Bowel Symptoms In Women Research Articles

Squatting-based exercises cure bedwetting in children and improve pain and bladder symptoms in premenopausal women.

This paper explores a practical approach to pelvic floor health called the Skilling technique. Unlike the commonly recommended "squeezing upwards" method which teaches a woman to voluntarily squeeze upwards (a learnt technique), the Skilling method is entirely reflex: the squatting-based exercises on which it is based, strengthen the three reflex pelvic muscle forces which pull against the suspensory ligaments pubourethral ligament (PUL) and uterosacral ligament (USL) to: close the urethra during effort (control of stress incontinence), open the urethra during micturition, and stretch the vagina in opposite directions to control inappropriate activation of the micturition reflex [overactive bladder (OAB)]. The strengthened ligaments better support the pelvic visceral plexuses (VPs), which unsupported, can fire off de novo impulses which the brain interprets as "chronic pelvic pain". This review investigates the impact of the Skilling technique on pain, bladder and bowel symptoms in women. In premenopausal women, results show a 50% symptom improvement in 68% to 82% of women who have chronic pelvic pain, urge, frequency, nocturia, abnormal emptying, and post-void residual urine. A modified Skilling technique was applied in children aged 6-11 years with day/night enuresis. Remarkably, an 86% cure rate was achieved over 4 months. It was hypothesized that this accelerated cure, which is achieved naturally with age, may be connected to the reinforcement of collagen which occurs with the increase in pubertal hormones. In summary, the Skilling technique is a promising and accessible method to enhance pelvic floor health for both women and children, offering a practical alternative to traditional approached like Kegel exercises.

Changes in bowel symptoms after different pelvic organ prolapse surgeries among elderly women at the 1-year follow up.

To investigate the prevalence of bowel symptoms in patients with pelvic organ prolapse (POP), to evaluate the changes in bowel symptoms after different POP surgeries, and to identify risk factors for unrelieved bowel symptoms. This was an observational prospective cohort study conducted at Peking University First Hospital from 2020 to 2021. Demographic, clinical, and therapeutic data were collected. Participants underwent POP Quantification examination and completed the Pelvic Floor Distress Inventory-20 questionnaire at baseline and 1 year postoperatively. The prevalence of bowel symptoms and bothersome bowel symptoms in women with POP was 46.38% and 24.40%, respectively. Surgical correction of prolapse was associated with significant relief in bowel symptoms (P < 0.05). Colpocleisis may relieve bowel symptoms better than reconstructive surgeries (41% vs. 31%, P = 0.048). However, 35% of women had at least one bowel symptom at the 1-year follow up. A long perineal body (Pb) and levator ani muscle injury were found to be predictors of unrelieved bowel symptoms in patients undergoing colpocleisis and those undergoing reconstructive surgery, respectively (odds ratio [OR] 2.306, 95% confidence interval [CI] 1.112-4.783, P = 0.025 and OR 3.245, 95% CI 1.266-8.317, P = 0.014, respectively), and perineoplasty was a protective factor for women who underwent colpocleisis (OR 0.102, 95% CI 0.025-0.417, P = 0.001) CONCLUSION: Women with POP have a high prevalence of bowel symptoms. Although bowel symptoms can be relieved after POP surgeries, one-third of women still experience bowel symptoms. A long Pb and levator ani muscle injury were associated with unrelieved bowel symptoms, while perineoplasty was a protective factor.

Bladder and bowel symptoms following imprisonment in West Australian female prisons

PurposeThe purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL).Design/methodology/approachOver a 12-month period 29 women, recently released from Western Australia’s female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King’s Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL.FindingsOf those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health.Originality/valueWomen imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.

