Do you suffer from endometriosis and also struggle with recurring bowel problems? You are not alone! In fact, around 85% of women with endometriosis suffer from bowel problems at the same time as their menstruation. What may initially seem like two separate issues is actually closely linked.
Contents:
The complex link between endometriosis and bowel health
Symptoms: When your bowel is sounding the alarm
Bowel endometriosis: When endometriotic lesions settle in the bowel
Chronic pain: Not just cyclical
Strategies for greater well-being
Conclusion: Breaking the vicious cycle
The complex link between endometriosis and bowel health
When the microbiome gets out of balance
Your bowel is home to trillions of bacteria, which not only influence your digestion but also play a major role in regulating your hormones. In endometriosis, however, this finely tuned balance is disrupted.
The oestrobolome—the term scientists use to describe the group of gut bacteria involved in oestrogen metabolism—plays a key role. Women with endometriosis are more likely to have bacteria that produce the enzyme β-glucuronidase. This enzyme can cause oestrogen that has already been excreted to re-enter the body, contributing to an oestrogen excess.
When the bowel becomes leaky
Another important factor is so-called "leaky gut". The bowel barrier is often weakened in women with endometriosis, making it easier for bacteria and toxins to enter the bloodstream. The result: Increased inflammation and higher histamine release, which not only intensify pain but also affect digestion.
Symptoms: When your bowel is sounding the alarm
Bowel problems in endometriosis can manifest in various ways:
Common digestive issues
- Constipation and sudden urges to defecate
- Severe bloating and nausea
- Vomiting in severe cases
- Severe pain when defecating
- The feeling of not being able to fully empty the bowel
- Food intolerances and SIBO (small intestinal bacterial overgrowth)
The irritable bowel trap
Alarmingly, women with endometriosis are three times more likely to be diagnosed with irritable bowel syndrome than healthy women. Endometriosis often remains undetected as the actual cause. Many affected women spend years going from one doctor to another without the link being identified.
Bowel endometriosis: When endometriotic lesions settle in the bowel
In around 8% of women with endometriosis, endometriotic lesions settle directly in the bowel wall—a condition known as bowel endometriosis. This can cause particularly distressing symptoms:
- Cyclical bowel bleeding
- Increased pain when defecating
- Constipation
- Depending on the location, pain during sexual intercourse
The "endobelly" phenomenon
Do you know the feeling: In the second half of your cycle, your belly suddenly becomes round and painfully bloated? This phenomenon is called "endobelly" and affects many women with endometriosis.
Possible causes of endobelly
Research into this phenomenon is still in its infancy, but experts suspect several factors:
- Luteal phase dysbiosis: More fermenting and putrefying bacteria lead to increased gas formation from FODMAPs (fermentable sugar compounds)
- Motility disorders: The small intestine moves more slowly, increasing the risk of SIBO
- Increased inflammation: Leaky gut and higher histamine release affect pain and digestion
- More frequent food intolerances: These can also lead to bloating
Immune system under constant stress
Endometriosis means chronic inflammation. This keeps your immune system permanently activated, which has several consequences:
- 2–3 times higher risk of food intolerances
- More frequent autoimmune diseases
- Increased allergies
- Visceral hypersensitivity (overly sensitive pain perception in the abdominal area)
Chronic pain: Not just cyclical
What many do not know: The pain is not limited to menstruation. Adhesions and so-called pain memory can also lead to acyclical lower abdominal pain or chronic persistent pain.
Adhesions can impair the bowel's mobility and obstruct the passage of stool. Visceral hypersensitivity means that even normal bowel movements can be perceived as painful.
Strategies for greater well-being
Nutritional therapy approaches
Based on the findings in the book "Women Have a Different Bowel" by Prof. Julia Seiderer-Nack, MD, targeted nutritional strategies can help:
During the luteal phase
- FODMAP reduction: Especially if symptoms occur mainly cyclically
- Low-histamine diet: Can reduce inflammation and pain
- Anti-inflammatory foods should be prioritised
Holistic bowel health
- Strengthen the microbiome: Through probiotic foods and prebiotic fibre
- Stabilise the bowel barrier: With glutamine, zinc and omega-3 fatty acids
- Personalise: After identifying specific intolerances
Important tests
If symptoms persist, you should consider the following tests:
- SIBO test: Especially if bloating is severe
- Food intolerances: Lactose, fructose, histamine
- Rule out endometriosis if you have not yet received a diagnosis
Conclusion: Breaking the vicious cycle
The link between endometriosis and bowel problems is complex but understandable. The important thing is that you know: You are not imagining the symptoms, and there are solutions!
A holistic approach that takes both endometriosis and bowel health into account can significantly improve your quality of life. Do not accept a diagnosis of "irritable bowel syndrome" without further investigation, but insist on a comprehensive assessment.
Book recommendation: For anyone who wants to delve deeper into the subject, I recommend the book "Women Have a Different Bowel". It offers sound scientific insights and practical tips specifically for women with hormone-related bowel problems.
This article is not a substitute for medical advice. If symptoms persist, consult your doctor or an endometriosis specialist.
Frequently Asked Questions (FAQ):
Can bowel problems be the first sign of endometriosis?
Yes, many women experience bowel problems before an actual endometriosis diagnosis. If you have cyclical bowel problems, you should have them investigated.
Can a special diet help with bowel problems caused by endometriosis?
An anti-inflammatory, low-histamine diet with reduced FODMAPs during the luteal phase can bring significant improvements. Individual adjustment is important.
Can bowel endometriosis be cured?
Bowel endometriosis usually requires surgical removal of the lesions. The decision should always be made with an endometriosis specialist.
