The Link Between Endometriosis and Bloating
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Medically reviewed by Cordelia Nwankwo, MD
"Endo belly" is a colloquial term that describes the bloating and associated symptoms that can occur with endometriosis. Bloating and pain from endo belly can be severe and be accompanied by symptoms such as constipation, diarrhea, and feeling unwell.
Endometriosis bloating can occur at any time, but often happens:
Around or during menstruation
During ovulation
After eating
This article will discuss the symptoms and causes of endo belly, how bloating due to endometriosis is diagnosed, triggers for endo belly, and ways it can be managed.
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Why Does Endometriosis Cause Bloating?
With endometriosis, tissue that is similar to the lining inside the uterus attaches to and grows on other areas of the body, usually within the pelvis or abdomen. Hormones that affect menstruation, such as estrogen, can also cause this tissue to grow. The inflammation and scar tissue caused by endometriosis can affect surrounding organs and cause symptoms such as pain and gastrointestinal issues.
The buildup of endometriosis tissue can cause inflammation, scarring, and blood-filled ovarian cysts. Fibrous, "sticky" endometrial tissue can form and cause organs in the pelvis and abdomen to stick together (called adhesions).
Endometriosis tissue can also form on the bowel, the peritoneum (membranous lining of the abdomen and covering the intestines), the cul-de-sac/pouch of Douglas (small area of the peritoneum between the uterus and rectum), the rectum, small intestines, or appendix. This can irritate the organs and cause gastrointestinal distress, including bloating, constipation, painful bowel movements, and diarrhea, most notably during menstruation.
Endometriosis lesions (areas of endometrial tissue growth) do not have to be attached to the bowel to cause inflammation, bloating, and related symptoms. Inflammation of the intestines can slow the progression of food through the small intestine after eating, which can contribute to pain and bloating.
In addition to lesions, inflammation, and scar tissue, endo belly can be caused or affected by:
Fibroids
Gut bacteria imbalance
Endo Belly Symptoms
Endo belly refers to extreme abdominal bloating associated with endometriosis.
Symptoms of endo belly include:
Abdominal distention: Bloating that causes the abdomen or pelvis to stick out and appear pregnant
Pain: Can feel like cramping, stabbing, pressure, or other pain sensations, and can be severe
Changes to bowel movements: Constipation, diarrhea, an urgency to have a bowel movement, the sensation of an incomplete bowel movement, and/or pain during bowel movements
Nausea or vomiting: Can be more common when lesions are within or close to the bowel
Flatulence: Accumulated intestinal gas
Endo belly can feel different for each person. Symptoms can vary and range in severity and duration.
Endometriosis symptoms can vary, and not everyone experiences all of the symptoms. Some people with endometriosis do not experience symptoms at all. Common symptoms of endometriosis can include:
Abdominal and/or pelvic pain
Menstrual periods that are heavy and/or irregular
Menstrual cramps that can be very painful
Clots larger than the size of a dime
Bloating
Fatigue
Pain during or after sex
Digestive problems such as constipation, diarrhea, blood in the stool, or pain with bowel movements
Pain in the back, leg, or groin
Depression
Steps to Diagnose Bloating Related to Endometriosis
Your healthcare provider will start by talking to you about your symptoms and medical history. They may also do a physical or pelvic exam. If they suspect endometriosis, they may start by giving you noninvasive medical treatment to see if symptoms improve.
If symptoms don't improve within a few months or they are severe, your healthcare provider may do other diagnostic tests.
Imaging tests alone can't be used to diagnose endometriosis, but they may be used to look for signs of the condition. These tests may include:
Ultrasound: Uses sound waves to look at organs and may include a transvaginal ultrasound, in which a small wand is inserted into the vagina to get a clearer picture of reproductive organs and pelvic area
Magnetic resonance imaging (MRI): Uses magnetic waves to examine organs and tissues inside the body
Computed tomography (CT): Uses X-ray images and computer technology to get detailed views inside the body
Sigmoidoscopy: A minimally invasive procedure that looks at the rectum and lower part of the colon
The only way to confirm a diagnosis of endometriosis is through surgery. Typically this is done using a procedure called laparoscopy. During a laparoscopy, the surgeon will:
Make a small incision in the abdomen
Insert a tube with a light and camera
Look at the tissues in and around the uterus and other pelvic organs, checking for endometriosis tissue growth
Take a small sample of abnormal tissue if any is found, and send it to be studied (biopsy)
Endometriosis Bloating vs. Other GI Issues
Endo belly can have symptoms that mimic other gastrointestinal (GI) issues. People with endometriosis can also have comorbid (co-occurring) GI conditions.
The symptoms of bowel endometriosis can resemble irritable bowel syndrome (IBS). But with endometriosis, the symptoms can coincide with the menstrual cycle, getting worse in the days before and during menstruation. IBS symptoms that seem to have a monthly pattern may be a sign of endometriosis that's affecting the bowel.
