Endometriosis and your pelvic cavity

Endometriosis that implants on the peritoneum in the pelvic cavity (see Figure 3-5) can cause severe inflammation that leads to adhesions or scar tissue. These adhesions can then cause all these organs and tissues — the uterus, ovaries, tubes, intestines, and bladder — to stick to each other so they don't move in the usual manner. This restriction of movement and the inflammation due to endometriosis cause the pain or discomfort. In addition, these same adhesions can make the intestines, bladder, and reproductive organs malfunction.

Male Reproductive System

Looking closer at the pain

Endometrial implants in the pelvic cavity can result in scar tissue, which binds organs and tissue together. When the tissues and organs stick together, movement (such as occurs during sexual intercourse) results in pain. The eventual result may be a frozen pelvis, which is as bad as it sounds.

The local inflammation produces irritating chemicals, which also cause pain. Likewise, stretching of the lining and irritation of the nerves are painful.

Endometriosis in the pelvic cavity can cause pain in several ways:

i Nerve endings on the surface of the peritoneum can be stimulated by endometrial tissue to cause discomfort. As the endometrial implants grow into deeper tissue, they may affect larger, more significant nerve fibers that course through the pelvic cavity toward the vulva, buttock, and legs.

i Endometriosis may simply irritate these nerves or actually entrap them, causing even more bizarre symptoms, such as back and leg pain, loss of feeling in the legs, vulvar discomfort, and other lower extremity symptoms. (Check out Chapter 2 for more information on the symptoms of endometriosis.)

S Pelvic wall endometrial lesions can rupture. The fluid released contains many irritants that lead to pelvic pain.

S Fluid entering the pelvis from a ruptured endometrioma can lead to pain. This fluid is very caustic to the surrounding structures.

S Endometrial tissue at menstruation can cause pain. Because endometriosis has the same tissue, it causes chemical changes and affects the peritoneum to cause pain.

S Enlargement of endometrial implants on organs and the peritoneum can cause swelling, stretching, and pressure.

S Scar tissue causes pain when structures stick together in unnatural ways. (Chapter 13 shows you how you can manage the physical pain associated with endometriosis in the pelvic cavity — and everywhere else!)

Endometriosis and your uterine ligaments

Because endometriosis tends to fall into the bottom of the pelvic cavity, the uterine ligaments are a common spot for endometriosis to implant (check out "The uterine ligaments: The stabilizers" earlier in this chapter for more about these ligaments). When endometriosis implants on the ligaments (refer to Figure 3-5), it grows into the peritoneal covering and then into the ligament fibers. This invasion causes the same inflammatory response doctors see in other organs and tissues, such as in arthritis or strained muscles and ligaments.

Usually the endometriosis becomes firm and feels like nodules. In fact, the uterus can feel fixed (without its usual mobility) on exam because the ligaments have lost their small amount of elasticity. The nodules can also cause pain when touched because they're inflamed. So the firm feeling of the nodules, along with pain and the decrease in uterine movement, may suggest endometriosis to your doctor.

Endometriosis causes a variety of reactions in the tissues. One response is inflammation, which may scar and eventually shorten the ligament. This inflammation also irritates ligament nerves, so even normal movement of the uterus during sex or routine activity is painful. In contrast, healthy uterosacral ligaments normally stretch a little and keep the uterus in position without pain during these activities.

Endometriosis and the cut-de-sacs

This section heading may sound more like a catchy name for a 1960s singing group than a discussion about endometriosis! Of the two cul-de-sacs in the pelvis, endometriosis is more common in the posterior than in the anterior, but both locations have their share of problems. Check out Figure 3-5 for a clear picture of how endometriosis affects your posterior and anterior cul-de-sacs.

A prime location: The posterior cul-de-sac

The posterior cul-de-sac, often referred to as the dead end of the pelvis, is at the very bottom of the pelvis. Due to gravity (assuming a woman is walking upright), all the fluids and tissue from retrograde menstruation and anything else (such as blood and infection from other organs) probably end up here. And that makes the posterior cul-de-sac a prime location for endometrial implants. Because the ovaries hang down into the cul-de-sac, everything in the posterior cul-de-sac (including the end of the fallopian tubes, the back of the uterus, and the intestines) can also have contact with the disease.