Effects of Alfuzosin, an α1-Adrenergic Antagonist, on Anal Pressures and Bowel Habits in Women With and Without Defecatory Disorders

Some patients with defecatory disorders (DD) have high anal pressures that may impede rectal evacuation. Alpha-1 adrenoreceptors mediate as much as 50% of anal resting pressure in humans. We performed a randomized, placebo-controlled study of the effects of alfuzosin, an alpha1-adrenergic receptor antagonist, on anal pressures alone in healthy women and also on bowel symptoms in women with DD. In a double-blind study performed from March 2013 through March 2017, anal pressures were evaluated before and after 36 women with DD (constipation for at least 1 year) and 36 healthy women (controls) were randomly assigned (1:1) to groups given oral alfuzosin (2.5 mg immediate release) or placebo. Thereafter, patients were randomly assigned (1:1) to groups given oral alfuzosin (10 mg extended release) or placebo each day for 2 weeks. Participants kept daily diaries of bowel symptoms for 2 weeks before (baseline) and during administration of the test articles (treatment). Weekly questionnaires recorded the overall severity of constipation symptoms, bloating, abdominal pain, nausea, and vomiting; overall satisfaction with treatment of constipation was evaluated at weeks 2 and 4. The primary endpoint was the change in the number of spontaneous (SBMs) and complete SBMs (CSBMs) between the treatment and baseline periods. We evaluated relationships between stool form, passage, and complete evacuation. Alfuzosin reduced anal resting pressure by 32 ± 3 mm Hg versus 16 ± 3 mm Hg for placebo (P=.0001) and anal pressure during evacuation by 26 ± 3 mm Hg versus 16 ± 3 mm Hg for placebo, (P= .03). However, alfuzosin did not significantly increase the rectoanal gradient, SBMs or CSBMs compared with placebo. Both formulations of alfuzosin were well tolerated. Hard stools and the ease of passage during defecation accounted for 72% and 76% of the variance in the satisfaction after defecation, respectively, during baseline and treatment periods. In a randomized trial, alfuzosin reduced anal pressure at rest and during simulated evacuation in healthy and constipated women, compared with placebo, but did not improve bowel symptoms in constipated women. This could be because the drug does not improve stool form or dyssynergia, which also contribute to DD. ClinicalTrials.gov number, NCT01834729.

Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study

Study ObjectiveTo assess long-term bowel symptoms in women who underwent segmental bowel resection for deep-infiltrating endometriosis (DIE) compared with women who underwent resection of severe endometriosis without bowel resection. DesignCohort study with matched controls (Canadian Task Force classification II-2). SettingCleveland Clinic. Patients71 patients (36 cases and 35 controls). InterventionsPatients who were at least 4 years out from undergoing segmental bowel resection due to DIE were matched with patients who had undergone resection of stage III/IV endometriosis without bowel resection. The patients completed validated questionnaires, and data were analyzed using the Wilcoxon rank-sum, χ2, and Fisher exact tests. Measurements and Main ResultsThe Bristol Stool Form Scale, Patient Assessment of Constipation Symptoms Questionnaire (PAC-SYM), and St Mark's Vaizey Fecal Incontinence Grading System were used to elicit information. The median duration of follow-up was 10.1 years (range, 4–18 years). The mean patient age and body mass index were comparable in the cases and the controls. A larger proportion of cases than controls reported new bowel symptoms (58% [21 of 36] vs 14% [5 of 35]; p = .001), as well as abdominal pain, incomplete bowel movements, and false alarms on the PAC-SYM questionnaire; however, total PAC-SYM and Vaizey Fecal Incontinence Grading System scores were similar in the 2 groups (median, 8 [interquartile range, 8–10] vs 8 [8–10]; p = .86). Similarly, the proportion of patients with normal stool consistency (Bristol Stool Form Scale score 2–6) was similar in the 2 groups (80.6% [29 of 36] vs 94.3% [33 of 35]; p = .59). ConclusionSegmental bowel resection for DIE may be associated with a higher incidence of new bowel symptoms (possibly due to abdominal pain, incomplete bowel movements, and/or false alarms), but not with worse constipation or fecal incontinence, compared with surgery without bowel resection.

Postoperative bowel function, symptoms, and habits in women after vaginal reconstructive surgery.

