|Discussion in 'All Categories' started by Angie White - Jan 17th, 2012 7:41 pm.|
|I have had endometreosis for over 20 years. have had hysterectomy done but a small piece of ovary remains attached to my bowel. I have recently dealt with breast cancer and have had a mastectomy. I have been on micronor but doctors are telling me to get off of them because my cancer is hormone receptive. I am looking for alternative treatment. To go off the micronor means pain 24/7. No one seems to have answers for me. I am hoping you can help me. Thanks so much|
re: endometreosis by Dr M.K. Gupta - Jan 22nd, 2012 3:15 am
Dr M.K. Gupta
Dear Angie White
Diagnostic laparoscopy can be performed in your case together with endometrial nodular dissection and removal of reminent ovary. Bowel symptoms really are a common but often unrecognised consequence of endometriosis, especially chronic and recurrent endometriosis. Nobody knows exactly what proportion of ladies with endometriosis have bowel symptoms; it may be five percent, 30 %, or any place in between. However, we're fairly sure that a comparatively large proportion in our members suffer from bowel symptoms of some kind.
When the American, British, and Australian endometriosis groups were placed in the early to mid 1980s, it became clear that lots of of their members had bowel symptoms. At the time, few doctors realised that bowel symptoms were a common symptom of endometriosis. It was only when the nation's endometriosis groups began speaking with leading gynaecologists concerning the experiences of their members that doctors began to search for and find bowel symptoms within their patients. Nowadays, most gynaecologists and many GPs understand the relationship between bowel symptoms and endometriosis.
However, a lot of GPs still do not think of endometriosis when their young female patients report symptoms for example intermittent constipation or diarrhoea, or alternating bouts of the two. Most importantly, they do not think to ask the young woman if her bowel symptoms vary with her menstrual cycle - the important thing feature of bowel symptoms because of endometriosis.
As a result, some ladies are not being identified as having endometriosis. Causes Most bowel symptoms are not because of the presence of endometriosis at first glance of the bowel itself. Rather, they're usually because of irritation from implants and nodules located in adjacent areas, such as the Pouch of Douglas, uterosacral ligaments, and rectovaginal septum.
In those cases when the endometrial implants can be found around the bowel, the implants are often lying on the outside top of the bowel or rectum rather than in the bowel itself. Nevertheless, endometriosis can penetrate into and through the bowel wall on some occasions. The large bowel is a a lot more common site of endometriosis compared to small bowel.
Some bowel symptoms are due to adhesions constricting, twisting, or pulling on the bowel. Diagnosis Diagnosing bowel symptoms because of endometriosis - like every tentative proper diagnosis of endometriosis - depends on the woman’s description of her symptoms and menstrual history.
Bowel symptoms because of endometriosis are generally only present or are worse around the time of the period, though they might be present through the month. They're also usually reported along with one or more from the classical symptoms of endometriosis, such as painful periods and painful intercourse, instead of on their own.
Women whose bowel symptoms result from endometrial nodules in the Pouch of Douglas may find a vaginal examination painful. The gynaecologist can also be able to feel nodules within the Pouch of Douglas.
Sometimes the gynaecologist will refer the woman to a bowel specialist if he or she is not sure whether the bowel symptoms are due to endometriosis or any other cause. Occasionally, the gynaecologist may refer the woman to some bowel specialist for a colonoscopy. A colonoscopy is definitely an examination of within the bowel with a telescope-like instrument.
In many women with endometriosis, the colonoscopy will be normal because endometrial implants and nodules rarely penetrate with the wall from the bowel wall so that they aren't visible during a colonoscopy. Treatment Endometrial nodules within the Pouch of Douglas, uterosacral ligaments, and rectovaginal septum are usually larger and deeper than ordinary implants. They do not usually react to medications so they must be removed surgically. Because they are hard to reach, there is a danger the bowel might be damaged accidentally during surgery.
Therefore, the surgeon should be experienced at laparoscopic surgery. Cutting (excision) techniques are often used rather than burning (cautery or diathermy) techniques. Superficial endometrial implants on the surface from the bowel are often removed by carefully taking out the relevant area of the membrane that covers the bowel wall.
If the endometriosis has penetrated through a portion of the bowel wall that section of the bowel mayhave to be removed (bowel resection). Few gynaecologists are able to perform bowel resections, so often a bowel surgeon is going to be contacted to perform the resection.
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