Bowel Endometriosis Surgery: When Surgery Is Recommended in Houston, TX

By Ritha Belizaire, MD, FACS, FASCRS

QUICK INSIGHTS

Bowel endometriosis surgery involves removing endometrial tissue that has grown into or onto the intestinal wall. This tissue causes pain, bowel symptoms, and sometimes obstruction. Surgery is typically considered when medical management fails or when severe symptoms affect daily function. Modern approaches often use minimally invasive techniques. Not all bowel endometriosis requires surgery—evaluation by a colorectal surgeon helps determine the best approach.

KEY TAKEAWAYS

• About 5-12% of women with endometriosis develop bowel involvement, most commonly affecting the rectum and sigmoid colon.
• Surgical goals include pain relief, preserving bowel function, and removing disease while minimizing complications.
• Robotic-assisted techniques allow precise removal of deep pelvic endometriosis with shorter hospital stays and faster recovery.
• Multidisciplinary evaluation helps determine whether bowel resection, shaving, or disc excision is most appropriate for your situation.

WHY IT MATTERS

Understanding when bowel endometriosis surgery is recommended helps you make informed decisions about your care. Surgery can significantly improve quality of life when symptoms interfere with work, relationships, or daily activities. Knowing modern minimally invasive options exist may ease concerns about recovery time and returning to the responsibilities that matter most to you.

Introduction

As a board-certified colorectal surgeon, I've helped many Houston patients navigate the decision about bowel endometriosis surgery.

Bowel endometriosis surgery involves removing endometrial tissue that has grown into or onto the intestinal wall. In Houston, I see patients who experience significant pelvic pain, painful bowel movements, and sometimes obstruction from this condition.

Advanced imaging helps identify the extent of bowel involvement before surgery. Not every case requires surgery—medical management works well for some patients.

Surgery becomes an option when symptoms interfere with daily life despite other treatments. Modern robotic techniques allow precise removal of disease while preserving bowel function whenever possible.

At Houston Community Surgical, I work with gynecologic surgeons to create individualized surgical plans.

This article explains when bowel endometriosis surgery is recommended and what you can expect from modern minimally invasive approaches.

What Is Bowel Endometriosis?

Bowel endometriosis occurs when endometrial tissue grows into or onto the intestinal wall. This tissue behaves like the lining inside the uterus—it responds to monthly hormonal changes. When it attaches to the bowel, it can cause inflammation, scarring, and sometimes partial obstruction.

The rectum and sigmoid colon are most commonly affected. In my Houston practice, I see patients who've experienced years of painful bowel movements, bloating, or constipation that worsens during their menstrual cycle. These symptoms often get dismissed as irritable bowel syndrome or "just bad periods."

Bowel involvement affects about 5-12% of women with endometriosis. The tissue can grow on the outer bowel wall (superficial disease) or penetrate deeply into the intestinal layers. Deep infiltrating disease typically causes more severe symptoms and may require surgical evaluation.

Diagnosis requires careful imaging and sometimes colonoscopy to rule out other conditions. Understanding the extent of bowel involvement helps determine whether surgery is appropriate for your situation.

When Is Surgery Recommended for Bowel Endometriosis in Houston?

Surgery becomes an option when medical management no longer controls your symptoms. Research indicates that patient selection criteria for bowel resection should consider symptom severity, disease extent, and impact on daily function.

I recommend surgical evaluation when patients experience severe pain that limits work or relationships, bowel obstruction symptoms, or progressive worsening despite hormonal therapy. Surgery may also be appropriate when imaging shows deep infiltration affecting bowel function.

Organ preservation approaches guide my surgical planning whenever possible. Not every case requires bowel resection—some patients benefit from shaving techniques that remove disease while preserving the intestinal wall.

Medical management typically includes hormonal suppression and pain control. When these approaches fail or when disease causes mechanical problems, surgery offers a path toward symptom relief. The decision requires careful discussion about your goals, concerns, and expectations.

What Are the Goals of Bowel Endometriosis Surgery?

The primary goal is relieving pain while preserving bowel function. I focus on removing all visible disease, restoring normal anatomy, and preventing future complications. Complete excision of endometriosis provides the best chance for long-term symptom improvement.

Studies show that pain relief is typically good after bowel resection, though individual outcomes vary. Many patients experience significant improvement in pelvic pain, painful bowel movements, and quality of life.

Preserving fertility matters for many patients. Surgical planning considers your reproductive goals and aims to minimize impact on ovarian function. Removing bowel disease can actually improve fertility in some cases by reducing pelvic inflammation.

Preventing recurrence requires complete disease removal and sometimes ongoing hormonal management after surgery. I discuss realistic expectations about symptom improvement and the possibility that some patients may need additional treatment over time.

Surgical Approaches for Houston Patients: Robotic and Minimally Invasive Options

Robotic-assisted surgery allows precise removal of deep pelvic endometriosis through small incisions. Recent studies demonstrate that robotic multidisciplinary approaches provide good perioperative outcomes with shorter hospital stays compared to traditional open surgery.