The objective was to characterize postoperative bowel symptoms in women undergoing vaginal prolapse reconstructive surgery randomized to preoperative bowel preparation vs a regular diet. Subjects (N = 121) completed two bowel diaries: a 7-day bowel diary immediately before surgery and a 14-day diary postoperatively. Self-reported bowel diary data and symptoms included the time to first bowel movement (BM), daily number of BMs, Bristol Stool Form Scale score, pain, and urgency associated with BM, episodes of fecal incontinence, and use of laxatives. Antiemetic use was abstracted from medical records. Outcomes of groups were compared using Chi-squared/Fisher's exact test or Student's t test as appropriate. Mean time to first postoperative BM was similar in the bowel preparation (n = 60) and control groups (n = 61), 81.2 ± 28.9 vs 78.6 ± 28.2 h, p = 0.85. With the first BM, there were no significant differences between bowel preparation and control groups regarding pain (17.2 vs 27.9 %, p = 0.17), fecal urgency with defecation (56.9 vs 52.5 %, p = 0.63), fecal incontinence (14.0 vs 15.0 %, p = 0.88) and >1 use of laxatives (93.3 vs 96.7 % p = 0.44) respectively. Antiemetic use was similar in both groups (48.3 vs 55.7 % respectively, p = 0.42). There were no differences in the return of bowel function and other bowel symptoms postoperatively between the randomized groups. Lack of bowel preparation does not have an impact on the risk of painful defecation postoperatively. This information may be used to inform patients regarding expectations for bowel function after vaginal reconstructive surgery.

Prevalence of unreported bowel symptoms in women with pelvic floor dysfunction and the impact on their quality of life

Little information is available on the recurrent coexistence of pelvic organ prolapse (POP), urinary (UI) and/or anal (AI) incontinence and defecatory dysfunctions and the relationship between these disorders. The purpose of this study is to report the prevalence, bother, and impact on quality of life (QoL) of unreported bowel symptoms in women presenting to a Brazilian tertiary urogynecology clinic. The study was a cross-section survey of 172 patients with symptoms of pelvic floor disorders (PFD). Patients who reported any defecatory and/or continence disorders were included in the study group, and the others were included in the control group. Patients with UI were also compared with those with double incontinence (DI): AI and UI. Univariate analysis was conducted using the Mann-Whitney U test for continuous nonparametric data. After the interview, 54.6% (n = 94) of patients presented AI and/or defecatory disorders: 67.0% constipation, 41.4% AI, and 34.0% fecal urgency. Women from the study group scored worse in the QoL questionnaires compared with women from the control group. Among women with UI, 23.21% had associated AI. Women with DI scored worse in the QoL questionnaires. Anal and urinary dysfunctions are usually associated and have a great impact on a woman's QoL. An integrated approach across specialties should lead to improved patient care. Therefore, our study is relevant because it emphasizes the importance of urogynecologists routinely investigating such symptoms. To do so, standardized questionnaires should be included in the evaluation of all these patients.

Increased Fluid Intake Is Associated With Bothersome Bowel Symptoms Among Women With Urinary Incontinence

To determine the association between the type and volume of fluid intake and bowel symptoms in women with urinary incontinence. We hypothesize that a lower volume of fluid intake would be associated with greater straining with bowel movements in women with urinary incontinence. We performed a cross-sectional study of 256 women presenting with complaints of urinary incontinence from 2009 to 2010. Data on fluid intake, fluid intake behavior, urinary and bowel symptoms were collected using validated questionnaires. The relationship between quartiles of total daily fluid intake and bowel symptoms was analyzed. The behavior of restricting fluid intake was reported by 32% of the women. Increasing quartiles of total daily fluid intake was significantly associated with greater bother from straining with bowel movements (P = 0.04). Women with no bother from straining with bowel movements had significantly lower median daily fluid intake (2839 mL) than women with quite a bit of bother (3312 mL; P = 0.01). The association between the volume of fluid intake and straining with bowel movements persisted after controlling for age, body mass index, history of prolapse or incontinence surgery, and stage of prolapse (P < 0.05). There was no association between caffeinated fluid intake and any bowel symptom or between the behavior of restricting fluid intake and any bowel symptom. In women with urinary incontinence, higher volume of total fluid intake is reported by women with greater straining with bowel movements. The behavior of fluid restriction is not associated with bothersome bowel symptoms.

