Signs of Bowel Endometriosis That Are Often Misdiagnosed in Houston, TX

By Dr. Ritha Belizaire

Quick Insights

Bowel endometriosis symptoms occur when endometrial tissue grows on or into the intestinal wall. This causes painful bowel movements, bloating, and changes in bowel habits. Endometriosis and irritable bowel syndrome (IBS) share overlapping symptoms, which can lead to diagnostic challenges and potential misdiagnoses. The rectum and sigmoid colon are affected in up to 90% of cases. Many patients receive an IBS diagnosis for years before the true cause is identified.

Key Takeaways

• Women with bowel endometriosis often experience painful bowel movements that worsen during menstrual periods.
• Symptoms include alternating diarrhea and constipation, rectal bleeding during periods, and severe abdominal cramping.
• Deep infiltrating endometriosis can penetrate the bowel wall, requiring specialized imaging like MRI or ultrasound.
• Accurate diagnosis typically requires evaluation by a colorectal surgeon familiar with endometriosis patterns.

Why It Matters

Understanding these gastrointestinal endometriosis signs helps you recognize when digestive issues need specialist evaluation. Persistent bowel symptoms that align with your menstrual cycle deserve more than an IBS diagnosis. Early identification can prevent years of unnecessary discomfort and guide you toward appropriate treatment options that address the underlying condition.

Introduction

As a board-certified colorectal surgeon serving Houston, some women report that their digestive symptoms were initially attributed to irritable bowel syndrome, leading to delays in the accurate diagnosis of endometriosis.

Bowel endometriosis symptoms occur when endometrial tissue grows on or into the intestinal wall, causing painful bowel movements, bloating, and changes in bowel habits that closely mimic IBS. The rectum and sigmoid colon are affected in up to 90% of cases, yet many patients receive an IBS diagnosis without imaging or specialist evaluation.

If your digestive symptoms worsen during your menstrual cycle, you may need more than dietary changes or fiber supplements. At Houston Community Surgical, I provide specialized imaging and evaluation for bowel endometriosis symptoms that require a colorectal surgeon familiar with this condition.

This article explains the specific signs that suggest bowel involvement and when specialist evaluation is appropriate.

What Is Bowel Endometriosis and Why Is It Overlooked?

Bowel endometriosis occurs when endometrial tissue grows on or into the intestinal wall. This tissue responds to your menstrual cycle just like the lining of your uterus. During your period, it swells and bleeds, causing inflammation in the bowel wall.

Deep infiltrating endometriosis can penetrate several millimeters into the bowel wall. The rectum and sigmoid colon are most commonly affected because of their proximity to the uterus and ovaries.

In my Houston practice, I see patients whose symptoms were attributed to IBS for years. The key difference is timing. Bowel endometriosis symptoms typically worsen during menstruation, while IBS symptoms follow no predictable pattern related to your cycle.

Many physicians don't consider endometriosis when evaluating digestive complaints. Standard IBS workups include blood tests and sometimes colonoscopy, but these tests often appear normal in bowel endometriosis. The tissue grows on the outside of the bowel wall, not inside where a colonoscopy can see it.

This diagnostic gap leaves many women managing symptoms without addressing the underlying cause.

Common Bowel Endometriosis Symptoms in Houston That Mimic IBS

The most common bowel endometriosis symptoms include painful bowel movements, bloating, and alternating diarrhea and constipation. These mirror classic IBS complaints, which explains why misdiagnosis is so frequent.

Research shows that symptom variability makes diagnosis challenging. You might experience severe cramping with bowel movements one week, then constipation the next. This inconsistency often leads physicians to conclude that you have a functional disorder rather than a structural disease.

Dyschezia—difficulty or pain with bowel movements—is particularly common. Studies describe this symptom as one of the most reliable indicators of bowel involvement. The pain typically feels deep in the pelvis or rectum and intensifies with straining.

Some women notice rectal bleeding during their periods. This isn't the bright red blood you'd see with hemorrhoids. Instead, it appears as dark blood mixed with stool, occurring only during menstruation.

I've observed that patients often describe a feeling of incomplete evacuation. You feel like you need to have a bowel movement, but nothing happens when you try. This sensation results from inflammation and swelling in the bowel wall during your cycle.

Severe bloating that worsens throughout your period is another hallmark sign. Your abdomen may become visibly distended, and clothing that fit comfortably days earlier suddenly feels tight.

Red Flags That Suggest More Than IBS

Certain patterns should prompt you to seek specialist evaluation rather than accepting an IBS diagnosis. The most significant red flag is symptom timing that aligns with your menstrual cycle.

If your digestive symptoms consistently worsen during your period, this suggests hormonal influence. IBS symptoms fluctuate based on stress, diet, and other factors, but they don't follow a monthly pattern tied to menstruation.

Diagnostic pathways and imaging become essential when symptoms persist despite standard IBS treatments. If you've tried dietary modifications, fiber supplements, and medications without improvement, further investigation is warranted.

Clinical guidance suggests that lesions larger than one centimeter or those penetrating more than five millimeters into the bowel wall require surgical evaluation. These measurements can only be determined through specialized imaging.

Pain with intercourse, especially deep penetration, combined with bowel symptoms raises suspicion for deep infiltrating disease. The proximity of the rectum to the vagina means that endometrial tissue affecting one area often impacts the other.