The posterior cul-de-sac is also a common site for deep endometriosis, where the endometrial implants have grown through the peritoneum (covering) of the structures (the ligaments, intestines, ovaries, tubes, and uterus) and started to grow in the underlying, deeper tissues. The endometriosis can grow into the ligaments and become inflammatory nodules (see Chapter 1) that then irritate the intestines or the back of the uterus, causing all of them to stick together. Endometriosis can also become nodules that stretch the tissue or put pressure on nearby structures. The implants can even grow into the vagina (remember, the top of the vagina is at the bottom of the cul-de-sac).

In the most severe case, this inflammation actually completely closes off the cul-de-sac. That is, the whole space behind the uterus becomes one large (and very painful) mess, with the intestines, ligaments, uterus, ovaries, and tubes all stuck together in a frozen pelvis.

A less popular location: The anterior cul-de-sac

Endometriosis occurs less often in the anterior cul-de-sac than in the posterior cul-de-sac (see the previous section). This fact makes sense because the ends of the fallopian tubes are in the posterior cul-de-sac, so the regurgitated endometrial tissue goes into the posterior cul-de-sac area most of the time. (See "Endometriosis and your fallopian tubes" for more info on endometrial tissue and fallopian tubes.) Only in abnormal cases are tubes in front of the uterus in the anterior cul-de-sac.

But endometriosis in the anterior cul-de-sac isn't rare, and although this area has fewer organs, they can still stick together, just like structures in the posterior cul-de-sac. The bladder is in the anterior cul-de-sac and is the most common site for endometriosis in the anterior cul-de-sac. The bladder can stick to the front of the uterus. If the adhesions are bad, the uterus may even stick to the anterior abdominal wall (the front surface of the peritoneal cavity) compressing the bladder between these structures.

In very severe cases, the tubes, ovaries, and even the small intestine stick to the front surface of the uterus, bladder, or abdominal wall. This result isn't common, but it can cause severe pain and bowel and bladder dysfunction. Although much rarer than the posterior cul-de-sac's frozen pelvis, the anterior cul-de-sac may also be obliterated so that no space, only a mass of tissue, remains.

Endometriosis and your bladder

The bladder is the most common anterior cul-de-sac site for endometriosis, and the condition can be painful. Because it's constantly filling and emptying, the bladder is stretching several times a day, which can cause pain in itself. But the bladder is also a muscle, and inflamed muscles hurt when used — just ask someone with a muscle strain!

In addition, because the bladder muscle isn't very thick, the endometriosis can work its way through the muscle and cause bleeding in the urine. In some cases the bladder sticks to the front of the uterus or to the intestines.

Endometriosis in your bladder can cause f Painful urination f Bladder spasms f Urinary urgency (when you "gotta go right now!") f Blood in the urine

We discuss endometriosis and your bladder more in Chapter 6.

Endometriosis and your intestines

Endometriosis is quite common in the intestines and in the appendix. In fact, the intestines are the most common site for endometriosis outside of the reproductive organs (which isn't surprising because they're in the neighborhood). Endometriosis can appear in your intestines in several ways, including


tissue and invading the walls. Resulting symptoms may be


Painful sex


Right- or left-sided pain


Generalized pelvic or abdominal pain


Bloating and cramping after eating


Blockages in the small intestine


Bleeding with bowel movement


Change in stool color or consistency

We talk about endometriosis and your intestines in detail in Chapter 6.

51 Tips for Dealing with Endometriosis

51 Tips for Dealing with Endometriosis

Do you have Endometriosis? Do you think you do, but aren’t sure? Are you having a hard time learning to cope? 51 Tips for Dealing with Endometriosis can help.

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  • iida
    When does sac in endometrial implant into uterus?
    2 years ago
  • Angelica
    Can a frozen pelvis heal?
    2 years ago
    Where can endometriosis grow?
    2 years ago
  • Minnie Johnson
    Is it daugerous to hv fluid in your endometritis cavity?
    2 years ago
  • Futsum
    Can you feel endometriosis implant in cul de sac?
    9 months ago

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