Tu2018 Rectal Compliance, Acclimation, and Bowel Symptoms in Women With Irritable Bowel Syndrome (IBS)

Tu2018 Rectal Compliance, Acclimation, and Bowel Symptoms in Women With Irritable Bowel Syndrome (IBS)

Prevalence of bowel symptoms in women with pelvic floor disorders

To determine the prevalence of a variety of bowel symptoms in women with pelvic floor disorders We reviewed charts of consecutive new patients presenting to our urogynecologic clinic between July 2006 and April 2008. Women completed two bowel symptom questionnaires: (1) a nonvalidated questionnaire inquiring about symptoms of fecal/flatal incontinence, painful bowel movements, difficulties in bowel movement, and the need for splinting and (2) the validated, Colorectal-Anal Distress Inventory (CRADI) subscale of the short form of the Pelvic Floor Distress Inventory. Demographic and clinical information were extracted from patients' charts. Four hundred sixty-three women were included. Only 3% of the women presented with defecatory dysfunction or fecal incontinence as their chief complaint. However, 83% answered affirmatively to the presence of at least one CRADI bowel symptom. The most common bowel symptom was incomplete emptying at the end of a bowel movement (56%), followed by straining to have a bowel movement (55%), and flatal incontinence (54%). Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms.

Bowel Symptoms in Women One Year After Sacrocolpopexy

Bowel Symptoms in Women One Year After Sacrocolpopexy

Bowel symptoms in women 1 year after sacrocolpopexy

The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy. This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II-IV prolapse. In addition to sacrocolpopexy (+/- Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon's discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively. The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups. Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.

A Randomized, Double-Blind, Placebo-Controlled Study to Assess Efficacy and Safety of 0.5 mg and 1 mg Alosetron in Women With Severe Diarrhea-predominant IBS

Alosetron is indicated for women with chronic, severe diarrhea-predominant IBS (d-IBS) who have not responded adequately to conventional therapy. Constipation is the most common adverse event with alosetron treatment. Multiple dosing regimens were assessed in a randomized, double-blind, placebo-controlled study (S3B30040) to determine efficacy, tolerability, and evaluate constipation rate. 705 women with severe d-IBS were randomized to placebo, alosetron 0.5 mg once daily, 1 mg once daily, or 1 mg twice daily for 12 wk. The primary end point was the proportion of week 12 responders (patients with moderate or substantial improvement in IBS symptoms) on the 7-point Likert Global Improvement Scale (GIS). Secondary end points were average rate of adequate relief of IBS pain and discomfort, and bowel symptom improvements. The proportion of GIS responders at week 12 (primary time point) was significantly greater in all alosetron groups compared with placebo (54/176 [30.7%], 90/177 [50.8%], 84/175 [48%], and 76/177 [42.9%] for placebo, 0.5, 1 mg once daily, and 1 mg twice daily alosetron groups, respectively; P< or = 0.02). Results were similar for the average adequate relief rate (treatment effects > or =12%, P< or = 0.038). Bowel symptoms were improved in all alosetron groups. Constipation was the most common adverse event (9%, 16%, and 19% patients in the 0.5 mg, 1 mg once daily, and 1 mg twice daily groups, respectively). One event of intestinal obstruction and one of ischemic colitis occurred in the 0.5 mg group, and one event of fecal impaction occurred in the 1 mg twice-daily group. All were self-limited and resolved without sequelae. Alosetron 0.5 mg and 1 mg once daily as well as 1 mg twice daily are effective in providing global improvement in IBS symptoms, adequate relief of IBS pain and discomfort, and improvement in bowel symptoms in women with severe d-IBS. Lower dosing regimens resulted in a decreased constipation rate.

