Bowel Endometriosis Surgery in Houston, TX
Ritha Belizaire, MD, FACS, FASCRS Board-Certified General and Colorectal Surgeon
Bowel Endometriosis Overview
Bowel endometriosis occurs when tissue similar to the uterine lining grows into the wall of the intestine, most often the rectum or sigmoid colon. It can cause painful bowel movements, cyclic bloating, and changes in bowel habits that many patients live with for years before getting an accurate diagnosis.
If your digestive symptoms seem to follow your menstrual cycle and no one has been able to explain why, bowel endometriosis may be the missing piece.
As a board-certified colorectal surgeon, I specialize in the bowel component of endometriosis surgery. I work alongside gynecologic surgeons to provide complete surgical care, with my focus on protecting and restoring bowel function. Whether your bowel symptoms are still unexplained or your gynecologist has told you the bowel is involved, you don't have to navigate this alone or start your care over from scratch.
What Is Bowel Endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus. When that tissue reaches the intestinal wall, it is called bowel endometriosis.
The rectum and sigmoid colon are the most commonly affected areas, though endometriosis can also involve the appendix and small bowel. Research suggests that bowel involvement occurs in roughly 5 to 37 percent of patients with endometriosis, making it more common than many people realize.
Unlike other forms of endometriosis that are managed primarily by gynecologists, bowel endometriosis involves a structure that falls within the domain of colorectal surgery. The tissue can grow on the surface of the bowel, partially into the muscle layer, or completely through the wall. The depth of that involvement determines what type of surgical approach is needed and which specialists should be part of your care team.
This is what makes bowel endometriosis different from endometriosis elsewhere in the pelvis. When the bowel wall is affected, the surgical expertise required shifts toward a surgeon who operates on the intestine every day.
Symptoms of Bowel Endometriosis
The hallmark of bowel endometriosis is digestive symptoms that follow your menstrual cycle. Symptoms often worsen in the days before and during your period, then improve afterward. This cyclic pattern is the single most important clue that your bowel symptoms may be related to endometriosis rather than a primary gastrointestinal condition.
Common symptoms include:
- Painful bowel movements during or around your period
- Bloating and abdominal distension that comes and goes with your cycle
- Constipation or diarrhea that worsens around menstruation
- Rectal pressure or pain deep in the pelvis
- Rectal bleeding during your period (less common, but a strong indicator)
- A feeling of incomplete emptying after a bowel movement
In my practice, I often see patients who have carried an IBS diagnosis for years before anyone connected their bowel symptoms to their menstrual cycle. A systematic review found that women with endometriosis are two to three times more likely to receive an IBS diagnosis than women without the condition. That overlap is exactly why so many patients wait years for accurate answers.
If that pattern sounds familiar, it deserves more than another IBS prescription.
Why a Colorectal Surgeon for Bowel Endometriosis?
Most endometriosis care is managed by gynecologists, and for good reason. But when the disease involves the bowel wall, the surgical problem changes. Removing endometriosis from the intestine requires the same techniques used in colon cancer surgery, diverticulitis surgery, and other complex bowel operations. That is the daily work of a colorectal surgeon.
There are three main surgical approaches for bowel endometriosis, and the right one depends on how deep the tissue has grown and how much of the bowel wall is involved:
- Shaving removes disease from the outer surface of the bowel without opening it. This approach carries the lowest complication rate and is appropriate when the tissue has not penetrated deeply.
- Disc excision cuts out a full-thickness section of the bowel wall and closes the opening. It works well for smaller, isolated lesions.
- Segmental resection removes a full segment of the bowel and reconnects the two healthy ends. This is necessary when endometriosis has grown extensively through the wall or involves a large portion of the bowel circumference.
A meta-analysis of 60 studies found that complication rates range from roughly 2 percent for shaving to about 10 percent for disc excision and segmental resection. The goal is always to use the least invasive technique that fully addresses the disease.
In my practice, I perform these bowel procedures using robotic-assisted minimally invasive surgery, which offers improved precision in tight pelvic spaces and can support a faster recovery. It's the same approach I bring to colon cancer surgery and rectal prolapse repair, complex bowel work in tight spaces.
How We Work With Your Gynecologist
One of the most common concerns I hear from patients is whether seeing a colorectal surgeon means starting over with a new care team. It does not.
If you already have a gynecologist or a minimally invasive gynecologic surgery (MIGS) specialist managing your endometriosis, that relationship stays in place. Your gynecologist continues to lead your gynecologic care. My role is to join your team and handle the bowel component of your surgery.
In practice, this usually works one of two ways:
- Your gynecologist refers you to me because imaging or prior surgery has shown bowel involvement. We coordinate before your operation, operate together when needed, and I manage the bowel portion while your gynecologist addresses the pelvic and reproductive organs.
- You come to me first because bowel symptoms brought you in before anyone mentioned endometriosis. If I find that the bowel is involved, I connect you with a gynecologic surgeon and we build your surgical plan together.
Either way, you are not choosing between doctors. You are adding the right specialist to the team so that every part of the disease is addressed by the surgeon best trained to treat it.
No one gets left behind. Your care gets stronger.
What to Expect From Bowel Endometriosis Surgery
Before surgery, you will undergo a thorough evaluation to determine the extent of bowel involvement. This typically includes a pelvic MRI, which gives your surgical team a detailed map of where the endometriosis has grown and how deeply it has penetrated the bowel wall. In some cases, a colonoscopy may also be recommended to evaluate the inside of the bowel.
Your gynecologic surgeon and I review this imaging together to plan the operation. We determine in advance which surgical technique is most appropriate for your case, whether that is shaving, disc excision, or segmental resection. The goal is always to remove the disease completely while preserving as much healthy bowel as possible.
