Endometriosis and digestive issues: Understanding causes and symptoms for better relief!

Endometriosis and the gut microbiome: A two-way relationship

One of the most common symptoms experienced by those with endometriosis is bloating, often referred to as “endo belly” (due to the sometimes dramatic swelling of the abdomen). Other symptoms include constipation, diarrhea, and rectal bleeding (blood in the stool). While digestive endometriosis, where endometrial lesions form on the intestines, colon, or rectum, could be responsible for these symptoms, it only affects about 7.6% of women with endometriosis. To better understand the connection, it’s essential to look at the nature of the disease: chronic and inflammatory.

When the immune system detects an endometrial lesion, it triggers an immediate inflammatory response at the site. Due to the close proximity of organs in the abdominal cavity, this inflammation can easily spread to the digestive system, leading to intestinal spasms, bloating, abdominal pain, and disrupted bowel movements. Scar tissue can also form, creating adhesions that bind organs together, reducing intestinal mobility and, in turn, affecting digestive function. But that’s not the whole story.

The chronic inflammation caused by endometriosis can also lead to dysbiosis, an imbalance of good and bad bacteria in the gut microbiome. Since about 70% of the body’s immune cells are located in the gut, an imbalanced microbiome further fuels inflammation, worsening both the disease and its symptoms.

Other causes of digestive problems in women with endometriosis

First, many medications used to manage endometriosis pain can negatively impact gut health. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin are well-known for causing gastrointestinal side effects. Progestins, which mimic the effects of progesterone and are often prescribed for endometriosis, can lead to water and salt retention, contributing to bloating. Additionally, long-term use of birth control pills can cause nutrient deficiencies, particularly in zinc and magnesium, which are crucial for healthy digestion. Opioid-based painkillers (such as morphine, codeine, oxycodone, and tramadol) slow bowel movements, increasing the risk of constipation and further disrupting gut bacteria.

Furthermore, digestive symptoms common in endometriosis may overlap with other health conditions, so it's important to rule out coexisting digestive or autoimmune disorders. These could include gut yeast infections, chronic inflammatory bowel diseases (IBD) like Crohn’s disease or ulcerative colitis, small intestinal bacterial overgrowth (SIBO), or irritable bowel syndrome (IBS), which affects about 90% of women with endometriosis. There are also links between endometriosis and celiac disease, an autoimmune disorder where consuming gluten triggers an immune response that damages the small intestine. A study of over 1,600 women found that 2.5% of those with endometriosis also had celiac disease, compared to just 0.66% in the general population. Women with endometriosis are also seven times more likely to have hypothyroidism(9.6% vs. 1.5% in the general population).

How to improve digestive comfort with endometriosis?

The first step in managing digestive problems linked to endometriosis is to consult a healthcare professional, such as a general practitioner or gastroenterologist. They can help rule out other potential digestive or autoimmune conditions and investigate any functional disorders that could explain your symptoms.

Keeping a food diary is also a helpful tool. Track everything you eat and any digestive issues that follow. You should also note your emotional state during meals, your menstrual cycle phase, and bowel movement frequency. These details can help identify triggers for digestive flare-ups and foods that are better or worse tolerated.

While it may seem tempting to cut out certain foods or food groups to ease your digestive system, it’s important not to follow restrictive diets for too long, as they can alter the gut microbiome and backfire. Working with a registered dietitian is highly recommended to create a personalized plan. This plan should address both local issues, such as intestinal permeability, and systemic concerns, like reducing overall inflammation.

Another way to improve digestion is by supporting intestinal mobility. Physical therapy sessions or osteopathy can help. Self-massage of the abdomen with chamomile oil, known for its calming properties, is another option, or you can see a professional for abdominal massage therapy. The goal is to relieve tension and improve fluid circulation, which can enhance digestive function.

Finally, there are some simple habits you can adopt to support better digestion, including:

• Reducing stress and eating in a calm environment away from screens, so your body can focus on digestion.
• Chewing food thoroughly to aid digestion.
• Drinking water between meals to avoid diluting stomach acid.
• Taking a short walk after meals to promote digestion.

These steps, combined with professional guidance, can significantly improve digestive comfort for women with endometriosis.

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