Bowel symptoms in women planning surgery for pelvic organ prolapse

The objective of the study was to measure associations between bowel symptoms and prolapse. Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed. Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. Colorectal-Anal Distress Inventory obstructive subscale scores were higher in stage II women (median 29 [interquartile range 8,92] versus 17 [0,33] and 25 [0,38] for stages III and IV, respectively; adjusted P = .01). The few statistically significant correlations between symptoms and vaginal descent were negative and weak (less than 0.2). Bowel symptoms and questionnaire scores do not increase with prolapse stage in women presenting for sacrocolpopexy.

Prevalence of anorectal dysfunction in women attending health care services

The aim of this study was to assess the prevalence of different bowel symptoms (constipation, faecal incontinence and faecal evacuation dysfunction) and associated urinary symptoms in women attending health care services. All women attending colposcopy clinics and general gynaecology clinics in a district general hospital in the southwest of England were invited to participate in the study. In addition, women attending the local family planning clinic were also recruited. Women attending these clinics routinely completed a history sheet and were asked to complete the Birmingham Bowel and Urinary Symptoms Questionnaire. Two hundred women participated in the study: 116 (64.4%) had at least one bowel symptom from the list in the questionnaire and 57 (31.6%) of women thought they had a bowel problem but only 26 (14.4%) consulted their family doctor regarding the problem while four (2.2%) were referred for specialist opinion. Six were unsure about their bowel symptoms. There were 46 (25.5%) of women who had constipation, 99 (55%) had faecal incontinence and 97 (53.8%) complained of faecal evacuation dysfunction. Only 48 (26.6%) of women were free of any bowel complaint. One patient with faecal incontinence discussed her problem with her midwife but no further action was taken as she was too embarrassed to discuss it with her doctor. Seventy-eight (43.3%) of patients had urinary symptoms. Fifty-five (30.5%) thought they had a urinary problem but only 29 (16.1%) consulted their doctor and 17 (9.4%) were referred for specialist opinion. Sixty-one (33.8%) of those who admitted to have urinary incontinence also had faecal incontinence. Forty-nine (27.2%) of the patients were free of all symptoms. The mode of delivery as well as previous surgery did not have any influence on urinary incontinence nor on anal incontinence. This study has demonstrated a high prevalence of bowel symptoms in women attending health care services.

Anal sphincter defects and bowel symptoms in women with and without recognized anal sphincter trauma

The purpose of this study was to determine the rate of new bowel symptoms and anal sphincter defects in primiparous women with and without recognized anal sphincter (AS) injury. One hundred seventeen primiparous women classified with increasing degrees of perineal trauma and 21 controls delivered by cesarean section were enrolled immediately postpartum and demographic and delivery data were collected. At 6 weeks' postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Logistic regression, chi-square, and 2-sample t tests were used for statistical analysis. A significant difference in new bowel symptoms was reported in women with (39%) and without (11%) recognized AS injury (P = .002). AS defects were present in 0%, 15%, 23%, 37%, and 67% of women with C/S, first-, second-, third-, and fourth-degree lacerations, respectively. Combined defects of the internal and external AS were associated with the greatest risk of new bowel symptoms (OR 32.1 [95% CI 9.6-107], P < .001). In women with and without recognized AS trauma, new bowel symptoms were strongly correlated with the presence of anatomic AS defects postpartum.

Poster 20: Bowel Symptoms in Women With Urge Urinary Incontinence Aged 40???60 Years

