What Is Bowel Endometriosis and How Can You Treat It?

What Is Bowel Endometriosis and How Can You Treat It Naturally?

Key Takeaways

  • Bowel endometriosis is connected to gut health and gut-related conditions like IBS. This gives us some idea of how we can approach healing it naturally.
  • Probiotics may be helpful for bowel endometriosis, based on their effectiveness for other gut-related conditions.
  • An anti-inflammatory and hormone-supportive diet, stress relief, and support for liver function may also help balance hormones and reduce endometriosis symptoms.

Of women diagnosed with endometriosis, about 10-12% of them will have bowel endometriosis.

Bowel endometriosis occurs when endometrial tissue (the tissue that lines the uterus) infiltrates the large intestine [1 Trusted SourcePubMedGo to source]. It can be painful, and it can result in intestinal lesions, most often in the rectum and sigmoid colon (the last section of the colon before the rectum).

Bowel endometriosis shows us that there is a significant connection between endometriosis and gut health, and this connection can inform our treatment approach when discussing natural and complementary therapies.

So, what is bowel endometriosis? In this article, we’ll answer this question and discuss symptoms, the connection between gut health and endometriosis, and natural treatments for bowel endometriosis.

What Is Bowel Endometriosis? 

In bowel endometriosis, endometrial-like tissue infiltrates the large bowel, particularly the rectum and sigmoid colon. It can also spread to the uterosacral ligaments, which attach part of the uterus (the cervix) to the tailbone (sacrum) and provide structural support. This tissue can build up and form cysts called endometriomas. The surrounding tissue can also become inflamed and eventually form scar tissue or adhesions, causing organs and tissues to stick to each other. This results in pain and discomfort. 

A literature review found that bowel endometriosis is the most common type of endometriosis occurring outside of pelvic endometriosis [2 Trusted SourcePubMedGo to source].

In pelvic endometriosis, endometrial tissue builds up in the pelvic area, most commonly in the ovaries, but it can also impact the fallopian tubes and the urinary system (ureter, bladder, and urethra). It affects 10-15% of women of reproductive age and causes symptoms like pain, infertility, and disrupted hormones.

Bowel endometriosis, affecting 10-12% of women diagnosed with endo, may be considered “deep” endometriosis, or it may only cause superficial lesions in the bowel wall. Bowel endometriosis may progress from pelvic endometriosis, but it can also exist on its own without any pelvic involvement [2 Trusted SourcePubMedGo to source].

Symptoms of Bowel Endometriosis 

Many symptoms of bowel endometriosis are non-specific, meaning they could also be symptoms of other intestinal conditions, like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). These symptoms may include [2 Trusted SourcePubMedGo to source, 3 Trusted SourcePubMedGo to source]:

  • Diarrhea
  • Constipation
  • Cramping
  • Painful bowel movements
  • Pain during menstruation
  • Deep pain during intercourse
  • Chronic pain
  • Blood in the stool
  • Rectal bleeding
  • Bloating
  • Pain while sitting
  • Pain in the perineum (area between the anus and the vagina)
  • Bowel obstruction (in rare cases)


It’s important to get an accurate diagnosis, since treatment options can differ between bowel endometriosis and Crohn’s disease, for example.

However, there are no clear guidelines on patient evaluation for suspected bowel endometriosis. Before getting tested, patients may report issues with infertility, pain, and gastrointestinal symptoms to their gynecologist or primary care practitioner.

Along with symptom evaluation and medical history, possible testing options include:

  • Transvaginal and/or transrectal ultrasonography
  • Magnetic resonance imaging (MRI)
  • Double-contrast barium enema

Without getting into too many details, these imaging techniques can look for endometrial tissue in the colon and help determine severity of the disease.

The Connection Between Gut Health and Endometriosis

As the most common kind of endometriosis outside of the pelvis, bowel/intestinal endometriosis tells us there’s a link between gut health and endometriosis. 

Research shows that gut dysbiosis can disturb estrogen levels [4 Trusted SourcePubMedGo to source] and that women’s health conditions associated with unbalanced estrogen levels (PCOS, obesity, endometriosis, cardiovascular disease, breast cancer) are associated with low bacterial diversity in the digestive tract [5 Trusted SourcePubMedGo to source].

Building on this idea, a 2021 systematic review and meta-analysis found that women with endometriosis may be 2-3 times more likely to develop IBS than women without endometriosis [6 Trusted SourcePubMedGo to source].

