Patient-Reported Bowel Symptoms and Endometriosis Location and Stage, a Retrospective Cohort Study

Objective: To determine if there is a relationship between patient-reported bowel symptoms (bloating, bowel changes with menses, rectal pain/dyschezia) and endometriosis findings at the time of surgery. Design: Retrospective cohort study. Setting: Multi-hospital health system of Catholic Health in Long Island, NY. Participants: Patients who underwent excisional endometriosis surgery between October 2020 and February 2025. Results: A total of 391 patients were included in the study. Seventy percent of patients reported at least one gastrointestinal (GI) symptom. Deep endometriosis (DE) was identified in 31% of patients. The American Association of Gynecologic Laparoscopists (AAGL) stage was distributed as follows: I (103, 26%), II (100, 26%), III (61, 16%), and IV (127, 32%). A histological diagnosis of endometriosis was positive in 325 patients (83.1%). There was a statistically significant relationship between the following GI symptoms and location of endometriosis in the posterior cul-de-sac peritoneum: bloating (adjusted odds ratio [aOR]: 3.07, 95% confidence interval [CI]: 1.58–5.94), bowel changes with menses (aOR: 1.84, 95% CI: 1.03–3.30), rectal pain and/or dyschezia (aOR: 2.58, 95% CI: 1.06–6.28). When regression analysis was applied, there was no statistically significant association between GI symptoms and DE. Conclusions: The distribution of AAGL stage in our study suggests that complex surgical findings are common in the endometriosis referral population. There remains a lack of clear understanding around the relationship between patient-reported bowel symptoms and the location and AAGL stage of disease. It follows that any patient with endometriosis regardless of symptoms should be expected to have a more severe and surgically complex disease process. When surgical management is considered, they should be triaged to a surgeon who specializes in endometriosis.