Complications of Endometriosis with Dyschezia
Infertility is the primary expected complication in patients with endometriosis presenting with dyschezia, affecting approximately 50% of these patients and representing the most clinically significant long-term outcome. 1
Primary Complication: Infertility
- Endometriosis affects at least one-third of women with infertility, with approximately 50% of patients with endometriosis presenting with infertility as a primary complication 2, 1
- The presence of dyschezia indicates bowel involvement, which is characteristic of deep infiltrating endometriosis—a more severe form associated with higher rates of infertility 3, 4
- The mechanism linking endometriosis to infertility involves altered endometrial receptivity and progesterone resistance, leading to aberrant decidualization, implantation failure, and recurrent miscarriages 5
Additional Complications to Anticipate
Diminished Ovarian Reserve
- Women with endometriosis are at increased risk of premature ovarian insufficiency (POI), with ovarian volume <3 cm³ and <5 antral follicles indicating diminished ovarian reserve 2, 6
- Progressive disease can lead to ongoing ovarian damage, particularly in cases requiring repeated surgical interventions 6
Bowel-Related Complications
- Dyschezia is present in approximately 73% of patients with endometriosis and indicates deep infiltrating disease affecting the rectovaginal septum or bowel wall 7
- Chronic abdominal pain occurs in 49% of patients with bowel involvement 7
- Potential for bowel obstruction, stricture formation, or need for bowel resection in severe cases 4
Cardiovascular Risk
- Patients with endometriosis have an 11-34% increased risk of stroke (HR 1.17-1.34), mediated partly by associated hysterectomy/oophorectomy and hormone therapy 2
- Increased risk of hypertension and hypercholesterolemia in women with endometriosis 2
Disease Progression and Recurrence
- Up to 44% of women experience symptom recurrence within one year after surgical treatment, potentially leading to progressive organ damage and worsening fertility outcomes 8, 6
- The progressive nature of endometriosis means that delayed diagnosis or treatment can result in more extensive disease and greater impact on fertility 1
Clinical Pitfalls to Avoid
- Do not delay fertility preservation counseling in reproductive-aged women with endometriosis and dyschezia, as this indicates more advanced disease 2
- Recognize that the depth of endometriotic lesions (indicated by bowel symptoms like dyschezia) correlates with severity of complications rather than just the extent of visible disease 8
- Medical therapy alone does not eradicate endometriotic lesions, so patients desiring fertility may require surgical intervention despite symptom improvement with hormonal treatment 8