Objective To investigate the clinical characteristics of preoperative intestinal symptoms in patients with bowel endometriosis and to compare the effects of shaving versus segmental bowel resection on postoperative intestinal function. Methods A total of 105 patients diagnosed with bowel endometriosis and treated by the same surgical team at the Obstetrics and Gynecology Hospital， Fudan University between Aug 1， 2013 and Dec 30， 2017 were prospectively enrolled in this study. Clinical data were collected via outpatient visits and telephone follow-ups at four time points： preoperative （T0） and postoperative （T1： Nov 2018； T2： Nov 2020； T3： Apr 2024）. The primary outcome was bowel symptoms and gastrointestinal function scores； secondary outcome was pain scores. A generalized estimating equation （GEE） model was used to analyze the interaction effect of surgical approach and follow-up time on outcomes. Results Ultimately， a total of 89 patients were included （15.24% loss to follow-up）， among whom 79 patients （88.76%） underwent shaving excision. Preoperatively， 46 patients （51.68%） presented with bowel symptoms， primarily anus bulge （21 cases， 46.65%） and diarrhea （15 cases， 32.61%） during menstruation. Postoperatively， there was a significant increase in constipation rates （T1：71.43%；T2：50.00%；T3：72.00%）. Both surgical groups exhibited significant improvements in dysmenorrhea， gastrointestinal discomfort scores as well as gastrointestinal quality of life index （P<0.000 5）. However， the segmental resection group had significantly higher scores for low anterior resection syndrome， constipation compared with the shaving excision group（P=0.02 and P=0.05）. Conclusion Approximately half of the patients with bowel endometriosis exhibit typical bowel symptoms preoperatively， such as anus bulge and diarrhea. Both shaving excision and segmental resection effectively alleviate pain； however， shaving excision demonstrates an advantage regarding preservation of bowel function， whereas segmental resection may elevate risks associated with postoperative constipation or altered defecation patterns due to structural changes. The selection of surgical approach should carefully balance lesion removal and functional preservation， moreover， be sure that potential risks are thoroughly informed to patients prior to surgery.