There is also evidence suggesting a relationship between the gut and female reproductive tract microbiota and certain patterns of gut bacteria and female reproductive diseases (like PCOS, endometriosis, and bacterial vaginosis) [7 Trusted SourcePubMedGo to source].

Given these connections between gut health and endometriosis, it’s possible that addressing gut dysbiosis and increasing bacterial diversity in the colon could help the body process and dispose of estrogen correctly. This could help maintain hormonal balance and reduce endometriosis symptoms.

We don’t know for sure that there’s a causal relationship between gut bacteria and female reproductive diseases like endometriosis. However, we know enough to suggest that improving gut health could help with endometriosis symptoms. 

Conventional Treatments for Bowel Endometriosis 

Medications commonly used to treat bowel endometriosis include:

  • Hormone therapy (birth control, synthetic progesterone, combined hormonal contraceptives)
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Gonadotropin releasing hormone (GnRH) antagonists 

Of course, these medications often come with short-term and long-term side effects. 

Surgery is another typical treatment option for women with bowel endometriosis, and for many women it may be necessary. But to avoid any potential complications, we encourage patients to try other treatment routes before surgery, and don’t be afraid to get a second opinion if surgery is recommended. If you do ultimately need surgery, these are some of the procedures you can expect. 

A laparoscopy can help assess the severity of endometriosis lesions in the colon and possibly involve an excision of any nodules, depending on their size and whether there is any kind of bowel obstruction. Laparoscopic surgery is usually recommended for patients who are in severe pain. 

In severe cases, a colorectal surgeon may perform a bowel resection, where the diseased part of the bowel is removed and the remaining colon is reattached. 

To prevent the need for surgery and even long-term medication use, natural and complementary treatments may help manage endometriosis symptoms. 

Natural Treatments for Bowel Endometriosis

Most of the data we have on alternative and complementary therapies for endometriosis has been taken from women who have pelvic endometriosis. Nevertheless, a systematic review and meta-analysis looked at therapies like [8 Trusted SourcePubMedGo to source]:

  • Acupuncture
  • Exercise
  • Electrotherapy
  • Yoga

Research shows these treatments led to:

  • Pain relief
  • Improved quality of life
  • Reduction in hormone-related side effects
  • Improved dyspareunia (painful intercourse)
  • Reduced depression and anxiety

The researchers determined that acupuncture had the strongest evidence in favor of its use for endometriosis pain [8 Trusted SourcePubMedGo to source].

Could Probiotics Help With Intestinal Endometriosis?

One recent review highlighted two clinical trials where Lactobacillus probiotics improved pain associated with endometriosis. In rat studies, probiotics were also able to prevent endometriosis growth and reverse immune regulation associated with the disease [9 Trusted SourcePubMedGo to source].

More research is needed, but probiotics have such a low risk of side effects and such a high potential for efficacy that they’re worth trying. Probiotics are also often used as a complementary therapy, so even patients taking medication for intestinal endometriosis may benefit. Of course, consult with your doctor first.

We already have good evidence that probiotics are helpful for:

More research still needs to be done on the effects of probiotics for bowel endometriosis. However, probiotics can help with many gastrointestinal conditions, in ways like lowering inflammation and protecting the gut lining. So, it’s possible that they could also be helpful for women with bowel endometriosis. 

Managing Hormones Naturally

Since endometriosis is at least partially influenced by hormonal imbalances, implementing strategies to regulate your hormones may be helpful. Some of these strategies include: 

  • Eating an anti-inflammatory diet with enough healthy carbs and fats to support hormone balance and reduce stress
  • Balancing blood sugar by eating balanced meals with protein, fat, and carbs
  • Reducing stress via therapy, exercise, breathing techniques, and doing things you love
  • Supporting liver function with supplements like milk thistle, N-acetyl cysteine (NAC), or zinc

The Bottom Line on Bowel Endometriosis

Bowel endometriosis occurs when endometrial tissue from the uterus invades the large intestine, creating lesions and potentially cysts that can cause pain and gastrointestinal issues like constipation and bloating.

Traditional treatment options for bowel endometriosis are less than ideal. Commonly prescribed medications come with difficult side effects and surgery can create a big disruption in your life, not to mention the risks that come with any surgical procedure. But these are not your only options for treatment. Supporting your gut health and hormones with probiotics, a healthy diet, and stress management can go a long way toward relieving endometriosis symptoms and recalibrating the immune system. 

Reach out to us at the Ruscio Institute for Functional Medicine if you want to learn more about how you can work with one of our practitioners to heal endometriosis. 

➕ References
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