Management of bowel dysfunction after pelvic surgery for endometriosis

INTRODUCTION: Bowel dysfunction is a common and debilitating condition affecting patients with endometriosis. Despite the extent of surgery, symptoms may persist or arise, often overlapping with low anterior resection syndrome (LARS) or irritable bowel syndrome (IBS) typical features. This review aims to summarize the multifactorial pathophysiology and current therapeutic options for postoperative bowel dysfunction after endometriosis surgery. METHODS: A structured narrative review was conducted through a comprehensive search for studies published between 2000 and 2025. Inclusion criteria focused on postoperative functional outcomes and treatments (medical, rehabilitative and interventional) effectiveness. The available evidence is limited and largely extrapolated from related conditions such as LARS and neurogenic bowel dysfunction. RESULTS: The complex pathophysiology of postoperative dysfunction involves preoperative visceral hypersensitivity, surgical disruption of pelvic autonomic nerves, reduced rectal compliance, and pelvic floor dyssynergia. While dietary interventions (e.g., low-FODMAP diet) and pharmacological treatments (laxatives, antidiarrheals, or neuromodulators) serve as first-line therapies, they are often insufficient for severe symptoms. Emerging evidence supports the use of transanal irrigation (TAI) for mechanical emptying and sacral neuromodulation (SNM) for refractory sensorimotor disorders. Functional rehabilitation, including pelvic floor physiotherapy and manual therapy, represents a further opportunity to influence specific symptoms. CONCLUSIONS: Postoperative bowel dysfunction in endometriosis management requires a transition from rigid treatment protocols to a multidisciplinary, symptom-oriented approach. The support of specialized nursing, physiotherapy, and advanced interventions like TAI and SNM is essential. Future prospective studies using standardized outcome measures are needed to better define these therapeutic pathways and improve patient quality of life.