Bowel Endometriosis: A Colorectal Surgeon's Diagnostic Approach in Houston, TX

By Dr. Ritha Belizaire

Quick Insights

Bowel endometriosis occurs when endometrial-like tissue grows on or into the intestinal wall. This tissue responds to hormonal changes, causing inflammation and scarring. Symptoms often mimic irritable bowel syndrome or other digestive disorders. Many patients experience years of pain before receiving an accurate diagnosis. Persistent bowel symptoms with pelvic pain warrant evaluation by a specialist familiar with this condition.

Key Takeaways



• Bowel endometriosis affects up to 37% of women with endometriosis, most commonly involving the rectum and sigmoid colon.
• Cyclic bowel symptoms: pain, bloating, or changes in bowel habits that worsen during menstruation are key diagnostic clues.
• Diagnosis often requires specialized imaging, such as a transvaginal ultrasound or MRI performed by experienced radiologists.
• Surgical options range from conservative bowel-preserving techniques to segmental resection, depending on disease severity and symptoms.

Why It Matters

Understanding bowel endometriosis can end years of uncertainty and ineffective treatments. Accurate diagnosis opens the door to targeted therapies that may significantly improve your quality of life. Whether you choose medical management or surgery, knowing what's causing your symptoms empowers you to make informed decisions about your care and reclaim control over your daily activities.

Introduction

As a board-certified colorectal surgeon at Houston Community Surgical, I've seen too many patients suffer for years before discovering their bowel symptoms stem from endometriosis.

Bowel endometriosis occurs when endometrial-like tissue grows on or into the intestinal wall, most commonly affecting the rectum and sigmoid colon. This tissue responds to hormonal changes during your menstrual cycle, causing inflammation, scarring, and progressive symptoms.

Many Houston-area patients experience cyclic bowel pain, bloating, or changes in bowel habits that worsen during menstruation. Yet, these warning signs are frequently dismissed as irritable bowel syndrome or stress.

The diagnostic delay is real and frustrating. I've met patients from Houston Heights, Montrose, Midtown Houston, and surrounding areas who spent five, even ten years seeking answers before someone connected their digestive symptoms to endometriosis.

In this article, I'll explain how bowel endometriosis develops, why it's so often missed, and what diagnostic steps can finally provide clarity and relief.

What Is Bowel Endometriosis?

Bowel endometriosis develops when tissue similar to the uterine lining grows on or into the intestinal wall. This tissue behaves like endometrial tissue inside the uterus, thickening and breaking down with each menstrual cycle.

When it attaches to the bowel, it causes inflammation, scarring, and sometimes partial obstruction. The rectum and sigmoid colon are most commonly affected.

Studies show that up to 37% of women with endometriosis have bowel involvement. The tissue can grow on the outer surface of the bowel or penetrate deeper into the muscular layers.

In my Houston practice, I often see patients whose bowel endometriosis has progressed silently for years. The tissue creates adhesions that can pull organs together or narrow the bowel passage.

Some patients develop nodules that feel like firm lumps during examination. The severity varies widely; some women have minimal symptoms despite significant disease, while others experience debilitating pain from smaller lesions.

Why Bowel Endometriosis Is Frequently Misdiagnosed

The symptoms of bowel endometriosis overlap significantly with common digestive disorders. Bloating, cramping, and changes in bowel habits can easily be attributed to irritable bowel syndrome. Many patients receive IBS diagnoses and spend years trying dietary changes and medications that don't address the underlying problem.

Research demonstrates that diagnostic delays average five to seven years for bowel endometriosis. The cyclic nature of symptoms provides the most important clue, yet many physicians don't ask about menstrual timing when evaluating digestive complaints. Patients often don't volunteer this connection either, assuming their periods and bowel symptoms are separate issues.

I've found that careful history-taking often reveals the pattern. When I ask specifically about symptom timing, patients frequently realize their worst bowel days coincide with their periods. This recognition can be the turning point toward accurate diagnosis.

Common Symptoms That Often Get Overlooked

Cyclic bowel pain is the hallmark symptom of bowel endometriosis. This pain typically intensifies during menstruation and may feel like deep cramping or sharp stabbing sensations in the lower abdomen or rectum. Some patients describe it as pressure that makes sitting uncomfortable.

Changes in bowel habits often follow menstrual patterns too. Colorectal surgery consensus guidelines identify diarrhea, constipation, or alternating patterns as common presentations. Painful bowel movements during periods, rectal bleeding that coincides with menstruation, and severe bloating are additional warning signs.

In my experience, patients often normalize these symptoms because they've lived with them for so long. They assume everyone with periods experiences similar issues. When I explain that cyclic bowel symptoms aren't typical, many patients feel validated for the first time.

How Bowel Endometriosis Is Diagnosed in Houston

Diagnosis begins with a detailed medical history focusing on symptom timing and menstrual patterns. Physical examination may reveal tender nodules behind the uterus or along the bowel, though not all lesions are palpable. Standard colonoscopy typically appears normal because endometriosis grows from the outside of the bowel inward.

Specialized imaging provides the most reliable diagnosis. Transvaginal ultrasound performed by experienced radiologists can identify bowel nodules and assess their depth. MRI offers detailed views of pelvic anatomy and can map the extent of disease. These imaging studies help determine whether endometriosis has penetrated the bowel wall.

I often coordinate with gynecologists and radiologists in the Houston area who specialize in endometriosis imaging. This multidisciplinary approach ensures we don't miss subtle findings. Sometimes diagnosis is only confirmed during surgery, when we can directly visualize and biopsy suspicious tissue. Nearby facilities include Texas Medical Center, which serves the broader Houston community.

