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Dr. Kala
Dr. Kala, OB/GYN (Doctor)
Category: OB GYN
Satisfied Customers: 4463
Experience:  Caring US educated & trained physician, 26 years of experience in OBGYN & women's health care.
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I am waiting endoscopy and laparoscopy

Resolved Question:

I am waiting for an endoscopy and laparoscopy for suspected intestinal endometriosis. The consultant I saw told me that intestinal endometriosis is very rare - how rare is it? Is it difficult to find a surgeon with experience dealing with it, or is it simply utilising the same skill set required to treat a different illness, such as cancer or crohns?
Is there such a thing as mild intestinal endometriosis or is it by nature deemed an extensive case due to the fact it has spread to the intestine?
Also, could there be a differential diagnosis for blood from the rectum and with stool that only occurs at the onset of menstruation (with small spotting that occurs on the day ovulation would be expected). I do not suffer from constipation, and the consultant found no heamorhoids or fissures. The bleeding is getting more pronounced each month, and the pain worse, so if there could be a more sinister explanation I'm concerned about the waiting times.
(Other symptoms - 6 years of no protection, and no pregnancy. Husband recently took sperm test and is fine. There are a couple occasions a month where the pain from belly button down is so strong that it's nearly unbearable, ragged breathing, goosebumps, clammy, generally only resolved after an hour to two hours when the bowel is fully emptied. Diagnosed with IBS in 2001, based on symptoms. Fatigue. Mood swings/transient depression. Difficulties fully emptying bladder).
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. Kala replied 1 year ago.
Hi, I am privileged to help you get more understanding about your current concern.Endometriosis can be mild, moderate or severe based on degree of involvement of internal organs. Symptoms can vary from mild to sever as well, but often does not correlate with the degree of involvement. Generally a diagnosis can be made on direct visualization via laparoscopy (placement of a small microscope in the pelvic cavity); but the degree of involvement at the time of laparascopy may be under or overestimated. For the above reasons, we generally make the diagnosis based on clinical history, presentation and exam. If the diagnosis is suspected treatment can begin with the use of several different medications (hormonal generally) to see the effect. Laparoscopy can be offered after a treatment trial or if there is concern of infertility. Regarding instestinal involvement, again this is generally suspected based on symptoms. The degree is related to the severity of symptoms. And again a treatment medication trial is recommended. The treatment trials are used in this diagnosis because of the significant benefits in a short period of time (4-6 weeks or less) side effects small (mild hot flashes) which are far less risky then the risk of surgery & anesthesia to end up giving the same treatment. Let me know if you have any further questions regarding this issue.
Customer: replied 1 year ago.
Could you let me know how rare it is to have symptomatic intestinal endometriosis? Is it something most Doctors/surgeons will have experience with? My consultant said it was very rare but rare has quite a sliding scale.
Expert:  Dr. Kala replied 1 year ago.
Actually it is not rare, in my patients with endometriosis I see this 10-15% of the time. But I am a gynecologist with many years of experience, so that may be a reason your provider has not seen as many cases.
Dr. Kala, OB/GYN (Doctor)
Category: OB GYN
Satisfied Customers: 4463
Experience: Caring US educated & trained physician, 26 years of experience in OBGYN & women's health care.
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