I use robotic techniques for most bowel endometriosis cases in Houston. The enhanced visualization and instrument precision help me work safely in the deep pelvis. This approach typically involves collaboration with gynecologic surgeons to address all disease sites.

Specialized colorectal care includes advanced minimally invasive techniques tailored to your unique anatomy and disease extent.

Robotic hybrid techniques have shown acceptable complication rates and good functional outcomes. The procedure may involve bowel resection with reconnection, shaving of superficial disease, or disc excision depending on disease depth.

Minimally invasive surgery reduces postoperative pain and speeds recovery. Most patients go home within two to three days. The smaller incisions mean less tissue trauma and typically faster return to normal activities compared to open surgery.

What to Expect: Recovery and Outcomes

Recovery from bowel endometriosis surgery typically takes four to six weeks. Most patients experience significant pain improvement within the first few months. Quality of life improvements often include better bowel function, reduced pelvic pain, and improved ability to work and maintain relationships.

Hospital stay usually lasts two to three days. I encourage early walking and gradual return to normal diet. Some patients experience temporary bowel changes as the intestine heals—this typically resolves within weeks.

Potential complications include infection, bleeding, or temporary bowel dysfunction. Serious complications are uncommon with experienced surgical teams. I discuss specific risks based on your disease extent and overall health.

Long-term outcomes depend on disease severity and completeness of excision. Many patients experience years of symptom relief after surgery. Some may need ongoing hormonal management to prevent recurrence. Regular follow-up helps monitor for any returning symptoms.

If fecal incontinence is a concern after advanced pelvic surgery, ask about Axonics sacral neuromodulation as an effective, minimally invasive option for restoring continence and quality of life.

A Patient's Perspective

I've worked with many patients facing the difficult decision about bowel endometriosis surgery.

One patient who recently trusted me with her care shared her experience:

"I recently had surgery performed by Dr. Belizaire, and I cannot express how grateful I am for the exceptional care I received."

  —  Paulyann

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

Every surgical journey is different. What matters most is creating a plan that addresses your specific concerns while preserving function and dignity throughout the process.

Conclusion

Bowel endometriosis surgery offers meaningful relief when symptoms interfere with your daily life despite medical management. Modern robotic techniques allow precise disease removal while preserving bowel function whenever possible. Enhanced recovery protocols help patients return to normal activities faster after colorectal procedures.

I work with gynecologic specialists to create individualized surgical plans that address your specific concerns. Not every case requires bowel resection—careful evaluation helps determine whether shaving, disc excision, or resection best serves your goals. Management options exist for bowel dysfunction that may occur after pelvic surgery.

I serve Houston and nearby communities such as Houston Heights, Medical Center, and surrounding areas. If you're experiencing symptoms that limit your work, relationships, or daily function, don't wait.

Schedule a same-day consultation at Houston Community Surgical. 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.

For more expert tips and updates on advanced colorectal treatments and surgical options, subscribe to my colorectal health newsletter.

Frequently Asked Questions

How do I know if my bowel symptoms are from endometriosis?

Bowel endometriosis typically causes pain that worsens during your menstrual cycle. You may experience painful bowel movements, bloating, constipation, or diarrhea that follows a monthly pattern. These symptoms often get dismissed as irritable bowel syndrome. Advanced imaging like MRI or transvaginal ultrasound can identify endometrial tissue on or in the bowel wall.

Sometimes colonoscopy is needed to rule out other conditions. If your bowel symptoms align with your cycle and haven't responded to standard treatments, evaluation by a colorectal surgeon with endometriosis experience can help determine whether bowel involvement is present.

What is the recovery time after bowel endometriosis surgery?

Most patients go home within two to three days after minimally invasive bowel endometriosis surgery. Full recovery typically takes four to six weeks. You'll experience some fatigue and temporary bowel changes as your intestine heals. I encourage early walking and gradual return to normal diet.

Many patients notice significant pain improvement within the first few months. Return to work depends on your job—desk work may be possible within two weeks, while physically demanding jobs may require four to six weeks. Individual recovery varies based on disease extent and whether bowel resection was needed.

Will I need a colostomy after bowel endometriosis surgery?

Colostomy is rarely needed for bowel endometriosis surgery. Modern techniques allow me to remove disease and reconnect the bowel in most cases. Temporary diversion may be considered if extensive resection is required or if healing concerns exist, but this is uncommon. Most patients undergo bowel resection with immediate reconnection and never need a stoma.

During your consultation, I'll review your imaging and discuss whether your specific situation might require temporary diversion. The vast majority of my patients with bowel endometriosis maintain normal bowel continuity throughout their surgical journey.

Where can I find bowel endometriosis surgery in Houston?

Dr. Ritha Belizaire at Houston Community Surgical provides physician-led evaluation and treatment for bowel endometriosis. Located in Houston and serving patients from Houston Heights, Medical Center, and surrounding areas, my practice focuses on clear answers, respectful care, and evidence-based surgical options. If you're unsure what's causing your symptoms, scheduling a visit can help you understand next steps.