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Endometrium – the inner lining of the uterus, permeated with blood vessels and having a complex structure. This is a hormone-dependent tissue, its main function is to create favorable conditions for the implantation of a fertilized egg. If implantation does not occur, the endometrium is rejected, menstruation begins. After that, a new layer grows, and the cycle repeats.
If for some reason the endometrial cells are outside the uterus, they, like the normally functioning cells of the intrauterine layer, respond to the action of hormones – they bleed during menstruation. The disease is very dangerous due to its severe consequences, as well as the fact that at a late stage it is necessary to subject the patient to surgical intervention. With the advent of menopause, endometriosis no longer bothers a woman, because the hormonal regulation of the reproductive system disappears.
Introduction to Intestinal Endometriosis
This disease refers to the extragenital form of endometriosis, that is, its foci are outside the reproductive system. Experts insist on clarifying the terminology describing extragenital endometriosis. They believe that it would be more correct to use the term “endometrioid heterotopia”.
There are 4 degrees of the pathological process:
There are one or two foci, they are superficial.
There are several foci, they are located shallow.
Foci of intestinal lesions are numerous, deep and pronounced.
The endometrium grows into the walls of the intestine, the foci occupy a large area, are difficult to treat.
Among intestinal lesions, approximately 20% of cases are endometriosis of the colon, 70% – endometriosis of the rectum. The disease spreads by contact and hematogenous way, after the process passes from the genitals to the peritoneum.
About 1-2% of women under 40 know firsthand what intestinal endometriosis is. During pregnancy, this disease may spontaneously disappear without treatment. If you do not take measures to eliminate this form of endometriosis, the foci of its spread can create prerequisites for the development of cancer. There are also cases of intestinal obstruction and perforation of the intestine.
Symptoms of intestinal endometriosis
Signs of the disease appear before menstruation, create a vivid clinical picture during it, and then disappear.
The deeper the damage to the intestinal tissues, the more pronounced the symptoms of the disease:
Prolonged debilitating pain in the anus, perineum, rectum,
Diarrhea or constipation, ribbon-like stools;
Flatulence;
blood in stool;
Frequent stools or bloody diarrhea during menstruation;
Pain during sexual contact;
Partial or complete intestinal obstruction.
Over time, it becomes impossible to independently carry out defecation without manual assistance, symptoms of intestinal stenosis appear.
With a visual examination during surgery, you can see the foci of the endometrium on the outer surface of the organ. They form islands of plaques, nodules, and may resemble polyps. Over time, endometrioid formations grow into the deep tissues of the intestine or circularly cover the intestine from the outside.
Causes of intestinal endometriosis
Intestinal endometriosis occurs due to the introduction of endometrial cells into the intestinal mucosa.
Risk factors for the development of pathology:
Inflammatory diseases of the reproductive organs;
history of abortion;
Excess estrogen levels due to ovarian dysfunction;
Liver disease
Obesity;
Diabetes;
Arterial hypertension;
High susceptibility to stress;
Sedentary lifestyle.
Diagnosis of intestinal endometriosis
Often this disease is difficult to differentiate from an intestinal infection or obstruction. You can suspect endometriosis when the negative symptoms are cyclical, closely related to the days of menstruation. With complaints, patients turn to a gynecologist, proctologist, gastroenterologist.
At the beginning of the appointment, the doctor will establish an anamnesis of the pathology, conduct a visual gynecological examination, digital rectal examination. This may reveal foci of the endometrium in the vagina. Manual vaginal examination can diagnose adhesions and scarring in the uterus and fallopian tubes. Rectal digital examination is performed for suspected endometriosis of the rectum. This method will help to detect infiltrates, narrowing of the intestine.
Instrumental diagnostic methods:
Irrigoscopy (X-ray with the introduction of a contrast agent into the intestine) – helps to detect tumors, fistulas, intestinal perforation, even in “blind” areas;
Colonoscopy with biopsy – helps to differentiate endometriosis from colorectal cancer, take a tissue sample for analysis, perform minor manipulations to remove pathological foci;
Transvaginal sonography;
Ultrasound, CT of the pelvic organs;
Laparoscopy;
Sigmoidoscopy.
Most diagnostic methods are used before or during menstruation, when changes in tissue structure are most noticeable.
Treatment of intestinal endometriosis
In the early stages of the disease, when changes in the structure of the tissues of the organ are not yet so pronounced, antihomotoxicological conservative therapy is used. It is aimed at correcting hormonal imbalances.
In addition, drugs are prescribed to neutralize the symptoms of the disease:
Biostimulants;
Immunomodulators;
Antiviral agents;
Antibacterial drugs.
Physiotherapy gives good results:
Warming up the anterior abdominal wall;
Special baths;
Rising douche of the perineum to increase muscle tone;
Stone therapy with heated stones.
Treatment and rehabilitation last a long time – 3-6 months, since the disease affects the deep tissues of the intestine. If conservative therapy fails, or intestinal obstruction occurs, surgical intervention is used. The affected areas of the colon and rectum are excised, the resulting defects are sutured.
If there is a risk of peritonitis, a colostomy is applied, and reconstructive operations are planned in the future. Approximately 15-40% of operated women have relapses of the disease.
To prevent the development of intestinal endometriosis, it is recommended to contact a gynecologist in a timely manner with complaints about the pathology of the menstrual cycle, monitor the state of health when using spirals as contraception, do not smoke, and monitor hormone levels.