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What is Deep Endometriosis?

Published in Endometriosis Types 2 mins read

Deep endometriosis, also known as deeply infiltrating endometriosis (DIE), is a form of endometriosis where the endometrial tissue invades organs near the uterus, such as the bowel and bladder, and is found deep within the tissue or organ.

Understanding Deeply Infiltrating Endometriosis (DIE)

Here’s a more detailed look:

  • Definition: DIE is characterized by endometrial implants that penetrate more than 5mm beneath the peritoneal surface. These implants are not just on the surface but extend deep into the surrounding tissues and organs.

  • Organs Affected:

    • Bowel
    • Urinary bladder
    • Vagina
    • Rectovaginal septum (tissue between the rectum and vagina)
    • Ureters (tubes connecting the kidneys to the bladder)

  • Symptoms: The symptoms can vary based on the location and depth of the endometrial implants. Common symptoms include:

    • Severe pelvic pain
    • Painful periods (dysmenorrhea)
    • Pain during intercourse (dyspareunia)
    • Painful bowel movements (dyschezia)
    • Painful urination (dysuria)
    • Infertility

Diagnostic Approaches

Diagnosing DIE can be complex and often requires a combination of methods:

  1. Pelvic Exam: A physical examination to identify any palpable nodules or tenderness.
  2. Imaging Techniques:
    • Transvaginal Ultrasound: To visualize the pelvic organs and identify endometriotic lesions.
    • MRI (Magnetic Resonance Imaging): Provides detailed images of the pelvic region to detect deep infiltrating lesions.
    • CT Scan (Computed Tomography): Useful in certain cases to assess the extent of the disease.
  3. Laparoscopy: A surgical procedure where a small incision is made to insert a camera and surgical instruments to visualize and confirm the presence of endometriosis.

Management and Treatment

The management of DIE typically involves a multidisciplinary approach:

  • Pain Management:
    • Pain Medications: Over-the-counter or prescription pain relievers to manage pain.
    • Hormonal Therapy: Such as birth control pills, GnRH agonists, or progestins to suppress the growth of endometrial tissue.
  • Surgical Intervention:
    • Laparoscopic Surgery: To remove or excise the deeply infiltrating lesions. This can help alleviate pain and improve fertility outcomes.
    • Bowel Resection: In severe cases where the bowel is significantly affected, a portion of the bowel may need to be removed.

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