OBJECTIVE: The objective of this study was to determine if there is an association between symptoms of urge urinary incontinence and abnormal bowel symptoms. METHODS: The study group consisted of 46 consecutive women in the age group 40–60 years reporting urge urinary incontinence on their initial evaluation. The control group consisted of 38 women without urinary incontinence reporting to the gynecology clinic for their annual examination. All women were administered 3 validated questionnaires to evaluate urinary symptoms, irritable bowel symptoms, and symptoms of constipation. Women taking anticholinergic medications and women with inflammatory bowel disease were excluded. RESULTS: The 2 groups were similar with respect to age (mean 51.7 ± 5.7 vs 50.6 ± 5.3 years), race, menopausal status (57% vs 50%), and parity (2.5 ± 1.35 vs 2.7 ± 1.9). Women in the study group were significantly more likely to report strong or overwhelming sensation to void (40%) compared with the control group (5%, P<0.001). Women in the study group were also more likely to report decreased length of time between daytime voids (median 1.3 hours) and decreased number of episodes of nocturia (median 1.5) when compared with the control group (median 1.7 hours and 0.5 episodes, respectively, P<0.001). The average score on the irritable bowel symptom questionnaire for women in the study group (2.1 ± 1.2) was similar to that of control women (1.7 ± 0.9, P=0.8). However, women in the study group scored significantly higher on the constipation questionnaire (0.73 ± 0.75) than control women (0.40 ± 0.49, P=0.02). Women with urge incontinence had higher scores than control women with respect to the following bowel symptoms: bowel movements that were hard, small, incomplete, and painful, as well as stomach cramps and straining with bowel movements. CONCLUSION: Symptoms of constipation are more common in women presenting with urge incontinence than control women in the 40- to 60-year age group.

Paper 43: Bowel Symptoms in Women With and Without Recognized Anal Sphincter Trauma

OBJECTIVES: 1) To determine the rate of new bowel symptoms and anal sphincter defects in primiparous women with and without recognized anal sphincter injury and 2) To determine if bowel symptoms correlate with anal sphincter defects on endoanal ultrasonography. METHODS: A cohort of 117 primiparous women classified with increasing degrees of perineal trauma and 21 controls delivered by Cesarean section were recruited immediately postpartum. All subjects completed a Modified Manchester Bowel Function Questionnaire to estimate predelivery bowel habits and demographic and delivery data was collected. Subjects returned at 6-weeks postpartum where a repeat Manchester questionnaire was completed and endoanal ultrasonography was performed. The internal and external anal sphincters were evaluated and were reported as intact versus disrupted. Chi-square and student t-test were used for statistical analysis. RESULTS: A significant increase in new bowel symptoms was found in subjects with increasing perineal trauma: 1/21 (4.8%) c/s subjects, 6/54 (11%) 1st and 2nd degree lacerations, and 25/64 (39%) 3rd and 4th degree tears, P=0.002. The overall rates of anal sphincter defects in women with 1st, 2nd, 3rd, and 4th degree lacerations was 15%, 23%, 37%, and 67%, respectively. No defects were noted in the c/s group. The specific defects by degree of laceration are presented in the table. The presence of new bowel symptoms was strongly correlated with anal sphincter defects in each laceration group (P values 0.0001–0.03). The greatest risk of new bowel symptoms was found in women with combined defects of the internal and external anal sphincters (OR 18.7, 95% CI 3–101, P<0.001). CONCLUSIONS: Anal sphincter defects were found with increasing frequency in subjects assigned with increasing degrees of perineal lacerations. New bowel symptoms were strongly correlated with the presence of anal sphincter defects on ultrasound.TABLE 1

Intestinal endometriosis

Endometriosis involving the intestine usually takes the form of asymptomatic, small, superficial serosal implants on segments of bowel lying in the pelvis in proximity to the genital organs. Deeper and more extensive intestinal wall involvement may result in obstruction and occasionally bleeding and requires distinction from a neoplasm or other inflammatory bowel process. Intestinal endometriosis should be considered in the differential diagnosis of recurring lower abdominal pain and other episodic bowel symptoms in women of child-bearing age. The diagnosis may be suspected based on the patient's history and frequently associated gynecologic symptoms. Due to the extramucosal location of the endometrioma, preoperative evaluation is unlikely to establish the diagnosis with certainty. Intestinal involvement by endometriosis, to the degree that it produces symptoms, almost always requires excision. Asymptomatic serosal lesions found incidentally at celiotomy for other disease should be biopsied and the diagnosis confirmed by frozen section. Symptomatic disease should be treated by resection of the involved intestine or by local excision, if the latter is feasible, and primary colon carcinoma can be excluded with confidence. Decisions regarding concurrent treatment for the underlying endometriosis should be made after consultation with an experienced gynecologist and must be based on the patient's menstrual status, age, and desire for future pregnancy.