In cases where patients pain persists despite medical management, surgery for endometriosis should be considered. The goal of surgery is to both diagnose and treat endometriosis. During surgery endometriosis implants are removed and/or destroyed. Research shows long-term symptom relief following surgery for endometriosis. An expert endometriosis surgeon is able to remove endometriosis from the ovaries, bladder, pelvis, ureters, intestines, fallopian tubes, and other organs. Surgery is performed through a minimally invasive approach (either laparoscopic or robotic) and does not require an overnight hospital stay. Endometriosis surgery can be challenging due to scar tissue and difficult anatomy, and an expert with additional training is recommended. The goal of our MIGS team is to partner with the patients to make surgical decisions that can improve their quality of life.
In the literature, up to 10% of patients who have endometriosis will have intestinal involvement of which, 85-90% are located on the rectosigmoid colon. Complete surgical management includes removal of all endometriosis, including disease located on the intestines. Depending on the size and location of the endometriosis, this could involve superficial removal or bowel resection.
Our colorectal team, led by Dr. Melissa Murphy, are experts in the workup, diagnosis, and management of intestinal endometriosis. If intestinal endometriosis is suspected, combination surgery with gynecology and colorectal surgery results in the safest and best patient outcomes.
Patients suffering from endometriosis can also experience dysfunction in their pelvic floor. Chronic pain can cause trauma to the muscles, ligaments, nerves, and fascia of the pelvis and abdominal wall. This can result in pain in the pelvis, difficulty urinating, difficulty having bowel movements, painful sex, and pain with movement. Pelvic floor therapy directly targets the pelvic floor to improve patients’ symptoms. Research shows that patients with endometriosis have improved pain relief when treated with pelvic floor physical therapy after surgery. Pelvic floor physical therapy combines exercises, stretches, manual techniques, and behavior modification to improve patients’ quality of life. Pelvic floor physical therapists partner with the patient to identify their function and quality of life goals to achieve maximal results.
Endometriosis can cause gastrointestinal symptoms such as diarrhea, constipation, bloating, painful bowel movements, and nausea. Many of these symptoms overlap with other gastrointestinal conditions such as irritable bowel disease, inflammatory bowel disease, celiac disease, and food sensitivities. Additionally, patients with endometriosis are almost twice as likely to have irritable bowel disease. Women & Infants Center for Women’s Gastrointestinal Health offers a comprehensive multidisciplinary focus on gastrointestinal conditions for patients suffering from chronic pelvic and abdominal pain. Our team is experienced in endometriosis and works closely with the gynecology team to improve the quality of life for their patients.
Patients with endometriosis and chronic pelvic pain can have dietary triggers which worsen their symptoms. Adjusting your diet can improve your quality of life and daily function. Teaming with a dietician and the nutrition team can help you learn how to eat a healthy and balanced diet.
Patients suffering from chronic pelvic pain often have bladder and urinary symptoms. This includes pain with emptying the bladder, pain with a full bladder, frequent urination, and urinary urgency. Endometriosis can grow on the bladder and cause these symptoms, but this is rare. More commonly, patients with endometriosis also have painful bladder syndrome, a chronic condition where the patient has pain or pressure in their bladder and/or pelvis. Our providers in urogynecology are national experts in painful bladder syndrome and pelvic floor dysfunction, conditions patients with endometriosis often have. If you have urinary symptoms, consult with our urogynecology team for treatment.
Endometriosis is associated with a higher risk of infertility, or the inability to become pregnant. Not every patient with endometriosis will have infertility and not every patient with infertility has endometriosis. Endometriosis can contribute to infertility by causing scarring in the pelvis including the fallopian tubes and ovaries, chronic inflammation, decreased egg growth, and hormonal imbalances. Our team of infertility providers are experienced in the treatment of endometriosis-associated infertility. They can partner with you to discuss medical and surgical treatment, egg freezing, and IVF.
