Evaluation of Bowel Function of Women with Colorectal Endometriosis: a Cross-Sectional Study

The objective was to evaluate bowel function in women with colorectal endometriosis according to treatment type. Cross-sectional study, carried out with 141 women with endometriosis, followed by the University of Campinas from May 2020 to April 2021. Women were divided into 3 groups according to the kind of treatment: 16 women with conservative surgery, 35 women with radical surgery treatment, and 90 women with clinical treatment. The clinical and sociodemographic characteristics of these women were evaluated. To access bowel outcome, we used the following questionnaires: the Bristol Stool Scale, the Bowel Function in the Community, the Gastrointestinal Quality of Life Index (GIQLI), and the Pelvic Floor Distress Inventory (PFDI-20). The mean treatment time was 32.24 ± 29.37 months. The women of the three groups had similar gastrointestinal quality of life index scores (p = 0.27) and pelvic floor distress inventory scores (p = 0.23). Women in the radical surgery group had a higher frequency of evacuatory effort and change in posture to evacuate (p = 0.01 and 0.009, respectively) than did those in the other groups. Women with constipation had worse quality of life and more pain than those without constipation. In conclusion, women with endometriosis treated with radical surgery (segmental resection) had a higher frequency of constipation. In addition, women with endometriosis and constipation had a worse quality of life and higher pain scores compared to those without constipation. Similar content being viewed by others Data Availability Data is available upon request. Code Availability Not applicable.

Roman H. Friends group (French colorectal Infiltrating endometriosis study group). Surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: a multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod. 2017;46(2):159–65. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268–79. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018;4(1):9. Roman H, Ness J, Suciu N, et al. Are digestive symptoms in women presenting with pelvic endometriosis specific to lesion localizations? A preliminary prospective study. Hum Reprod. 2012;27(12):3440–9. Roman H, Bubenheim M, Huet E, et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod. 2018;33(1):47–57. Darwish B, Roman H. Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol. 2016;215(2):195–200. Mehedintu C, Frincu F, Brinduse LA, et al. J Clinical Med. 2021;10(21):5211. Guerriero S, Ajossa S, Orozco R, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47(3):281–9. Medeiros LR, Rosa MI, Silva BR, et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015;291(3):611–21. Seracchioli R, Mabrouk M, Manuzzi L, et al. Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis. Hum Reprod. 2009;24(11):2729–35. Posegger KR, Maeda CT, Taveira JP, et al. Brazilian-Portuguese validation assessment of the gastrointestinal quality of life index for patients after laparoendoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2022;32(2):125–31. Arouca MA, Duarte TB, Lott DA, et al. Validation and cultural translation for Brazilian Portuguese version of the Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20). Int Urogynecol J. 2016;27(7):1097–106. Martinez AP, Azevedo GR. The Bristol Stool Form Scale: its translation to Portuguese, cultural adaptation and validation. Rev Lat Am Enfermagem. 2012;20(3):583–9. Domansky RC, Santos VLG. Cross-cultural adaptation and validation of the Portuguese version of the Bowel Function in the Community instrument. J Wound Ostomy Continence Nurs. 2007;34(6):671–7. Vercellini P, Frattaruolo MP, Rosati R, et al. Medical treatment or surgery for colorectal endometriosis? Results of a shared decision-making approach. Hum Reprod. 2018;33(2):202–11. Roman H, Vassilieff M, Tuech JJ, et al. Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril. 2013;99(6):1695–704. Roman H, Milles M, Vassilieff M, et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol. 2016;215(6):762.e1-762.e9. Abo C, Moatassim S, Marty N, et al. Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril. 2018;109(1):172–8. Roman H, Tuech JJ, Huet E, et al. Excision versus colorectal resection in deep endometriosis infiltrating the rectum: 5-year follow-up of patients enrolled in a randomized controlled trial. Hum Reprod. 2019;34(12):2362–71. Seracchioli R, Ferrini G, Montanari G, Raimondo D, Spagnolo E, Di Donato N. Does laparoscopic shaving for deep infiltrating endometriosis alter intestinal function? A prospective study. Aust N Z J Obstet Gynaecol. 2015;55:357–62. Marty N, Touleimat S, Moatassim-Drissa S, et al. Rectal shaving using plasma energy in deep infiltrating endometriosis of the rectum: four years of experience. J Minim Invasive Gynecol. 2017;24(7):1121–7. Roman H, Moatassim-Drissa S, Marty N, et al. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril. 2016;106(6):1438–45. Noël JC, Chapron C, Bucella D, et al. Estrogen and progesterone receptors in smooth muscle component of deep infiltrating endometriosis. Fertil Steril. 2010;93(6):1774–7. Milone M, Vignali A, Milone F, et al. Colorectal resection in deep pelvic endometriosis: surgical technique and post-operative complications. World J Gastroenterol. 2015;21(47):13345–51. Roman H, Bridoux V, Tuech JJ, et al. Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol. 2013;209(6):524–30. Roman H, Darwish B, Bridoux V, et al. Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients. Fertil Steril. 2017;107:977-986.e2. Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG. 2016;123(8):1360–7. Scheepers WFW, Mass JWM, Kar MMAV. Bowel function and quality of life following surgery for deep endometriosis. J Psychosom Obstet Gynaecol. 2022;43(3):334–9. Bray-Beraldo F, Pellino G, Ribeiro Junior MAF, et al. Evaluation of bowel function after surgical treatment for intestinal endometriosis: a prospective study. Dis Colon Rectum. 2021;64(10):1267–75. Mabrouk M, Ferrini G, Montanari G, et al. Does colorectal endometriosis alter intestinal functions? A prospective manometric and questionnaire-based study. Fertil Steril. 2012;97(3):652–6.

We thank Helymar da Costa Machado, a statistician from Women’s Hospital (CAISM), for the statistical analysis of this study Author information Authors and Affiliations Contributions All the authors participated actively in the study, as follows: D.A. Yela has conceptualized and designed the study. She has also involved in the interpretation of results, and she has written and reviewed the manuscript. N.A.C. Villa has conceptualized and designed the study and helped in the acquisition of the date, interpretation of results, and writing the manuscript, C.L. Benetti-Pinto has reviewed the manuscript. Corresponding author Ethics declarations Ethics Approval All women signed an informed consent form before participating in the study. This study was approved by the research ethics committee of the institution (number: 4.057.069). Consent to Participate Trained study personnel obtained informed consent from all participants. Consent for Publication All authors participated in the study and development of the manuscript titled “Evaluation of bowel outcome of women with colorectal endometriosis: A cross-sectional study.” All authors have read the final version and give consent for the article to be published in the Reproductive Sciences journal. Conflict of Interest The authors declare no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Villa, N.A.C., Benetti-Pinto, C.L. & Yela, D.A. Evaluation of Bowel Function of Women with Colorectal Endometriosis: a Cross-Sectional Study. Reprod. Sci. 30, 3590–3596 (2023). https://doi.org/10.1007/s43032-023-01324-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-023-01324-7