Looking at all possible causes of bloating and GI symptoms, and treating them together, if necessary, may help make symptom relief more effective.
The bloating from endo belly can cause the abdomen to distend—sometimes drastically. During a flare, this extended belly can also feel hard to the touch. For some people, this makes them appear as if they are several months pregnant.
Especially when swollen, endo belly can be very painful and debilitating.
Relief for Bloating: Endometriosis Treatment
It's important to treat endometriosis as a condition, not just look for symptom relief. Endometriosis may be treated with medication or with medical procedures.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil/Motrin (ibuprofen) can help with pain management. If pain is not relieved with over-the-counter (OTC) medication, your healthcare provider can help you determine if you need prescription medication for pain relief.
Because endometriosis tissue responds to hormones in a similar way to the endometrial lining in the uterus, hormone-based treatment can be used to treat endometriosis in some cases. These medications may include:
Combination oral contraceptives: Control hormones using estrogen and progesterone
Progestin: Stops menstrual periods and inhibits endometrial tissue growth, including endometriosis tissue
Gonadotropin-releasing hormone (GnRH) analogues: Temporarily induce menopause to lower estrogen levels in the body
Testosterone: A synthetic version of the hormone can suppress the production of estrogen and progesterone
Hormone treatments can have side effects and can affect your ability to get pregnant. Talk to your healthcare provider about the pros and cons of hormonal therapy to see if it is right for you.
Surgery
Several surgical options exist for treating endometriosis.
Laparoscopy
Laparoscopy is the most common surgical treatment for endometriosis. The initial procedure is the same as used to diagnose endometriosis. Some surgeons will treat endometriosis at the same time they diagnose it.
During the procedure, the surgeon can eliminate endometriosis tissue by:
Excision: Removing endometriosis tissue
Ablation: Destroying endometriosis tissue with intense heat
In some cases, a larger incision is needed. When a larger incision is used, the procedure is called a laparotomy.
Endometriosis tissue can grow back after these procedures, and repeat surgeries may be necessary.
Hysterectomy and/or Oophorectomy
A hysterectomy removes the uterus, while an oophorectomy removes the ovaries. These procedures can be done separately or together.
Removal of the ovaries significantly lowers estrogen levels, which slows or stops endometrial tissue growth, and may put an end to endometriosis symptoms (though endometriosis can return after hysterectomy and/or oophorectomy).
Removal of the ovaries starts menopause and induces menopausal symptoms such as hot flashes. It can also increase the risk of cardiovascular disease and bone disease.
These surgeries affect fertility. Talk to your healthcare provider about all of the benefits and risks of these procedures.
Bowel Surgery
Surgery to remove endometrial tissue from the bowel may involve a bowel resection (removing part of the bowel), depending on the extent of treatment needed.
Occasionally, a colostomy (a bag attached to an opening created in the abdomen to collect feces) may be needed while the bowel heals, but this is usually temporary.
Endometriosis-Related Bloating Triggers
Triggers for endometriosis-related bloating can be very individual. In addition to the association with menstruation, people with endo belly may notice certain factors make symptoms worse.
Stress appears to be associated with endometriosis, but it's unclear if endometriosis causes or is caused by stress.
Certain foods may aggravate endometriosis symptoms, such as inflammatory foods. Deciding on what diet to follow is an individual choice, and following a strict plan may be difficult. Keeping a food diary may help you detect if certain foods trigger or worsen your symptoms.
If you feel you need to cut out a lot of foods, talk to your healthcare provider about seeing a nutrition expert, such as a registered dietitian, to make sure you are getting adequate nutrition.
How to Manage Endometriosis Bloating At Home
Home remedies won't treat the endometriosis itself, but they can help manage symptoms and bring some relief.
Some home management techniques to try include:
Apply heat, such a hot water bottle, warm bath, or heating pad.
Practice yoga, meditation, and relaxation exercises to help with flexibility, circulation in the area, and pain relief.
Talk to a physical therapist about exercises you can do at home, such as pelvic floor exercises or massage.
Wear loose, comfortable clothing to reduce restrictions around your belly.
Engage in regular exercise.
Talk to your healthcare provider about using a transcutaneous electrical nerve stimulator (TENS) machine, which uses electrical pulses to block pain signals.
Summary
Many people with endometriosis experience GI symptoms, such as bloating, changes in bowel movements, and abdominal pain. Abdominal bloating and the associated symptoms (sometimes called endo belly) caused by endometriosis can be severely painful and debilitating.
The only way to confirm a diagnosis of endometriosis is with surgery, usually a laparoscopy often followed by a biopsy.
Treating the condition in addition to symptom relief is important. Endometriosis can be treated using medications, such as pain relievers and hormone treatment. Surgery may also be used, including laparoscopy, hysterectomy, oophorectomy, and bowel surgery.
Symptoms may be relieved at home with remedies such as gentle exercising, applying heat, yoga and meditation exercises, and wearing loose, comfortable clothing.
