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Endometriosis vs Irritable Bowel Syndrome: What's the Link?

Updated: Jun 14

Gastrointestinal symptoms in endometriosis


Endometriosis is a chronic, inflammatory gynaecological condition, and it occurs when tissue, that normally lines the uterus, is found in other parts of the body. Organs affected by this ‘stray’ tissue can include the reproductive organs, including the ovaries, fallopian tubes and cervix. However, it can also affect other abdominal organs such as the bowel and bladder.


The presence of this ‘stray’ tissue can cause irritation and inflammation and can also cause scarring. As a result, it can lead to symptoms including pelvic pain, pain during periods and intercourse, heavy periods, fatigue, pain with bowel movements and intense abdominal pain.


Gastrointestinal symptoms (bloating/diarrhoea/constipation) are common in endometriosis. These symptoms overlap with those of irritable bowel syndrome (IBS), making it difficult to distinguish between the conditions, and causing the possibility of misdiagnosis and/or delayed diagnosis.


However, it is not uncommon for women to be diagnosed with both IBS and endometriosis. For instance, one study showed that 36% of women with IBS had a concurrent diagnosis of endometriosis(1). Another study showed that women with endometriosis were 3.5 times more likely to have been diagnosed with IBS than women without endometriosis(2).


If you suspect you have either condition, it's important that you speak to a doctor about your symptoms to ensure any underlying issue isn’t left untreated.⁠⠀


What's the link between endometriosis and IBS?


The exact reasons why women with endometriosis are more likely to have IBS are not fully understood, but several theories and mechanisms have been proposed to explain how the two conditions co-exist:


  • Inflammatory processes: endometriosis involves chronic inflammation due to the presence of endometrial-like tissue outside the uterus, which triggers an immune response. This chronic inflammation can affect nearby organs, including the bowel, potentially leading to IBS symptoms. IBS is also associated with low-grade inflammation, suggesting that a shared inflammatory process may link the two conditions(3).


  • Visceral hypersensitivity: women with endometriosis often experience heightened sensitivity to pain in the pelvic area, a condition known as visceral hypersensitivity. This increased pain sensitivity can extend to the gastrointestinal tract, contributing to the development of IBS symptoms such as abdominal pain and discomfort(4).


  • Hormonal influences: hormonal fluctuations, particularly related to the menstrual cycle, can exacerbate symptoms of both endometriosis and IBS. Oestrogen and progesterone can influence gut motility (changes in the movement of the gut and contents within the gut) and sensitivity, leading to gastrointestinal symptoms that mimic or worsen IBS in women with endometriosis.


  • Microbiome alterations: emerging research suggests that alterations in the gut microbiome may play a role in both endometriosis and IBS. An imbalance in the gut microbiota, can contribute to inflammation and gastrointestinal symptoms. Women with endometriosis may have distinct microbiome profiles that predispose them to IBS(5).


How can diet help manage symptoms of endometriosis and IBS?


Endometriosis and IBS affects every woman differently, so no treatment plan is guaranteed to work for everyone. However, certain lifestyle changes, home remedies, treatment strategies, and prescription medications can make your symptoms more manageable. I’ve discussed some of these strategies in my previous blog articles here and here.


There has also been further emerging evidence to support the low FODMAP diet approach in managing endometriosis and IBS. A study showed that 72% of women with both conditions experienced a >50% improvement in bowel symptoms on a low FODMAP diet at 4 weeks than those with IBS alone(6).


What’s the low FODMAP diet?


A low FODMAP diet is a 3-step diet that can reduce symptoms of medically diagnosed IBS. FODMAPs are a group of short-chain carbohydrates and sugar alcohols that are poorly absorbed in the small intestine. The term "FODMAP" stands for; fermentable oligosaccharides, disaccharides, monosaccharides & polyols.


For the first 4-6 weeks, high FODMAP foods are eliminated from the diet to reduce symptoms. Foods are then systematically reintroduced one at a time to identify which types of FODMAPs cause symptoms. The final stage of the diet is tailored to include only the FODMAPs that are well-tolerated, ensuring a balanced and enjoyable diet. However, the low FODMAP diet isn't isn't suitable for everyone, and should only be applied after a diagnosis of IBS.


If you have been diagnosed with IBS it’s important to work with a FODMAP trained dietitian so that you can get the right support and guidance to make the most appropriate changes for you.


Are you looking for some support with a low FODMAP diet? Or maybe you’d like to explore how diet can help you manage your endometriosis and IBS symptoms? If you'd to discuss these further, feel free to book your free 20-minute Discovery Call with me here, or you can also email me: laura@nurture-for-life.com

 

References


  1. Seaman, H.E., et al., Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study--Part 2. British Journal of Obstetrics and Gynaecology, 2008. 115(11): p. 1392-6.

  2. Mather, R., et al., Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digestive Diseases and Sciences. 2010. Apr;55(4):1085-9.

  3. Habib, N., et al., Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. International Journal of Women’s Health. 2020 ; 12 : 35-47.

  4. Hansen, K.E., et al., Visceral syndrome in endometriosis patients. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014. 179: p. 198-203.

  5. Leonardi, M., et al., Endometriosis and the microbiome: a systematic review. British Journal of Obstetrics and Gynaecology, 2020; 127: 239-249.

  6. Moore, J.S., et al., Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol, 2017. 57(2): p. 201-205.

 

 

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