Management of bowel dysfunction after pelvic surgery for endometriosis.

Introduction Bowel dysfunction is a common and debilitating condition affecting patients with endometriosis. Despite the extent of surgery, symptoms may persist or arise, often overlapping with low anterior resection syndrome (LARS) or irritable bowel syndrome (IBS) typical features. This review aims to summarize the multifactorial pathophysiology and current therapeutic options for postoperative bowel dysfunction after endometriosis surgery.

A structured narrative review was conducted through a comprehensive search for studies published between 2000 and 2025. Inclusion criteria focused on postoperative functional outcomes and treatments (medical, rehabilitative and interventional) effectiveness. The available evidence is limited and largely extrapolated from related conditions such as LARS and neurogenic bowel dysfunction.

The complex pathophysiology of postoperative dysfunction involves preoperative visceral hypersensitivity, surgical disruption of pelvic autonomic nerves, reduced rectal compliance, and pelvic floor dyssynergia. While dietary interventions (e.g., low-FODMAP diet) and pharmacological treatments (laxatives, antidiarrheals, or neuromodulators) serve as first-line therapies, they are often insufficient for severe symptoms. Emerging evidence supports the use of transanal irrigation (TAI) for mechanical emptying and sacral neuromodulation (SNM) for refractory sensorimotor disorders. Functional rehabilitation, including pelvic floor physiotherapy and manual therapy, represents a further opportunity to influence specific symptoms.

Postoperative bowel dysfunction in endometriosis management requires a transition from rigid treatment protocols to a multidisciplinary, symptom-oriented approach. The support of specialized nursing, physiotherapy, and advanced interventions like TAI and SNM is essential. Future prospective studies using standardized outcome measures are needed to better define these therapeutic pathways and improve patient quality of life. Similar content being viewed by others Funding No funding for the present manuscript. Author information Authors and Affiliations Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Martellucci, J., Orlandi, S. Management of bowel dysfunction after pelvic surgery for endometriosis. Int J Colorectal Dis (2026). https://doi.org/10.1007/s00384-026-05163-1 Received: Accepted: Published: DOI: https://doi.org/10.1007/s00384-026-05163-1