In my experience with Houston-area patients, women who describe their pain as "different" from typical cramping deserve thorough evaluation. If your pain feels sharp, stabbing, or localized to one side rather than generalized across your lower abdomen, this warrants imaging studies.

How Bowel Endometriosis Is Diagnosed in Houston

Accurate diagnosis requires imaging that can visualize tissue outside the bowel wall. Standard colonoscopy only examines the inside of your colon, missing external lesions entirely.

Multidisciplinary diagnostic approaches typically include pelvic MRI or transvaginal ultrasound performed by specialists experienced in identifying endometriosis. These imaging studies can show thickening of the bowel wall, nodules, and the relationship between endometrial tissue and surrounding structures.

MRI with bowel preparation provides the most detailed visualization. You'll drink contrast material that fills your colon, allowing radiologists to see how deeply tissue has infiltrated the bowel wall. This information guides treatment decisions.

I often coordinate with gynecologists who specialize in endometriosis to ensure comprehensive evaluation. Your symptoms may involve multiple pelvic organs, and treatment planning requires understanding the full extent of disease. Local medical institutions such as Baylor College of Medicine serve the broader Houston community with specialized diagnostic services.

Physical examination can sometimes detect nodules in the rectovaginal septum—the tissue between your vagina and rectum. This finding strongly suggests deep infiltrating endometriosis and prompts immediate imaging.

Blood tests and stool studies help rule out other conditions but don't diagnose bowel endometriosis. Normal inflammatory markers don't exclude this diagnosis. The inflammation is localized to the bowel wall and may not elevate systemic markers.

Definitive diagnosis ultimately requires surgical visualization, but imaging guides decisions about whether surgery is appropriate and what approach to use.

Specialized Colorectal Services and Advanced Treatment Options

When it comes to managing bowel endometriosis symptoms, individualized treatment is essential. My practice at Houston Community Surgical offers specialized colorectal care tailored to each patient's unique needs, including medical and minimally invasive surgical approaches.

For those experiencing fecal incontinence as a result of deep infiltrating endometriosis or pelvic floor dysfunction, we also offer Axonics sacral neuromodulation, an advanced treatment for improving bowel control and quality of life.

One Patient's Experience

I've learned that the most valuable feedback often comes from patients who felt heard after years of uncertainty.

"Dr Belizaire is awesome. I recommend her 100% because of her excellent bedside manner, operative skills, and experience. She is also just a top notch human being. Thank you for taking care of me, Dr Belizaire!!!"

                                                                                                        —   Sarah

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

When patients come to my practice after struggling with misdiagnosed symptoms, I focus on careful evaluation and clear explanations. Every patient deserves to understand what's happening in their body and to have their concerns taken seriously, especially when symptoms have been dismissed for years.

Conclusion

If your digestive symptoms consistently worsen during your menstrual cycle, you need more than an IBS diagnosis. Research demonstrates that minimally invasive surgical approaches can provide significant relief when bowel endometriosis is accurately identified and treated by a specialist familiar with this condition.

As a board-certified general and colorectal surgeon, I've helped hundreds of women finally get answers after years of dismissed symptoms. The key is recognizing that bowel endometriosis symptoms follow a predictable pattern tied to your menstrual cycle something IBS doesn't do.

Studies show that appropriate surgical intervention commonly provides pain relief and improved quality of life when conservative treatments have failed.

I serve Houston and nearby communities such as Houston Heights, Montrose, and surrounding areas with specialized colorectal care. If you're experiencing any of these symptoms, don't wait.

Schedule a same-day consultation to take the next step toward relief. 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.

Frequently Asked Questions

How do I know if my bowel symptoms are endometriosis or IBS?

The most reliable indicator is timing. Bowel endometriosis symptoms consistently worsen during your menstrual period, while IBS symptoms fluctuate based on stress, diet, and other factors without following a monthly pattern.

If you experience painful bowel movements, bloating, or changes in bowel habits that align with your cycle, specialist evaluation with imaging studies is appropriate. Standard IBS treatments that fail to provide relief also suggest the need for further investigation.

Can a colonoscopy detect bowel endometriosis?

Colonoscopy typically appears normal in bowel endometriosis because the tissue grows on the outside of the bowel wall, not inside where the scope can visualize. Accurate diagnosis requires specialized imaging like pelvic MRI or transvaginal ultrasound performed by radiologists experienced in identifying endometriosis.

These studies can show bowel wall thickening, nodules, and the depth of tissue infiltration. Physical examination may detect nodules in the rectovaginal area, which prompts immediate imaging.

What happens if bowel endometriosis goes untreated?

Untreated bowel endometriosis can lead to progressive symptoms including worsening pain, increasing bowel dysfunction, and potential bowel obstruction in severe cases. The inflammation and scarring can deepen over time, making surgical treatment more complex.

Many women experience years of unnecessary discomfort and reduced quality of life when the condition isn't properly diagnosed. Early specialist evaluation allows for appropriate treatment planning and may prevent progression to more extensive disease requiring complex surgical intervention.

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 symptoms. 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 the next steps.

If you want to stay informed about cutting-edge treatments for gastrointestinal endometriosis signs and receive physician updates, subscribe to my colorectal health newsletter.