at Pierpaolo Sileri
The symptoms are diarrhea alternating with constipation, abdominal swelling, pain during bowel movements. There may be a sense of heaviness in the perineum or rectum. Surgery is offered when no alternatives are possible
I have endometriosis. The gynecologist told me that the disease also affects the intestine. What can I do?
Answered by Pierpaolo Sileri, director of the Coloproctological Surgery Unit for chronic intestinal diseases, San Raffaele Hospital, Milan
Endometriosis is the abnormal presence of endometrium, which should only line the uterine cavity, outside the uterus. This tissue creates a chronic benign inflammation of the organs and tissues affected since, responding to hormonal stimuli, it behaves like the uterine endometrium, growing and flaking during the phases of the menstrual cycle. It accompanies the woman until menopause and can generate persistent adhesions and fibrosis. a pathology that affects at least three million women in Italy, a number underestimated due to the variability of symptoms (sometimes absent) and discovered by chance, often with mild disorders, in other cases highly disabling. Pelvic pain, especially in the peri-menstrual phase, painful menstruation, pain during sexual intercourse are frequent signs.
Symptoms
Almost a third of patients may have intestinal involvement, more frequently of the sigmoid colon and rectum, rarely of the appendix or cecum and much more rarely of the ileum. In case of intestinal involvement, diarrhea alternating with constipation, abdominal swelling, abdominal pain, pain on evacuation are possible. There may be a sense of heaviness in the perineum or rectum. Rectal bleeding may occur. Symptoms appear or are accentuated in the peri-menstrual period. In more severe cases, intestinal obstruction may occur. To complete the diagnosis of your gynecologist (abdominal and transvaginal ultrasound, magnetic resonance imaging), the colorectal surgeon will proceed with an accurate anamnesis on intestinal symptoms in conjunction with the menstrual cycle and independently of it.
The treatment
Proceed to a rectal examination in the peri-menstrual period and subsequently to an endoscopic examination to evaluate the sigmoid colon and the rectum (most frequent locations), looking for involvement of the intestinal wall by the anomalous tissue and to exclude other pathologies of the colon . Surgery is offered when no alternatives are possible and must be performed in reference centers and with a multidisciplinary approach. The technique of choice is laparoscopic, which allows a definitive diagnosis with a correct evaluation of the structures involved and treatment that is conservative and respectful – as much as possible – of the reproductive structures and possibly resective and curative of the intestine.
October 27, 2023 (modified October 27, 2023 | 1:19 pm)
© ALL RIGHTS RESERVED