Visceral syndrome in endometriosis

Researchers at Aarhus and Aalborg universities in Denmark have shown that a significant number of women with endometriosis suffer from a specific symptom correlation, which is uncommon in women without the disease.

For example, it is known that pain related to bowel and bladder function is seen often in endometriosis and that, indeed, the pain of women with endometriosis appears to be more severe than in women without the disease [1].

This cohort study by Karina Ejgaard Hansen et al investigated 610 women with diagnosed endometriosis and 751 reference women, who completed an electronic survey based on the EHP-30 questionnaire [2].

Their results confirm that the following symptoms occur in women with endometriosis:

Pelvic pain (unrelated to menstruation)
Painful urination (dysuria)
Painful bowel movements (dyschezia)
Irregular bleeding
Constipation or diarrhoea
Nausea or vomiting
Fatigue

We knew this already!

However, what this study shows – for the first time – is that five of these seven symptoms are reported ten times more often in women with endometriosis compared with controls (22.7% vs. 2.7%).

Furthermore, when analysing women with endometriosis – who only reported pain – the results where the same (24.3% vs. 2.2%).

A new symptom correlation in women with endometriosis?

This is the first time a study has shown that women with endometriosis may suffer from a specific symptom correlation – a visceral syndrome – which is uncommon in women without the disease.

These data feed into what WERF EPHect is trying to determine on a global scale through its harmonisation of standard operation procedures in the collection of bio-specimens and clinical data from women with endometriosis in order to ascertain which symptoms are associated with which types of endometriosis — and how we can utilise this knowledge to develop targeted treatments for these different sub-types of endometriosis.

Whereas WERF EPHect is a long-term project, when it comes to the short term, Karina Ejgaard Hansen has the following comment:

Psychologist Karina Ejgaard Hansen MSc, Aarhus University Hospital
Many women with endometriosis complain about painful bladder and/or bowel function despite the fact that visible disease on these organs may not have been identified. Consequently these patients receive little empathy for their unspecific symptoms.
It is an important message that non-specific pelvic pain, such as dysuria and/or dyschezia, as well as non-menstrual pelvic pain, constipation and/or diarrhoea, probably have a biological explanation, which may be that endometriosis contributes to disturbances within the nerve pathways of the bowel and bladder and consequently causes pain,

said Karina Hansen, and continued:

One could imagine that the serious delay in the diagnosis of endometriosis could be that these symptoms have not previously been associated with endometriosis.
This lack of understanding of the complexities of pain, including the visceral syndrome, results in serious consequences for the women affected, ie. years of unbearable pain, reduced quality of life, and a consequential lack of productivity [3].
Every physician needs to consider this when dealing with women in pain. It is the only way to avoid “misunderstandings”, or the “psychocolisation” of women who complain of non-specific pelvic pain – especially if this pain is cyclical

concluded Hansen.

References

Nnoaham, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011;96(2):366-73
Hansen, et al. Visceral syndrome in endometriosis patients. Eur J Obstet Gynecol Reprod Biol 2014;179:198–203
Simoens S, et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012;27:1292-9