Deeply infiltrative endometriosis: What to know

Deeply infiltrative endometriosis is an uncommon and severe type of endometriosis. It, like other types of endometriosis, causes the growth of uterine lining-like tissue in other parts of the body.

Deeply infiltrative endometriosis is a type of severe endometriosis that has progressed to organs close to or inside the pelvic cavity. This has the potential to harm the bladder, intestines, reproductive system, and other organs. It causes inflammation, which results in scar tissue known as adhesions.

Excruciating menstrual periods, pain during sex, chronic pelvic pain, difficulty peeing, and digestive difficulties are all indications of deeply infiltrative endometriosis. It may also have an impact on a person’s fertility. Although the condition can be severe, doctors find it difficult to diagnose because symptoms overlap with those of other health concerns.

This article discusses the symptoms, diagnosis, and treatment of profoundly infiltrative endometriosis. It also examines problems and fertility.

Definition

deeply infiltrative endometriosis

Endometriosis of the deep infiltrative kind is a type of endometriosis. Endometriosis causes endometrial tissue to grow in locations other than the uterus, such as the pelvis or abdomen.

These tissues function similarly to the endometrium in that they accumulate and shed during the menstrual cycle. However, because there is no route for this tissue to exit the body, it becomes stuck, causing inflammation, scarring, and cysts.

Endometriosis is classified as kind and stage based on its location, depth, and amount of tissue affected.

Endometriosis is classified into four types:

  • deeply infiltrative endometriosis
  • abdominal wall endometriosis
  • superficial peritoneal endometriosis
  • endometrioma

The American Society of Reproductive Medicine defined four phases of endometriosis severity in 1996:

  • Stage 1 (minimal): At this stage, there are few implants and little to no scar tissue.
  • Stage 2 (mild): There are implants deeper in the tissue at this stage, as well as some scar tissue.
  • Stage 3 (moderate): At this point, there are several deep implants, maybe with cysts on the ovaries and thick regions of scar tissue known as adhesions.
  • Stage 4 (severe): At this stage, there are several implants, some of which are deep, with dense adhesions and big cysts on one or both ovaries.

Deeply infiltrative endometriosis is uncommon, affecting just around 1% of women of reproductive age. It is a severe form of endometriosis in which endometrial tissues invade organs within the pelvis, abdomen, and other areas, such as:

  • ureters
  • lungs
  • umbilicus
  • diaphragm
  • peritoneum
  • abdominal surgical scars
  • ovaries
  • vagina
  • cervix
  • fallopian tubes
  • bowel
  • rectum
  • bladder

Symptoms

When it comes to endometriosis, a person’s disease stage does not always correspond to their amount of pain. A person, for example, may have few adhesions but excruciating cramping pain. A person may have severe profoundly infiltrative endometriosis with no symptoms.

Endometriosis symptoms vary depending on the location of the body affected. Lesions linked with profoundly infiltrative endometriosis frequently damage nerve-rich areas, causing significant discomfort and pain.

Reproductive tract

Endometriosis people frequently endure significant cramping and pain during menstruation. Doctors call this dysmenorrhea.

They may also have pain during sexual activity as well as nonspecific pelvic pain. This pain could be chronic or just occur at certain points of the menstrual cycle.

Because the condition can change the structure of the pelvis and cause scar tissue to form, deeply infiltrative endometriosis can also impact fertility.

Urinary tract

Endometriosis of the bladder or urinary tract can cause the following symptoms:

  • experience burning sensations when urinating
  • have blood in their urine
  • feel pain when the bladder is full
  • often feel the need to urinate urgently

Endometriosis of the bladder can also cause pelvic and lower back pain.

Bowel

Endometrial tissue can grow anywhere in the intestine, but according to 2014 research, approximately 9 out of 10 occurrences of bowel endometriosis affect the rectum or sigmoid colon.

Among the symptoms are:

  • constipation
  • painful bowel movements
  • diarrhea
  • general pelvic pain
  • pain during sexual intercourse

Symptoms frequently vary across people and with the menstrual cycle.

Diagnosis

Doctors may struggle to diagnose endometriosis because there is no single test that can confirm the condition. Symptoms may also be similar to those of other health issues.

A laparoscopy is often the best technique to diagnose endometriosis, but it is fraught with complications. As a result, doctors may employ a combination of the following:

Laparoscopy is most typically used by doctors to confirm the presence of endometriosis and to assess the severity of the condition. During the operation, a surgeon inserts a camera or laparoscope through a small incision in the pelvis to see if endometriosis is present.

Treatment

Although there is no cure for endometriosis, there are numerous treatment methods that may provide relief from severe symptoms.

