What Is the Predictive Value of History Taking for Bowel Endometriosis?

Abstract

Study Objective: To assess the predictive value of history taking in the diagnosis of bowel endometriosis. Design: A prospective study between October 2004 and September 2008. Setting: University-affiliated tertiary referral centre for endometriosis. Patients: 454 consecutive women who underwent laparoscopic surgery for treatment of pelvic pain and/or infertility-associated endometriosis. Intervention: All patients completed a thorough history including a systematic check of bowel and non bowel symptoms. Logistic regression analyses were performed to investigate the predictive value of these symptoms in regards to bowel endometriosis. Measurements and Main Results: 36.5% had bowel endometriosis. Women with bowel endometriosis were more likely to have dyschezia (p value<0.001), constipation (p=0.001), diarrhoea (p=0.01), cyclical diarrhoea (p=0.009) and rectal bleeding (p value =0.028) compared to patients without bowel endometriosis. With regard to non bowel symptoms, dysmenorrhoea (p=0.02) and dyspareunia (p<0.001) were found to be significant predictors for bowel endometriosis. Using regression analyses, the odds ratio of dyschezia was 3.16 (95% CI: 2.07-4.82), rectal bleeding 2.76 (95% CI: 1.10-6.89), dyspareunia 2.35 (95% CI: 1.57-3.53), cyclical bowel frequency 1.89 (95% CI: 1.17-3.05), constipation 1.82 (95% CI: 1.16-2.85), diarrhoea 1.82 (95% CI: 1.16-2.85), and dysmenorrhoea 1.81 (95% CI: 1.08-3.01). Conclusion: A detailed systematic history of bowel and non bowel symptoms is an integral part in the evaluation of patients with endometriosis. Dyschezia is the most significant predictor followed by rectal bleeding. Findings from this study may contribute towards a surgical triage for patients with endometriosis.