Rectovaginal Endometriosis: Anatomy, Sensation, and Relief

Rectovaginal endometriosis is a subtype of endometriosis in which the lining of the uterus (the endometrium) grows around the rectum, the vagina, and the structures between them. There is no cure for endometriosis. Rectovaginal endometriosis is the most severe form of endometriosis.

This article will discuss rectovaginal endometriosis, including general facts about the condition, symptoms, what to do if you think you may have it, treatment options, and more.

Rectovaginal Endometriosis Facts

Understanding the incidence, location, and effect on bowel movements is essential for understanding rectovaginal endometriosis. Facts include:

• Incidence: Rectovaginal endometriosis affects between 3.8% and 37% of people who have endometriosis.
• Location: Rectovaginal endometriosis affects various structures, including the rectum (the last few inches of the large intestine closest to the anus), the vagina, the rectovaginal septum (a structure that separates the vagina from the rectum), and the posterior cul-de-sac (the space behind the vagina and uterus, also called the pouch of Douglas).
• Effect on bowel movements: Rectovaginal endometriosis can affect bowel movements by causing constipation, painful bowel movements, rectal bleeding, and diarrhea.

Rectovaginal Symptoms and Pain

Symptoms of endometriosis overall include:

• Heavy periods
• Painful cramps during menstruation
• Pelvic pain
• Pain during sex
• Infertility
• Fatigue
• Bladder issues
  

Symptoms specific to rectovaginal endometriosis include:

• Painful bowel movements
• Rectal bleeding
• Constipation (difficulty and/or straining)
• Diarrhea
• Bloating and/or fluid retention
• Severe stomach/pelvic pain

It is important to note that not everyone with rectovaginal endometriosis will have symptoms. As well, the severity of symptoms experienced will vary based on the individual.

If You Suspect You Have Rectovaginal Endometriosis

See a healthcare provider to discuss your concerns if you suspect you have rectovaginal endometriosis. They will most likely ask about your symptoms and perform a pelvic exam.

Imaging tests such as an ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) colonography may be used to help make a diagnosis. That said, these tests cannot always detect abnormal tissue growth.

Laparoscopy (making small incisions and inserting a camera and surgical tools) may be performed to confirm the diagnosis and for treatment.

Treatment Options for Relief

There are various treatment options to help relieve the symptoms associated with rectovaginal endometriosis.

Hormonal birth control may be recommended, either as oral pills or implants. Pain-relieving medications may also be recommended.

Surgery

Surgery is often used to remove excess endometrial tissue in rectovaginal endometriosis. This is usually recommended for severe cases in which the tissue could cause complications. A 2013 study found that surgery can improve up to 70% of symptoms for rectovaginal endometriosis.

The procedure can be performed through the vaginal opening, laparoscopically (using small incisions and inserting tools), by laparotomy (using a larger incision into the abdominal cavity), or by combining techniques.

Bowel prep is a necessary component for endometriosis surgery. Bowel prep cleanses the bowel so the surgery can be done safely. A bowel prep includes a liquid diet and consuming a mixture that helps empty the bowels. Talk to your healthcare provider about potential concerns you may have and confirm what liquids are allowed.

After your surgery, your healthcare provider will provide post-op instructions. Be sure to follow these carefully.

Possible complications from surgery include:

• Bleeding into the abdomen
• Leaks where connections (anastomoses) were made
• Rectovaginal fistulas (a connection between the rectum and the vagina)
• Strictures (narrowing)
• Chronic constipation
• More operations
• Recurrence of rectal endometriosis

Summary

Rectovaginal endometriosis is a subset of endometriosis in which the endometrium extends to the vagina, rectum, and the structures between them. Symptoms include painful bowel movements, severe stomach pain, bloating, and more.

While diagnosis can be difficult and take time, those who suspect they have any type of endometriosis should consult a healthcare provider regarding their symptoms. While there is no cure for endometriosis, treatment options are available, including hormonal treatment and surgery.