The goal of treatment may be to alleviate pain, increase fertility, limit the growth of endometriosis tissue, or prevent it from reoccurring.

Conservative surgery

The surgeon’s goal with conservative surgery is to remove only affected tissue while leaving healthy tissue alone.

A surgeon can utilize a variety of procedures to treat endometriosis, but laparoscopic surgery (laparoscopic excision) is the gold standard. During this operation, the surgeon uses as little heat and electricity as possible to remove or cut the entire lesion from wherever it is in the body.

Laser ablation is frequently used by surgeons to eliminate endometriosis lesions, however there is a danger of harming surrounding healthy tissue. In most cases, ablation is not long-term beneficial. The best approach is laparoscopic excision.

Definitive surgery

If endometriosis affects a specific organ, a surgeon may recommend surgical removal of the affected organ. During a hysterectomy, for example, the surgeon may remove the uterus. The ovaries and cervix may also be removed. It is critical to remember, however, that a hysterectomy does not cure endometriosis because the implants frequently arise in other locations.

Medication for pain relief

To relieve pain, anti-inflammatory medications such as paracetamol or ibuprofen may be used. If these over-the-counter solutions do not provide relief, they may choose to consult with a doctor about prescription options.

Hormone therapy

A doctor may advise hormone therapy to reduce estrogen production in the body, as this hormone promotes the development of endometriosis tissue.

The combined oral contraceptive pill, progesterone-only options such as the minipill, Depo-Provera, the progesterone intrauterine system, and the contraceptive implant are all hormone treatment choices. Injections of leuprolide acetate (Lupron), a more potent hormonal therapy, are also a possibility.

Complications

Complications like as adhesions and a frozen pelvis are possible in people with deeply infiltrative endometriosis.

Adhesions are fibrous bands of scar tissue that occur as a result of injuries, surgery, or the body’s reaction to the inflammation caused by endometriosis implants.

A frozen pelvis occurs when the organs of the pelvis become linked to one another by adhesions and “frozen” in position. Operating on a frozen pelvis is extremely difficult since the anatomy is deformed, increasing problems.

Fertility

Endometriosis that is deeply infiltrative can impact a woman’s fertility. Adhesions can, for example, hinder eggs from traveling or implanting in the uterus. They can also block off the ovaries’ blood supply or trap blood in the ovaries, resulting in cysts.

According to studies, 30–50 percent of people with endometriosis are unable to conceive. Experts, on the other hand, have yet to confirm the link between the two.

Another thing worth mentioning is that if a person with deeply infiltrative endometriosis becomes pregnant, her chances of having a cesarean section are doubled when compared to people without endometriosis.

Questions to ask a doctor

If a woman has deeply infiltrative endometriosis, it’s critical to have an open and honest conversation with her doctor about her diagnosis and treatment options.

The questions below are an excellent place to start:

  • Can I have surgery to remove the adhesions?
  • Is the surgery risky for my situation?
  • Where are the adhesions located?
  • What are the treatment options?
  • Do I have extensive adhesions?
  • Will the endometriosis implants affect my fertility?

People can get support and information from organizations like the Endometriosis Association to assist them advocate for their own health. People with endometriosis can get help, education, and support from this organization.

Conclusion

Endometriosis with deep infiltrative endometriosis is an uncommon but serious type of endometriosis.

Endometriosis is a condition in which tissues that mimic the uterine lining grow and implant in other parts of the body, such as the bladder, lungs, and digestive tract.

These implants can cause scar tissue adhesions, causing pain and affecting a person’s fertility.

These implants have spread outside of the pelvis in cases with profoundly infiltrative endometriosis. As a result, it may cause problems with bladder and bowel function, as well as chronic pelvic pain, penetrative sex pain, and severe period cramps.

Pain medicines, hormone therapies, and surgery to remove adhesions are some of the therapeutic choices that may help an individual’s symptoms.

Sources:

  • https://pubs.rsna.org/doi/full/10.1148/rg.2018170093
  • https://www.endofound.org/endometriosis-treatment-support
  • https://academic.oup.com/humrep/article/24/4/827/632224
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905889/
  • https://www.karger.com/Article/FullText/339519
  • https://www.medicalnewstoday.com/articles/what-to-know-about-deeply-infiltrative-endometriosis
  • https://www.jmig.org/article/S1553-4650(20)30093-5/fulltext
  • https://www.fertstert.org/article/S0015-0282(97)81391-X/pdf
  • https://www.nhs.uk/conditions/endometriosis/treatment/
  • https://www.ncbi.nlm.nih.gov/books/NBK567777/
  • https://gynecolsurg.springeropen.com/articles/10.1186/s10397-019-1065-9
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/
  • https://www.endometriosis-uk.org/your-laparoscopy