The Consideration of Endometriosis in Women with Persistent Gastrointestinal Symptoms and a Novel Neuromusculoskeletal Treatment Approach

Abstract

Endometriosis is a chronic, hormone-dependent, inflammatory disease, characterized by the presence and growth of endometrial tissue outside the uterine cavity and it is associated with chronic pelvic pain and infertility [1,2]. Worldwide, approximately 176 million women between the ages of 15 and 49 are affected by endometriosis [3]. Endometriosis is a complex disease that induces a chronic inflammatory process and can be challenging to treat [4]. Chronic pelvic pain syndrome (CPPS) is defined as pelvic pain lasting greater than three to six months that is not solely related to menstruation, sexual activity or bowel movements [5]. The symptoms of CPPS include abdominal, lumbosacral, buttock, vulvovaginal, perineal and rectal pain, urinary and bowel symptoms, and pain associated with intercourse. Patients with endometriosis often suffer for many years and see multiple physicians and medical providers before receiving a diagnosis. In patients aged 1845, the average delay in diagnosis is 6.7 years [6]. This may be secondary to the fact that endometriosis is a diagnosis of exclusion. The gold standard for the diagnosis of endometriosis has been visual inspection by laparoscopy, preferably with histological confirmation [7]. Because there is lack of a noninvasive test for endometriosis, there is often a significant delay in diagnosis of this disease. One caveat is transvaginal ultrasonography, transrectal ultrasound, and MRI, have the potential to facilitate the diagnosis of certain types of endometriosis, particularly an endometrioma or deep infiltrating endometriosis [8]. No serum marker has been found to diagnose endometriosis with adequate sensitivity and specificity [9]. Compounding the complexity of diagnosis, patients can often have recurrence of the disease even after a surgical excision of endometriosis. The overall recurrence rates range between 6% to 67% [4]. Summary