Irritable bowel syndrome, or IBS, is a relatively common disorder that affects the colon. It is termed a diagnosis of exclusion because a diagnosis is reached only through the elimination of other disorders. The presence of IBS itself cannot be established with complete confidence based on the history, examination, or testing.
Many of the symptoms of IBS are similar to those of bowel endometriosis, such as diarrhea, constipation, bloating, cramping, and abdominal pain. Unlike endometriosis, however, IBS can be more or less controlled with medication or a change in the diet. Surgery is rarely needed. But, when endometriosis is misdiagnosed as IBS, patients can go years without receiving the surgical treatment that might be the best option for them. Doctors often mistake endometriosis for IBS because of the similarities in symptoms and possibly because of a lack of sufficient knowledge on endometriosis.
How Is IBS/Endometriosis Diagnosed?
Doctors, usually gastroenterologists, begin their investigative process by viewing the upper gastrointestinal tract through a scope inserted through the patient’s mouth, down the esophagus, and into the stomach (endoscopy). They then insert a scope through the patient’s backside to assess the rectum and colon. If all of the findings are perfectly normal, the doctors often conclude that the patient has IBS, without noticing the inflammation in the outer layer of the bowels. This is precisely where endometriosis lesions can attach and cause the symptoms that seemingly appear as IBS. All of this ultimately begs the question, “What do these doctors fail to ask the patients that can ultimately help reveal the underlying cause for their symptoms?”
Ask yourself this: “Do the symptoms of constipation, painful bowel movements, or diarrhea occur at the same time as your period?”
It is crucial that doctors ask patients the details of their symptoms in terms of the frequency of occurrence. Certain continuing patterns that are in sync with the menstrual cycle, which may differ for each patient, can more clearly point to endometriosis. For example, some women experience loose stool right before their period or diarrhea 1 to 2 days into their cycle followed by constipation and bloating.
These patterns should alert a physician that the cause of the symptoms is more than just IBS, and endometriosis should be ruled out by first referring the patient to a proper gynecological follow-up. Doctors should also question whether the patients have certain symptoms that strictly pertain to bowel endometriosis and not IBS, such as dyspareunia (pain upon sexual intercourse) or focalized leg or hip pain (neuropathy).
What Causes A Misdiagnosis Of IBS/Endometriosis?
Most physicians don’t ask these types of questions because they don’t know why to ask them, and it is not common practice to rule out endometriosis when considering such GI and bowel symptoms. When doctors evaluate a patient, looking into the stomach, the colon, and the rectum, they do so to look for a potential source of the pain inside the organs, not on the outside, where endometriosis lesions can lie.
Oftentimes, doctors also don’t refer the patient to a laparoscopic surgeon, who can observe the outer walls of these abdominal organs, assuming they are not equipped or trained to do so themselves. This is important to note, as a laparoscopic surgery with a biopsy and accompanying pathology report is the only proven way to formally diagnose endometriosis. By ignoring this, the physician does not rule out this possibility.
So what do these doctors recommend as a solution to their patient’s supposed illness? Typically, GI specialists will suggest some dietary adjustments, which may temporarily calm the bowel symptoms, giving a false impression that the problem is fixed. But the symptoms inevitably return, and usually very quickly. Even if a patient continues to display pain and symptoms after countless diet changes and Helicobacter pylori (H. pylori) treatment – all strong indicators of endometriosis – the physician may not provide the referral that the patient so desperately needs.
What Should You Do?
If a treatment isn’t working, or if the pain or other symptoms occur each month during your period, do your best to ensure that your doctor understands this.
Remember this very clearly. If you or somebody you know is diagnosed with IBS, do not assume it is a misdiagnosis. You may very well have the condition, and if so, a gastroenterologist will certainly know how to treat it. However, the underlying cause of the symptoms may be much more than IBS.
It is certainly the medical community’s responsibility to find new ways to improve and ensure that patients are not misdiagnosed. However, it is also important for patients to play an active role in order to ensure that they receive the best form of care that they both need and deserve. That is one of the primary purposes of this article – to educate you on endometriosis so that you can both be your own advocate and bring any necessary awareness to your doctor, who may have little or no knowledge of the disease.
Remember, if you are misdiagnosed with IBS when the true cause of your symptoms is endometriosis, the misdiagnosis gives the endometriosis more time to grow, which can create more problems and significantly more risk as time progresses. Therefore, it is crucial for patients to not stop listening to their body, even after they have seen their physician. Pay attention to how your body reacts to the treatments you receive, especially if it is surgical, and speak up if it isn’t working.