Pouch of Douglas

[Giraffegreen]

Hi, I'm a little confused and hoping I can get some understanding. I have endometriosis on my pouch of Douglas, which i understand is against the bowel? Does this mean I have bowel endometriosis or am I confused? No ones really explained anything to me, symptomatically my bowels are a nightmare. Any clarity would be appreciated.

[Firhd]

Hi,

I have it here too. It depends what side the endometriosis is on as the POD sits between the vagina and the colon, so it could be just one side or both. If you are having symptoms it definitely could be that. How were you diagnosed? Are you able to ask more questions to see what they found?

Xx

[Giraffegreen in reply to Firhd]

I was diagnosed by laparoscopy, I've asked for a copy of the surgeons notes so I could see what was actually written.

[Firhd in reply to Giraffegreen]

ok and did you have any treatment? I know when I had my laparoscopy they treated what they found (or tried to!). I had to get my notes too as I was really drowsy and couldn’t remember what had been said to me.

[Giraffegreen in reply to Firhd]

They did they told me they'd cauterised the patches, they didn't tell me anything really when I woke up. She showed me pictures I didn't understand and said to be happy because my ovaries and tubes are clear. The gynecologist 4 months after just listed like the POD and other places and scar tissue. She went through so quick i didn't have context and she wasn't amenable to questions or explaining anything to me. It's been a proper mission to get anywhere or understand.

[Firhd in reply to Giraffegreen]

Yea my experience was similar in terms of the after care as well I didn’t really feel like I had answers and it was frustrating. From my own experience I do have it on the bowel and it does cause symptoms, which are really difficult to manage. I know this not because of my original laparoscopy back in 2018 but because of an MRI scan I was given after being referred to gynae last year.

I had cauterisation as well originally but have since been told that excision is best. Im due to have a hysterectomy at the end of March but I have endometriosis in other places and adenomyosis. I was referred for the hysterectomy on the NHS but am having it privately as otherwise I would be waiting 18months or longer.

If you feel that things have been missed or you are still experiencing symptoms after you read the surgeon’s notes then I would recommend getting a second opinion, preferably with an endometriosis specialist if you have one in your area.

[Giraffegreen in reply to Firhd]

Thank you for your help, I have been referred to an endo specialist now after my physio recommended it.

[MyStar86]

You would need to be referred to an endometriosis specialist as it the pod can only be operated on by a colorectal surgeon. I had my initial lap and surgery then was referred to the colorectal surgeon to discuss the surgery etc as it’s not something a gynaecologist can operate on it needs specific people there to do it but to risk of the rectum and bowel with the surgery so it can only be excision surgery. Good luck

[Lindle in reply to MyStar86]

That's not the case. The POD is a fold of peritoneum so endo there can range from minor peritoneal endo (stage 1/2) right through to classic stage 4 when the POD is obliterated with fibrosis.

[MyStar86 in reply to Lindle]

do you mean some cases don’t require a colorectal surgeon then if it’s minor?

[Lindle in reply to MyStar86]

Yes. Mild cases of peritoneal endo, wherever it is located, only needs to be treated by a gynaecologist with a special interest in endo in secondary care. It is only deep endo in the POD that requires treating in a specialist centre and may need a colorectal surgeon present. The latter depends on whether there is infiltration of the bowel and the complexity involved such as whether a resection is required. The specialist lap surgeons operate on bowel endo otherwise, but if there is risk to the bowel a colorectal surgeon might be required to be available if needed.

[MyStar86 in reply to Lindle]

ah I see thank you for explaining. I only knew off my case which was deep infiltrating and I had to go through surgery with the colorectal surgeon doing all the bowel endo so I apologise I didn’t know about minor cases.

[Lindle in reply to MyStar86]

Please don't apologise - it's all about learning...

x

[Hoppergrass]

hi

I had the same area for my endometriosis, it’s a pouch between the rectum and vaginal cavity.