What is the Cause of Endo Belly?
By Meredith East-Powell
If you suffer with endometriosis or adenomyosis, bloating and digestive symptoms, including the dreaded “endo belly”, you’ll know how debilitating these symptoms can be. So what causes our least favourite endo symptom? And what can you do about it? Enter Clinical Nutritionist Meredith East-Powell, who discusses some of the factors behind endo belly, and ideas for combatting this symptom.
If you have endometriosis and struggle with bloating or ‘endo-belly’, you’re not alone.
Bloating and other digestive symptoms such as constipation and diarrhoea are common in women who have endometriosis. Often women are diagnosed with irritable bowel syndrome (IBS) before they receive a diagnosis of endometriosis. This is because many of the symptoms present the same in both endometriosis and IBS.
Another interesting thing to note is that endo-belly seems to occur regardless of the location of endometriosis. This means, that you could be experiencing gastrointestinal symptoms without endometriosis being located on the bowel. In other cases, some women have endometriosis lesions on the bowel and nearby organs, which can cause a range of symptoms such as bloating, painful bowel movements and constipation.
This means that endo-belly can be from endometriosis, but it can also be from digestive issues such as IBS.
Gut health is an important consideration for women with endometriosis, given that a dysfunctional immune response has a key role in the development of the disease, and that the gut microbiome can influence the immune system (1).
The gut microbiome is the microbial community of bacteria, viruses, fungi and other organisms that live in the digestive tract.
What causes IBS?
IBS is a syndrome, which is a set of associated signs and symptoms. One of the most common causes of IBS is small intestine bacterial overgrowth or SIBO.
Most of the bacteria that lives in our gut is located in the large intestine. SIBO occurs when there is too much in the small intestine.
The overgrowth of bacteria in the small intestine can cause a number of symptoms such as constipation and/or diarrhoea, abdominal pain and bloating.
In addition to symptoms, SIBO can cause food to not be digested properly. This can result in nutritional deficiencies such as protein, fats and carbohydrates, along with fat soluble vitamins (such as vitamin A, D and E).
There’s a greater chance of women with endometriosis developing SIBO due to the adhesions or scar tissue, which can interfere with the normal digestive processes. Endometriosis is also linked to dysbiosis, which is an imbalanced microbiome (1). Chronic stress is another factor to consider, as it can also impair digestion.
How do you diagnose and treat SIBO?
SIBO is diagnosed through a lactulose breath test which is completed at home. If your results are positive for SIBO it is commonly treated with:
Herbal antimicrobials or antibiotics
A diet that restricts carbohydrates such as:
Low FODMAP diet
The Fast Tract diet
SIBO specific food guide
SIBO Bi-phasic diet
Specific treatments and supplements that address the underlying cause of the overgrowth
SIBO treatment usually takes between 2-6 weeks and over time the diet becomes less restrictive with foods reintroduced. Some people may need a few rounds of treatment to clear the overgrowth and diet should be tailored according to the individual.
What else could cause endo-belly?
There can be a range of triggers that cause bloating, some examples include:
Intolerance to gluten, lactose, food chemicals such as histamine and the A1 protein found in cow’s dairy.
Two studies have shown IBS symptoms in women with endometriosis can be due to nickel sensitivity (2, 3).
Other causes of bloating and GI upset include hormonal changes, drugs (such as antidepressants) and stress.
Meredith East-Powell is a Clinical Nutritionist who has a special interest in endometriosis and gut health. You can read more about endometriosis and gut health at her website mereditheastpowell.com and connect with her on Instagram and Facebook.
References
Leonardi, M., Hicks, C., El‐Assaad, F., El‐Omar, E., & Condous, G. (2019). Endometriosis and the microbiome: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. doi:10.1111/1471-0528.15916
Borghini, R., Porpora, M. G., Casale, R., Marino, M., Palmieri, E., Greco, N., Donato, G., & Picarelli, A. (2020). Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study. Nutrients, 12(2), 341.
Yuk, J. S., Shin, J. S., Shin, J. Y., Oh, E., Kim, H., & Park, W. I. (2015). Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study. PloS one, 10(10), e0139388. https://doi.org/10.1371/journal.pone.0139388
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