Cycle-related Diarrhea and Dysmenorrhea are Independent Predictors of Peritoneal Endometriosis, Cycle-related Dyschezia is an Independent Predictor of Rectal Involvement

Abstract

Introduction The clinical presentation of endometriosis is extremely varied. Because endometriosis symptoms may overlap with symptoms caused by gastroenterological disorders, this can lead to misdiagnosis and a considerable delay in arriving at the correct diagnosis. The aim was to evaluate the type and duration of endometriosis-related symptoms and to identify predictors for patterns of involvement depending on symptoms. Material and Method The data of 266 consecutive patients who were operated on in the Endometriosis Center between 1/2016 and 12/2017 after receiving a histologically verified diagnosis of endometriosis were recorded. In addition to recording the clinical parameters, a questionnaire was distributed to the patients, who were asked about their medical history. Infertile patients were grouped together as Group 1 and compared to non-infertile patients (Group 2). Results The response rate for returned questionnaires was 79.47% (182/229). 41.8% of patients reported that they were infertile and 91.8% reported pelvic pain. In more than ⅓ of cases in both groups, more than 10 years passed between the initial symptoms and the final diagnosis (39.4 vs. 37.5%). On average, patients consulted 2.72 (± 1.58) resp. 3.08 (± 1.72) doctors before they presented to a hospital or were referred for laparoscopic diagnostic workup (p = 0.162). Cycle-related diarrhea (odds ratio 2.707; 95% CI: 1.063 – 6.895, p = 0.037) and dysmenorrhea (odds ratio 2.278; 95% CI: 1.193 – 4.348, p = 0.013) were associated with involvement of the pelvic peritoneum, cycle-related dyschezia was associated with rectal involvement by a factor of 4.6 in binary regression analysis (odds ratio 4.659; 95% CI: 1.132 – 19.186; p = 0.033). Conclusion Cycle-related diarrhea and dysmenorrhea increase the risk probability of peritoneal endometriosis. Dyschezia increases the risk probability of rectal endometriosis.

Evolution of Bowel Complaints after Laparoscopic Endometriosis Surgery: A 1497 Women Comparative Study

“…Haas et al showed that women with endometriosis in ENZIAN compartment C, which corresponds to our Group 3, were more likely to report gastrointestinal symptoms (24). In a recent retrospective series of 266 women, cycle-related dyschezia was independently associated with rectal involvement (25). In a recent study that evaluated the association between preoperative symptoms and revised ENZIAN classification, dyschezia was significantly correlated with rectal involvement corresponding to the ENZIAN C compartment (26).…”

“…In a prospective study, women with superficial endometriosis reported several cycle-related digestive symptoms with frequency ranges between 5-43% (13). In another retrospective study, cycle-related diarrhoea was significantly associated with superficial peritoneal endometriosis (25).…”

Diagnostic Benefit of the Detection of Mitotic Figures in Endometriotic Lesions

“…Around 10% of women aged 15 – 50 years suffer from dysmenorrhea, dyspareunia, abdominal and pelvic pain as well as infertility and are diagnosed with endometriosis 1 . The presentation of symptoms in women with endometriosis is suggestive for the location of the endometriotic lesions and the clinical stage 2 , but up to now, the definitive diagnosis of endometriosis needs surgery. Serum markers for endometriosis are being investigated but have not yet been clinically established 3 , 4 .…”

MicroRNAs Dysregulation as Potential Biomarkers for Early Diagnosis of Endometriosis

“…Up to 50% of women with pelvic pain and/or infertility and 10–15% of reproductive-aged women have endometriosis [ 6 ]. Endometriosis symptoms include infertility, dysmenorrhea, pelvic pain, dyspareunia, mittelschmerz, back pain, dysuria, dyschezia, abundant irregular menstruation, gastrointestinal problems (diarrhea or constipation), hematochezia, and chronic fatigue [ 7 , 8 , 9 ]. Adhesions, organ damage, and fibrosis are the main causes of infertility and pain in endometriosis’ severe phases [ 10 ].…”