questions about endometriosis affecting bowel

Hi,
I am 45 years old and have always had regular menstrual cycles until about four months ago when I completely missed a period and at the same time had rectal bleeding. colonoscopy showed internal hemmoroids (hemorrhoids). dr assured me that the hemmoroids (hemorrhoids) were the cause of the bleeding. I also called my ob/gyn dr and talked to the nurse, she said that the missed period could be peri-menopause. I had blood work done and all was normal.  But after reading about bowel endo causing rectal bleeding during menstruation I wondered if I hadnt missed my period but had it come out rectally?

I have had normal cycles since that incident four months ago until this last cycle when I had a little rectal bleeding two days before the onset of my period bleeding.  I never have had any of the classic symptoms of endo and all of my pap test and exams have been normal, I go every year. My colonoscopy's (I've had two so far) are also normal except for hemmoroids (hemorrhoids) and a few small polyps. I read that endo can attach to the bowel wall and cause bowel symptoms but no rectal bleeding unless it penetrates through the wall of the bowel, and then I read that a colonoscopy could not see it. Would a colonoscopy see it if has penetrated the wall??? in which case caused rectal bleeding.

Does endo always start growing in the uterus and then go to other body parts? or can it start growing in the rectum
If a person has endo directly on the bowel or rectum would a colonoscopy see it?
How many symptoms would you have to have in order to get laproscopic surgery?
I read that rectal bleeding during menstruation is a classic sign of endometriosis but they are not giving any other information. If a person has rectal bleeding during mensruation and has endo wouldnt a colonoscopy see it?
Is it possible for the period blood to come out of the rectum?



thanks

[Elaine Brown, MD]

Hi!
If endometriosis has penetrated the bowel wall significantly enough to cause rectal bleeding, it should be possible to visualize it with colonoscopy.
If you were my patient, I would advise you to wait it out for awhile. You do have a good explanation for your rectal bleeding, and laparoscopy at this point would not add much.

If you developed other symptoms of endometriosis, especially any pain or other condition that would benefit from additional surgery, I would consider laparoscopy at that point.  OR especially if you had persistant, or unexplained episodes of rectal bleeding, I would likewise consider a scope.  In other words, if there was something that we could TREAT (improve) with surgery.

Bowel endometriosis is rare, hemorrhoids are common.  That's the way I would be thinking.

Good luck!
Dr B