Bowel symptoms may need specialist assessment and sometimes colorectal input.

Bowel endometriosis may involve the surface of the bowel or deeper layers of bowel tissue. Bowel symptoms may also happen because of inflammation, adhesions, scar tissue, pelvic floor dysfunction, pain sensitivity or endometriosis close to the bowel. Not everyone with bowel symptoms has bowel endometriosis, but bowel symptoms that are cyclical, severe, worsening or linked with pelvic pain should be taken seriously.

Symptoms that may be relevant

Bowel symptoms linked with endometriosis may include:

  • painful bowel movements
  • constipation
  • diarrhoea
  • bloating
  • rectal pain
  • deep pelvic or rectal pressure
  • pain before, during or after opening the bowels
  • feeling that the bowel has not fully emptied
  • urgency
  • mucus or bleeding from the bowel
  • rectal bleeding that follows a menstrual pattern
  • bowel symptoms that worsen before or during a period

These symptoms can overlap with IBS, food intolerances, inflammatory bowel disease, pelvic floor dysfunction and other bowel conditions. That is why proper assessment matters.

Why bowel symptoms can be missed

Bowel symptoms are sometimes separated from gynaecological symptoms, even when they flare around the menstrual cycle. This can lead people to be told they have “just IBS” or digestive sensitivity without considering whether endometriosis could also be involved. The pattern matters. If bowel symptoms are worse around your period, ovulation or pelvic pain flares, mention this clearly.

Surface bowel disease and deep bowel disease

Bowel endometriosis can vary. It may involve tissue on or near the bowel surface, or it may involve deeper layers of the bowel wall. Deep bowel disease can be more complex and may need specialist imaging, surgical planning and colorectal input. Symptoms alone cannot confirm how deep disease is. Imaging and specialist assessment may help guide next steps, but a normal scan does not always rule out endometriosis.

Assessment and imaging

Assessment may include:

  • review of symptom pattern
  • pelvic examination if appropriate and consented to
  • specialist ultrasound
  • MRI for suspected deep disease
  • review by an endometriosis specialist team
  • colorectal assessment where bowel involvement is suspected
  • review of previous surgery notes, imaging or histology

When colorectal input may be needed

Colorectal input may be needed if deep bowel involvement is suspected, especially if surgery is being considered. This may be relevant where there is:

  • suspected deep bowel disease
  • rectovaginal or rectosigmoid involvement
  • cyclical rectal bleeding
  • significant pain with bowel movements
  • narrowing or blockage concerns
  • complex adhesions involving the bowel
  • previous bowel surgery
  • planned excision near the bowel

If bowel disease is suspected, it is reasonable to ask whether a colorectal surgeon should be involved before surgery, not only if something unexpected is found during the operation.

Treatment planning

Not everyone with bowel symptoms needs surgery. Care may include:

  • symptom review and monitoring
  • pain relief where appropriate
  • hormonal symptom management in selected cases
  • bowel support for constipation or diarrhoea
  • pelvic physiotherapy
  • dietitian support where useful
  • pain management input
  • specialist endometriosis review
  • planned surgery where appropriate

If surgery is considered, the plan should explain what may happen if bowel disease is found, what type of bowel procedure might be needed, what risks apply, and whether colorectal expertise will be available.

Questions to ask

You may want to ask:

  • Could bowel endometriosis or adhesions be involved?
  • Could pelvic floor dysfunction also be contributing?
  • Would specialist ultrasound or MRI help?
  • What would imaging show or miss?
  • Should colorectal surgery be part of the plan?
  • If bowel disease is found, what are the treatment options?
  • Would surgery involve shaving, disc excision or bowel resection?
  • What are the risks of bowel surgery?
  • What happens if bowel disease is found unexpectedly?
  • Who will coordinate my care?

Prepare before you speak with a healthcare professional

Use our Prepare for Appointment Tool to organise your symptoms, questions, previous treatments, scan results and priorities before your appointment. Try to record:

  • when bowel symptoms happen
  • whether symptoms link to your period or ovulation
  • whether symptoms happen with pelvic pain
  • what the pain feels like
  • whether there is bleeding
  • whether constipation or diarrhoea is present
  • whether you feel incomplete emptying
  • what helps or worsens symptoms
  • how symptoms affect daily life

You do not need a perfect diary. A clear symptom pattern can help the conversation feel more focused.

Finding the right type of care

Use the Endometriosis Care Directory to explore different types of endometriosis-related care providers. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.

Final reminder

Bowel symptoms can be part of the endometriosis picture, but they can also have other causes. They deserve proper assessment, especially when they are cyclical, severe, worsening or affecting daily life. If bowel involvement is suspected, care may need an endometriosis specialist and colorectal input so assessment and treatment are planned safely. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.