Understanding Deep Infiltrating Endometriosis
Insights from Dr. Priyadatt Patel, Gynecologist and Fertility Specialist at Balaji Horizon Women’s Hospital
Deep infiltrating endometriosis (DIE) is a severe form of endometriosis characterized by the growth of endometrial-like tissue that extends deeply into pelvic structures such as the bowel, bladder, nerves, and blood vessels. This advanced stage of the disease can lead to significant complications and requires careful diagnosis and management.
What is Deep Infiltrating Endometriosis?
Deep infiltrating endometriosis is defined by the presence of endometrial tissue that forms nodules at least 5 mm below the peritoneum, the thin membrane lining the abdominal cavity. This condition is often referred to as “stage 4” or “advanced disease” due to its severity and complexity. The deeper embedding of these lesions can lead to more pronounced symptoms and complications, making effective treatment more challenging.
Symptoms of Deep Infiltrating Endometriosis
The symptoms of deep infiltrating endometriosis can vary widely, but common experiences include:
Pelvic Pain: This can be constant or intermittent, often worsening before or during menstruation, or during and after intercourse.
Bowel Involvement: When endometriosis affects the bowel, it may lead to pain during bowel movements, as well as potential bleeding during menstruation.
Bladder Involvement: Women with endometriosis affecting the bladder may experience painful urination or notice blood in their urine during their period.
Diagnosis of Deep Infiltrating Endometriosis
Diagnosing deep infiltrating endometriosis involves a comprehensive approach, including:
Clinical Examination
During your consultation, I may perform an abdominal examination and an internal pelvic examination. This helps identify the location of your pain and check for endometriosis nodules, particularly around the vagina.
Ultrasound
A pelvic ultrasound scan is often recommended to visualize the pelvic organs, including the uterus and ovaries. This imaging can reveal the presence of endometriomas—benign cysts associated with endometriosis.
Further Investigations
If surgery is being considered, additional imaging may be necessary:
Pelvic MRI Scan: This non-invasive scan uses magnetic resonance imaging to produce detailed images of soft tissues in the pelvis, helping to assess the extent of endometriosis.
Diagnostic Laparoscopy: This keyhole surgery is performed under general anesthesia to directly visualize the abdominal and pelvic organs. If endometriosis is detected, it can often be treated during the same procedure.
Surgical Management of Deep Infiltrating Endometriosis
The primary approach to managing deep infiltrating endometriosis is surgical intervention, typically performed laparoscopically. During our consultations, I will discuss the various surgical options available, along with their risks, benefits, and expected recovery times.
Types of Surgery
Radical Laparoscopic Excision of Endometriosis (RLEE): This procedure involves removing deep endometriosis lesions and any associated adhesions or ovarian cysts.
Consultation with Specialists: Depending on the involvement of bowel or bladder structures, I may recommend consultations with colorectal or urology specialists to ensure a coordinated approach to your care.
Hysterectomy: In certain cases, especially when other treatments have failed and the patient does not wish to retain fertility, a hysterectomy (removal of the uterus) along with the ovaries may be discussed.
The Benefits of Surgery
Research indicates that many patients experience significant improvements in pain and quality of life following surgery. On average, patients report their quality of life improving from 55/100 before surgery to 80/100 afterward, with sustained benefits observed even two years post-operation.
For those suffering from specific pain, such as discomfort during bowel movements or intercourse, reported pain levels can decrease dramatically following treatment.
Postoperative Care
To further reduce the risk of recurrence, I typically recommend hormonal therapy following surgery. Options may include the Mirena coil, Dienogest, or GnRH analogues for a duration of 6 to 12 months.
Conclusion
Deep infiltrating endometriosis is a complex condition that can significantly impact a woman’s quality of life and fertility. However, with appropriate diagnosis and tailored treatment strategies, many women can find relief from symptoms and improve their overall well-being. If you suspect you may have deep infiltrating endometriosis, I encourage you to reach out to Balaji Horizon Women’s Hospital for a comprehensive evaluation and personalized care. Together, we can navigate your journey toward better health and fertility.
