Endometriosis and IBS

A study published in BJOG: An International Journal of Obstetrics and Gynaecology investigated whether women with endometriosis in the United Kingdom have an increased chance of being diagnosed with irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID).

Endometriosis – Endometrial cells normally line the inside of the uterus. Endometriosis is a condition wherein these cells, which are sensitive to female hormones, grow in places other than the uterine lining. This condition often develops on sites such as the ovaries, fallopian tubes, bladder, and intestines, which can lead to scar tissue formation. The typical symptoms of endometriosis are chronic pelvic pain, painful periods (dysmenorrhoea), pain during sexual intercourse (dyspareunia), and difficulty passing stool (dyschezia).

Irritable Bowel Syndrome – IBS is a functional gastrointestinal disorder, which means that there are abnormalities in the function or motility of the gut, with no visible or measurable damage to the digestive system. Its symptoms include abdominal pain, bloating, constipation, and/or diarrhea. Approximately 13-20% of Canadians of all ages have irritable bowel syndrome, although it is more common in women than in men.

Pelvic Inflammatory Disease – PID is a general term that refers to an infection of the uterus, fallopian tubes, or other reproductive organs. Some of the signs and symptoms of this disease are lower abdominal pain, pain during sexual intercourse, and pain during urination (dysuria).

As the study authors note, the overlapping symptoms of these three disorders create potential diagnostic difficulties, especially because there are no simple, non-invasive diagnostic tests for these conditions. The study population was comprised of women 15-55 years of age who were registered with medical practices contributing to the General Practice Research Database. In total, researchers matched and coded 5,540 women diagnosed with endometriosis and 21,239 controls without a diagnosis of endometriosis, for the presence of IBS and/or PID.

Researchers found that women with endometriosis were 6 times more likely to have received a diagnosis of PID and 3.5 times more likely to have received a diagnosis of IBS than women without endometriosis. However, investigators could not come to an agreement about the extent to which the gastrointestinal tract may be involved in endometriosis; the majority of sites with endometrial cell deposits are within the pelvic compartment, which is in close proximity to the large intestines. Any resulting inflammation and release of local hormone-like substances may explain the noted changes to bowel function in women with endometriosis.

Researchers concluded that there is a considerable problem of misdiagnosis among women with this disorder, stating that 10% of women with endometriosis had been treated for IBS during the period before their diagnosis, but this proportion was significantly reduced after a diagnosis of endometriosis had been reached. The fact that PID, IBS, and endometriosis can coexist requires a multidisciplinary approach to diagnosis and treatment of these disorders and their prevailing symptoms.

First published in the Inside Tract® newsletter issue 175 – 2010
Image Credit: © Fotolia.com/Dragos Iliescu
Seaman HE et al. Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study-Part 2. BJOG An International Journal of Obstetrics and Gynaecology. 2008;115(11):1392-6