On the day of surgery, the procedure is performed using minimally invasive techniques. I typically use a robotic-assisted approach, which allows for greater precision when working in the deep pelvis. Your gynecologist addresses the endometriosis affecting the reproductive organs, and I address the bowel component. In many cases, both portions are completed during the same operation.
For patients concerned about fertility, it is worth knowing that current research suggests bowel endometriosis surgery may support improved reproductive outcomes. A systematic review found that surgery for deep infiltrating bowel endometriosis may improve spontaneous pregnancy rates, though results vary by individual. Your gynecologist and reproductive endocrinologist are the best guides for fertility-specific planning. Once the bowel component is addressed, many patients find they are in a stronger position to pursue the next step in their care.
Recovery After Bowel Endometriosis Surgery
Recovery time after bowel endometriosis surgery depends on the type of procedure performed, but minimally invasive and robotic-assisted approaches have shortened the timeline considerably compared to open surgery.
In a recent study of patients who underwent laparoscopic segmental bowel resection for endometriosis, the median hospital stay was three days. Most patients passed gas on the first day after surgery and had their first bowel movement by day four. These are encouraging benchmarks, though every patient's recovery is different.
In general, here is what you can expect:
- First 1 to 2 weeks: Rest at home, manage discomfort with prescribed medications, start with a soft diet as your bowel function returns.
- Weeks 2 to 4: Gradual return to light daily activities, continued dietary adjustments, follow-up appointment to assess healing.
- Weeks 4 to 6: Most patients can return to work and normal routines, though strenuous exercise and heavy lifting should wait until cleared by your surgeon.
I walk every patient through a personalized recovery plan before surgery so there are no surprises. Your recovery is something we plan for together, not something you figure out on your own.
When to Seek Evaluation
You may benefit from a consultation with a colorectal surgeon if any of the following apply:
- Your bowel symptoms follow your menstrual cycle and no one has been able to explain why
- You have been diagnosed with endometriosis and your gynecologist has identified bowel involvement
- You have been living with an IBS diagnosis but treatments have not helped and your symptoms are cyclic
- You have had endometriosis surgery before but your bowel symptoms have returned or were never fully addressed
- You are seeking a second opinion on a surgical plan that involves the bowel
- You are outside the Houston area and looking for a colorectal surgeon with specialized experience in bowel endometriosis
Each of these is a reason to have a conversation, not a commitment to surgery. A thorough evaluation is always the first step.
Ready to find out if bowel endometriosis is behind your symptoms? Call 832-979-5670 or schedule a consultation online.
Bowel Endometriosis Surgery at Houston Community Surgical
Houston Community Surgical is a physician-owned colorectal and general surgery practice located in the Heights. In addition to bowel endometriosis, we offer a full range of colorectal surgery services. I previously spent years on faculty at UT Health Houston, where I taught as an assistant professor of surgery. I bring that same academic-level training to my private practice, where patients receive personalized, one-on-one care.
I offer same-day and next-day appointments for new patients. If you are not in the Houston area, I also provide virtual second opinion case reviews through www.2ndscope.com so you can connect with a specialist from wherever you are.
⚠️ DR. BELIZAIRE — PLEASE CONFIRM PREFERRED LANGUAGE AROUND OUT-OF-NETWORK / CASH-PAY STATUS BEFORE PUBLISHING
Houston Community Surgical is an out-of-network practice. Upon request, we can provide documentation to support your insurance reimbursement claim.
If you are experiencing bowel symptoms related to endometriosis, call 832-979-5670 to schedule a consultation. Expert help does not have to wait.
Frequently Asked Questions
Is bowel endometriosis surgery always necessary?
Not always. Treatment depends on the severity of your symptoms, the extent of bowel involvement, and your personal goals. Some patients manage well with hormonal therapy. Surgery is typically recommended when symptoms are severe, medical management has not helped, or the disease is deeply infiltrating the bowel wall.
What is the difference between shaving, disc excision, and segmental resection?
Shaving removes endometriosis from the outer surface of the bowel without opening it. Disc excision cuts out a full-thickness portion of the bowel wall and closes the defect. Segmental resection removes a section of bowel and reconnects the two healthy ends. The right approach depends on the size, depth, and location of the disease.
How long is recovery after bowel endometriosis surgery?
Most patients who undergo minimally invasive bowel surgery go home within a few days. Light daily activities can typically resume within two to four weeks. Full recovery, including return to exercise and heavy lifting, usually takes four to six weeks. Your timeline may vary depending on the extent of your procedure.
Will I need a colostomy bag?
A temporary diversion is rare with modern minimally invasive techniques. In most cases, the bowel is reconnected during the same operation. Your surgeon will discuss whether a temporary diversion could be necessary based on the complexity of your specific case.
Can I keep my current gynecologist if I add a colorectal surgeon?
Yes. Adding a colorectal surgeon to your care team does not replace your gynecologist. Your gynecologist continues to manage your gynecologic care. I handle the bowel portion of your surgery, and we coordinate together.
Does Houston Community Surgical accept insurance?
⚠️ DR. BELIZAIRE — PLEASE CONFIRM PREFERRED LANGUAGE AROUND OUT-OF-NETWORK / CASH-PAY STATUS BEFORE PUBLISHING
Houston Community Surgical is an out-of-network practice. Upon request, we can provide documentation to support your insurance reimbursement claim.
What if I don't live in Houston?
I see patients from across the country for bowel endometriosis consultations. I offer virtual second opinion case reviews through www.2ndscope.com so you can discuss your case and review your imaging remotely before deciding on next steps.
This page 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 on this page.
By Ritha Belizaire, MD, FACS, FASCRS Board-Certified General and Colorectal Surgeon Last Reviewed: May 2026
