection between endometriosis and bowel problems, the symptoms to look out for, diagnostic procedures, and potential treatments.

Table of contents

• What is Endometriosis?
• Understanding Bowel Endometriosis
• Symptoms of Bowel Endometriosis
• Causes of Bowel Endometriosis
• The Prevalence of Endometriosis
• Diagnosing Bowel Endometriosis
• Treating Bowel Endometriosis
• The Prognosis for Bowel Endometriosis

What is Endometriosis?

Endometriosis is a health condition where the tissue similar to the type that lines the uterus, known as the endometrium, grows outside the uterus. This condition predominantly affects the reproductive organs such as the ovaries, fallopian tubes, and the external part of the uterus. However, it can also extend to other parts of the body including the bowels, rectum, and other pelvic organs.

Understanding Bowel Endometriosis

Bowel endometriosis is a form of endometriosis that affects the gastrointestinal tract, specifically the bowels. It can appear in two forms: superficial (on the surface of the bowel) and deep (penetrating the bowel wall).

Read More: Understanding Bowel Endometriosis

Symptoms of Bowel Endometriosis

The symptoms of bowel endometriosis can vary widely depending on the location of the lesion, its size, and how deep it is in the bowel wall. Some women may experience no symptoms. However, common symptoms include:

• Difficulty in passing stool or loose, watery stools (constipation or diarrhea)
• Pain during bowel movements
• Menstrual discomfort
• Painful sexual intercourse
• Difficulty in conceiving (infertility)
• Blocked bowel (a rare symptom)

It is noteworthy that these symptoms can often mimic other conditions like irritable bowel syndrome (IBS), but the two conditions are distinct. One distinguishing factor is that with bowel endometriosis, symptoms often worsen before and during the menstrual period.

Read More: Endometriosis and Painful Intercourse: Is it Really Just Endometriosis?

Causes of Bowel Endometriosis

The exact cause of bowel endometriosis is still under study. However, several factors have been linked to its occurrence. These include genetic predisposition, inflammation, and levels of estrogen, a female sex hormone.

The Prevalence of Endometriosis

Endometriosis affects approximately 10%-12% of women of childbearing age. The condition is often diagnosed in women who are in their 30s, although it can occur at any age.

Diagnosing Bowel Endometriosis

The diagnosis of bowel endometriosis starts with the doctor asking about your symptoms and medical history, followed by a physical examination of your pelvic area. The doctor may also recommend imaging tests to get more information on the location and size of any cysts or tissue damage related to endometriosis. These tests include:

• Transvaginal or transrectal ultrasound: This procedure involves the insertion of a wand-like device into your vagina or rectum. This device releases sound waves that create images of your organs.
• Magnetic resonance imaging (MRI): An MRI test provides detailed images of your organs and tissues using a magnetic field and radio waves.
• Laparoscopy: This surgical procedure involves making a small incision near your belly button and inserting a thin viewing tool called a laparoscope.
• Barium enema: This type of X-ray is used to see changes or defects in your large intestine (colon).
• Colonoscopy: They pass a tube with a camera on its tip through the anus into the colon to directly visualize the wall and take samples from inside the colon.

Read More: Colon Chronicles: Delving into Bowel Endometriosis

Treating Bowel Endometriosis

The treatment plan for bowel endometriosis will be personalized, taking into account your symptoms, medical history, age, and reproductive plans. Treatments can include:

• Surgery: The aim of surgery is to remove as many lesions as possible while preserving your organs and overall health.
• Hormone treatments: These medications control estrogen levels which can worsen the symptoms of bowel endometriosis.
• Counseling: Given the ongoing nature of bowel endometriosis and its impact on both physical and mental health, counseling may be recommended to provide emotional support.

The Prognosis for Bowel Endometriosis

There is currently no cure for endometriosis. However, treatments like surgery and hormone therapy can help manage the symptoms. It is also important to note that symptoms could return if treatment is halted, or they could recur on their own, especially in cases with deep lesions.

Endometriosis is a complex condition that can cause bowel problems and other health issues. If you suspect you have endometriosis and are experiencing bowel problems, it’s important to consult with a healthcare provider. Early diagnosis and treatment can help manage symptoms and improve your quality of life.

References:

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

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

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

Bowel Disease

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