Treatment Options: From Conservative Care to Surgery

Treatment depends on symptom severity, disease extent, and your reproductive goals. Hormonal therapies that suppress menstruation can reduce symptoms by preventing the cyclic inflammation. Birth control pills, progestin therapy, or GnRH agonists may provide relief without surgery.

When conservative management fails or disease is severe, surgery becomes necessary. Minimally invasive approaches including robotic surgery allow precise removal of endometriosis while preserving bowel function when possible. Techniques range from shaving nodules off the bowel surface to removing affected bowel segments.

Robotic-assisted surgery offers advantages for deep pelvic dissection, providing enhanced visualization and precision. In my Houston practice, I tailor the surgical approach to each patient's specific anatomy and disease pattern. The goal is always to relieve symptoms while minimizing surgical risks and preserving quality of life.

If you're seeking care for bowel endometriosis or bowel involvement endometriosis, our practice provides specialized colorectal care and expert services for patients with complex colorectal conditions. Together, we can design a precise, evidence-based treatment strategy.

When to See a Houston Colorectal Surgeon

Consider consulting a colorectal surgeon if you have persistent bowel symptoms that worsen during your period. This is especially important if you've already been diagnosed with endometriosis elsewhere in your pelvis. Symptoms like cyclic rectal pain, painful bowel movements during menstruation, or rectal bleeding that follows your cycle warrant specialist evaluation.

Patients with fecal incontinence related to endometriosis or other pelvic floor disorders may benefit from cutting-edge therapies such as Axonics sacral neuromodulation, an advanced treatment for fecal incontinence.

I recommend seeking consultation before symptoms become severe. Early evaluation allows for more treatment options and may prevent disease progression. If you've tried hormonal management without adequate relief, or if imaging shows bowel involvement, a colorectal surgeon can help determine whether surgery might benefit you.

My approach emphasizes thorough evaluation before recommending any procedure. Understanding the exact location and depth of bowel involvement guides treatment decisions. Together, we can develop a plan that addresses your symptoms while considering your overall health goals and concerns about surgery.

A Patient's Perspective

When I meet patients who've struggled with unexplained bowel symptoms for years, I understand how isolating that experience can be.

"When I met Dr. Ritha Belizaire, I truly felt like I was dying. From that very moment, her care and compassion were life-changing. She performed my surgery and, without a doubt, saved my life." —  Fabienne

This is one patient's experience; individual results may vary.

Stories like Fabienne's remind me why accurate diagnosis matters so much. When patients finally understand what's causing their symptoms, they can move forward with confidence and hope.

Conclusion

Bowel endometriosis affects thousands of women who spend years searching for answers to their unexplained digestive symptoms. Understanding that cyclic bowel pain, bloating, or changes in bowel habits during your period aren't normal can finally end that frustrating diagnostic journey.

As a board-certified colorectal surgeon, I've seen how accurate diagnosis transforms lives, opening doors to targeted treatments that actually address the underlying problem rather than just managing symptoms.

Surgical evaluation by specialists familiar with bowel endometriosis ensures you receive comprehensive care tailored to your specific disease pattern. Whether you choose medical management or surgery, knowing what's causing your symptoms empowers you to make informed decisions about your health.

I serve Houston and nearby communities such as Houston Heights, Montrose, and Midtown Houston. If you're experiencing any of these symptoms, don't wait. Schedule a same-day consultation by calling our office at 832-979-5670 to request a prompt appointment in Houston.

Not local? I also offer virtual second opinion case reviews at www.2ndscope.com—so no matter where you are, expert help is just a click away.

This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

If you found this article helpful and want more expert advice, subscribe to my colorectal health newsletter for updates on bowel endometriosis, new treatments, and tips for digestive health.

Frequently Asked Questions

How do I know if my bowel symptoms are related to endometriosis?

The key indicator is timing—if your bowel symptoms worsen during your menstrual period, endometriosis may be involved. Cyclic patterns of pain, bloating, diarrhea, or constipation that consistently coincide with menstruation suggest bowel endometriosis rather than irritable bowel syndrome.

Painful bowel movements during your period or rectal bleeding that follows your cycle are additional warning signs. Standard colonoscopy often appears normal because endometriosis grows from outside the bowel inward. Specialized imaging like transvaginal ultrasound or MRI performed by experienced radiologists provides the most reliable diagnosis.

What surgical options exist for bowel endometriosis?

Surgical approaches range from conservative techniques to segmental resection, depending on disease severity and depth of bowel wall involvement. Shaving removes superficial nodules from the bowel surface without opening the intestine. Discoid resection removes deeper lesions while preserving most of the bowel.

Segmental resection removes affected bowel sections when disease penetrates deeply or causes narrowing. Minimally invasive and robotic-assisted approaches allow precise removal while minimizing recovery time.

Your surgeon will recommend the approach that balances symptom relief with preservation of bowel function based on your specific disease pattern.

Will surgery cure my endometriosis permanently?

Surgery removes visible endometriosis lesions and can provide significant long-term symptom relief, but endometriosis is a chronic condition that may recur. Many patients experience years of improvement after surgery, particularly when combined with hormonal management to suppress disease activity.

Recurrence rates vary based on disease severity, surgical completeness, and whether you continue hormonal therapy afterward. Regular follow-up with specialists familiar with endometriosis ensures any recurrence is detected early. The goal is maximizing your quality of life through the most effective combination of surgical and medical management tailored to your individual situation.

Where can I find bowel endometriosis treatment in Houston?

Dr. Ritha Belizaire at Houston Community Surgical provides physician-led evaluation and treatment for bowel endometriosis. Located in Houston, my practice focuses on clear answers, respectful care, and evidence-based options. If you're unsure what's causing your symptoms, scheduling a visit can help you understand next steps. Call 832-979-5670 to request an appointment.