Rectovaginal endometriosis occurs when tissue similar to the lining of your womb (endometrium) starts to grow elsewhere, specifically in your back passage (rectum), vagina and structures between them. The tissue responds to hormonal changes during your menstrual cycle in the same way that endometrium tissue in your womb does. However, as it is outside your womb, it can cause inflammation, scarring and other problems with nearby organs.
Rectovaginal endometriosis is one of the most severe types of endometriosis. In the four-stage classification system, it is classed as stage 4 endometriosis due to the large amount of endometrium tissue found outside the womb and the extent that it has spread. Rectovaginal endometriosis often causes gastrointestinal problems and chronic (long-term) pelvic pain and in some cases, leads to fertility problems.
Rectovaginal endometriosis is a less common but severe type of endometriosis, where the endometrium tissue grows into your rectum, vagina and tissues in between them.
The patches of endometrium tissue (lesions) that grow outside of your womb in rectovaginal endometriosis can become quite large, causing pain and disrupting the function of nearby organs. These lesions can also lead to bleeding and infections.
Is rectovaginal endometriosis common?
Rectovaginal endometriosis is a less common type of endometriosis, affecting around a third of women with endometriosis. Most women with endometriosis, therefore, have ovarian endometriosis, where the endometrium tissue lines the ovaries, or peritoneal endometriosis, where the endometrium tissue lines the abdominal cavity.
Symptoms of rectovaginal endometriosis include:
Other symptoms of rectovaginal endometriosis include:
Symptoms often get worse during periods. However, some people with rectovaginal endometriosis may not experience any symptoms. The severity of your symptoms doesn’t necessarily suggest how extensive your rectovaginal endometriosis is ie you can experience chronic pain with mild endometriosis or mild discomfort with severe endometriosis.
The exact causes of rectovaginal endometriosis aren’t yet known, although genetics may play a role as it can run in families. If you have a mother or sister with endometriosis, your risk of developing it is two to 10 times greater than a woman who has no family history of the condition.
Inflammation may also increase your risk as tissues affected by endometriosis have high levels of inflammatory markers.
Pelvic surgery, such as a C-section or laparotomy, may increase your risk of endometriosis too.
Endometriosis that penetrates deep into tissues, which includes rectovaginal endometriosis, tends to first develop in women in their early twenties.
Other potential risk factors for developing endometriosis include:
It can be difficult to diagnose endometriosis as symptoms vary and other conditions have similar symptoms. For some women without any symptoms, endometriosis may only be diagnosed as part of investigations into fertility problems.
If you do have symptoms of endometriosis, such as pelvic or abdominal pain, bloating, heavy and/or painful periods, or irregular vaginal bleeding, it is important to see your GP. They will ask you about your symptoms and your medical history.
They may also perform a physical examination of your pelvis to check for pain, lumps or other unusual growths. To do this, they will insert a gloved, lubricated finger into your vagina and rectum.
Further tests may be needed to make a diagnosis of endometriosis. Your doctor may therefore recommend you have an imaging test, such as:
Imaging tests do not always detect endometriosis. The only definitive way to diagnose endometriosis is with a procedure called a laparoscopy. This is a type of keyhole surgery, performed under general anaesthesia. Small cuts are made into your abdomen, through which a thin, flexible, telescope-like tube with a camera and a light on the end (a laparoscope) is inserted to look for endometrium tissue. Special surgical instruments can also be inserted to collect a tissue sample (biopsy) for examination in a lab.
There is no cure for rectovaginal endometriosis, however, treatments are available to help manage your symptoms. This usually involves a combination of medication and surgery.
Hormone treatment improves symptoms in around two-thirds of women with rectovaginal endometriosis. However, it can cause side effects, such as bloating, headaches and weight gain.
Hormone treatments work by reducing the build-up of endometrium tissue. However, they also prevent pregnancy and therefore do not improve fertility. They usually take several months to work.
Types of hormone medications include:
Over-the-counter pain medications can help manage pain caused by endometriosis. However, for severe types of endometriosis, which includes rectovaginal endometriosis, this isn’t an effective long-term treatment.
If you have severe rectovaginal endometriosis, your doctor may recommend surgery to remove the endometrium lesions. This is often performed via a keyhole procedure where small cuts are made into your abdomen through which a laparoscope can be inserted, alongside special surgical instruments.
Removing the endometrium tissue that has grown outside your womb has been shown to significantly improve pain caused by the condition.
Different techniques are used during rectovaginal surgery, depending on the location of your lesions. Your surgeon may use:
In rare cases, rectovaginal endometriosis can cause a blockage of the intestines. This needs treatment, which may include antibiotics, fluids given via a vein (intravenous) and/or surgery.
Every surgery comes with complications. For rectovaginal surgery, complications include:
As there is no cure for rectovaginal endometriosis, most women will need to manage their symptoms using medication and/or surgery to reduce the effect endometriosis has on their quality of life, which can be significant.
Even after rectovaginal surgery, your symptoms may return. However, hormone treatments can slow down the growth of new endometrium tissue.
It is important to have regular appointments with your doctor to track your symptoms and adapt your treatment plan if needed.
Can endometriosis cause mucus in stools?
Yes, rectovaginal endometriosis can cause blood and mucus in your stools.
Is rectovaginal endometriosis a progressive disease?
Yes, in most women, rectovaginal endometriosis a progressive disease as endometrium tissue gradually spreads and grows outside the womb. However, it doesn’t always progress in every woman with the condition.
What happens if bowel endometriosis is left untreated?
If you don’t have any symptoms, you likely won’t need any treatment. However, if you have symptoms of bowel endometriosis and it is left untreated, you may develop gastrointestinal problems and chronic (long-term) pelvic and/or abdominal pain.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.
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