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Endometriosis is a chronic condition in which cells that resemble the uterine lining called endometrial cells, grow outside the uterus such as the fallopian tubes, ovaries and the bowel system. The prevalence of endometriosis is estimated to be approximately 7–10 %. Women with endometriosis are known to have increased incidence and prevalence of irritable bowel syndrome.
Classic symptoms of endometriosis are:
Additionally, patients with endometriosis may also experience gastrointestinal symptoms such as abdominal pain, bloating, nausea, constipation, vomiting, painful bowel movements, and diarrhea. Symptom aggravation during menstruation has been reported such as cyclic-related bloating and constipation. These symptoms are the hallmark of Irritable Bowel Syndrome (IBS) as well.
Thus, there is a significant overlap in the symptomatology of both these conditions leading to a diagnostic dilemma. A common underlying pathology in both conditions is visceral sensitivity. This means someone with either condition has a lower pain tolerance for abdominal or pelvic pain due to their nerve endings being especially sensitive, which leads to a heightened response to pain.
Other explanations concerning the occurrence of these symptoms include:
A detailed history is crucial in diagnosing either condition. There are no tests to diagnose IBS so it is mainly identified by symptoms. Some tests, however, such as sigmoidoscopy, colonoscopy, stool examinations, blood tests and lactose tolerance tests, may be undertaken to exclude other diseases such as tumours, gallbladder disease, inflammatory bowel disease and coeliac disease.
On the other hand, the combination of pelvic examination and transvaginal or transrectal ultrasound is inexpensive, widely available and can be useful in diagnosing endometriosis. Magnetic resonance imaging and diagnostic laparoscopy are additional tests that can be employed but are expensive and invasive.
Treating IBS requires a holistic approach. Dietary changes form an important pillar in the treatment of IBS. Avoiding specific types of food such as insoluble fibre, beans, fatty food, foods with preservatives and artificial flavouring/colouring, caffeine, chocolate, sugar substitutes and alcohol is helpful, because these can trigger pain and other symptoms refraining from eating foods that have gluten too has proved to be beneficial.
Another diet plan that helps patients with IBS is following a Low FODMAP diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating.
In view of the increased role of a disturbed gut microbiota in IBS, use of probiotics in management of IBS has been advised. Many digestive processes rely on a balance of various bacteria, which are found naturally in the gastrointestinal tract. If these bacteria fall out of balance, gastrointestinal disorders may occur including IBS.
Most probiotics used in IBS treatment fall under two main categories- Lactobacillus and Bifidobacterium. Other lifestyle modifications include taking steps to reduce stress. Stress is a big factor which can exacerbate symptoms of IBS. Regular physical activity and meditation are shown to be beneficial in managing IBS.
In addition, certain medications may be required to treat the symptoms of IBS Antispasmodics, such as smooth muscle relaxants, and anticholinergics can be used to manage pain. Others include selective serotonin reuptake inhibitors (SSRIs) as well as tricyclic antidepressants. Antidiarrheals and laxatives are used to treat diarrhoea and constipation respectively. Most of these medications have no long-term side effects and can be used safely in all patient populations.
Behavioural therapies, such as cognitive behavioural therapy, psychotherapy and hypnotherapy have all been shown to have a positive effect in IBS, although they are usually reserved for the more refractory cases.
Endometriosis can be treated either medically or surgically. The latter is reserved for refractory and unresponsive cases. Hormonal therapy that suppresses the ovaries and thus inhibits or reduces menstrual flow is the initial choice, commonly used hormonal therapies include the combined contraceptive pill, gonadotropin- releasing hormone (GnRH) analogues, progestogens, etc. Surgical management of endometriosis commonly consists of laparoscopic ablation and excision.