endo and gastro problems, same symptoms?

• regular

  01/27/2010

  smilelots says:

  I've been having a lot of stomach pain and discomfort and it goes undiagnosed. I am beginning to wonder if the symptoms for endometriosis are the same and maybe I should be seeing a gyno instead of a gastro doc......... ??

  1 
• guru

  01/28/2010

  lynn says:

  Hi smilelots! It appears that you’re correct about this. I’ve summarized this explanation by Michael D. Birnbaum, MD, PC from his site www.infertilityphysician.com below.
  
  Intestinal Endometriosis
  
  Women with endometriosis frequently have gastrointestinal symptoms that were, until recently, attributed to IBS, a spastic colon, or, to those knowledgeable about endometriosis, to actual intestinal involvement from the disease itself. It is now clear that many with Endometriosis have intestinal involvement. That is, there are actual implants of Endometriosis either on or in the bowel wall. Medical literature reports an incidence of intestinal involvement ranging from 3-34%, the average being about 12%. Based on all the figures, a report in the New England Journal of Medicine estimates 5% of all women have intestinal Endometriosis.
  
  Pelvic Endometriosis is usually (but not always) limited to pre-menopausal women. Intestinal Endometriosis is different. It is not rare in post-menopausal women. In fact, when a post-menopausal woman develops Endometriosis, it almost always presents with intestinal involvement. As 70% of intestinal Endometriosis involves the sigmoid colon or rectum, it is initially believed to be colon or rectal cancer.
  
  The other intestinal sites (in decreasing order of frequency) are: appendix, cecum ( the initial portion of the colon), ileum (the last portion of the small intestine), and lastly, the transverse colon.
  
  Women with intestinal Endometriosis often have symptoms but, in most cases, the correct diagnosis is not made. To diagnose, one must ask the right questions. The diagnosis is usually made by history, because x-rays of the intestines do not show it and other studies such as colonoscopy do not show it either. Laparoscopy may or may not demonstrate implants on the bowel wall but you must know where to look. Endometriosis implants in the bowel wall may not be detectable except during open abdominal surgery.
  
  Diagnosing intestinal Endometriosis: A woman with intestinal Endometriosis will say that she has significant GI symptoms varying with her menstrual cycle. Symptoms may be present only at the time of the menstrual period or may be present all month long and worsen at the time of the period. Common symptoms are loss of appetite, nausea (but vomiting is rare), diarrhea, increased gas, significant bloating, crampy abdominal pain, painful bowel movements, and sharp stabbing rectal pain. Many women complain of constipation that seems to vary with the menstrual cycle. Unexplained iron- deficiency anemia may also be a clue to the presence of intestinal Endometriosis. Menstrually associated rectal bleeding is diagnostic of intestinal Endometriosis.
• guru

  01/28/2010

  lynn says:

  In many cases, it is obvious that the woman has intestinal Endometriosis. Either she has menstrually associated rectal bleeding or visible implants of Endometriosis on the (large or small) intestine at the time of laparoscopy. However, there is a sizable group of women who have all these symptoms but do not have rectal bleeding and whose intestinal surfaces appear normal at the time of laparoscopy. I was always willing to attribute the symptoms to either microscopic implants of Endometriosis in the bowel wall or larger implants that were hidden. Keep in the mind that it is the exception, not the rule, to find a woman who has a large mass of endometriosis in the bowel wall.
  
  Recent studies show that rather than attributing the gastrointestinal symptoms to hidden Endometriosis, there is in fact an associated intestinal abnormality that is seen in women with Endometriosis - abnormalities not found in women without this disease.
  
  Baylor University researchers in Houston looked at a group of women with Endometriosis to study intestinal function and noted that they frequently complain of chronic abdominal pain (not necessarily confined to the pelvis), nausea, vomiting, early satiety, bloating, distention and altered bowel habits. Using sophisticated tests, the study showed that they have significant alteration in the muscular action of their bowel wall. These abnormalities, often with increased frequency of intestinal wall muscle contractions, were never seen in normal women.
  
  Researchers also showed that the women with Endometriosis had reactive hypoglycemia during a glucose tolerance test. Blood sugars dropped to an abnormally low level despite having normal insulin levels. Thus, women with Endometriosis may be inordinately sensitive to the actions of insulin such that they end up with lower blood sugar levels for a given amount of insulin. One proposed mechanism is that the nerves that help regulate intestinal function overreact to the amount of insulin present.
  
  How this will all play out is uncertain. However, it indicates that women with Endometriosis have intestinal symptoms that appear unrelated to actual intestinal involvement from Endometriosis but rather an associated intrinsic abnormality in the intestinal wall. This makes possible the concept that women who develop Endometriosis have underlying endocrine and metabolic abnormalities differing from women who do not have Endometriosis, leading to the conclusion that Endometriosis is a more complex disease than simply the implants of endometrium where they do not belong.
  
  Many symptoms listed are those of the IBS, which is why this label is often applied. IBS is considered to be largely a psychosomatic disorder with an organic component. However, when a woman says her symptoms vary with her menstrual cycle, it is almost certainly intestinal Endometriosis.
  
  Sources:
  http://www.infertilityphysician.com/endometriosis/intestinal.html
  http://en.wikipedia.org/wiki/Endometriosis
• regular

  01/31/2010

  sandra says:

  I'm finally able to respond to this, but I did email smilelots about this privately. I have definitely noticed a correlation. I was not aware of intestinal endometriosis, though. That is interesting. I wish there was more about treatment.
  
  I suffer from really bad nausea (though no vomiting) and decreased appetite at times.
  
  I'm glad that smilelots noticed that this could be endo. I hope you have some questions answered at your OB/Gyn appointment.
  
  Lynn, thank you so much for sharing this info!

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