When we evaluate women with bloating and lower abdominal discomfort, we consider endometriosis as a potential cause.

What is Endometriosis?

Endometriosis is a common health condition in women. The name derives from the word “endometrium,” which is the tissue lining the inside of the uterus. Women with endometriosis develop tissue similar to endometrial tissue that grows outside of the uterus, most commonly involving the ovaries, bowel or the tissue lining the pelvis.

In endometriosis, displaced endometrial tissue and growths continue to swell, bleed, and break down as it normally would inside the uterus with each menstrual cycle. This can cause pain and swelling because the displaced tissue becomes trapped as it is located in an area where it is difficult to exit the body. This pain can be especially severe during the menstrual period.

When endometriosis involves the ovaries, trapped blood in the ovaries may form cysts called endometriomas. Surrounding tissue can become irritated and inflamed, eventually forming scar tissue and adhesions (abnormal tissue that binds organs together).

Symptoms of Endometriosis?

The most common symptom is pain. Women with endometriosis may experience different types of pain which include:

• Painful periods (dysmenorrhea): pelvic pain and cramping may begin before and extend several days into a menstrual period
• Chronic lower back and pelvis pain
• Pain during or after intercourse
• Painful urination during menstrual periods
• Painful bowel movements during menstrual periods

Other symptoms include:

• Abnormal or heavy menstrual flow: You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding)
• Infertility: Sometimes, endometriosis is first diagnosed in women seeking treatment for infertility

Endometriosis causing Gastrointestinal Distress

Women with endometriosis commonly experience gastrointestinal (GI) symptoms, such as bloating, abdominal pain, diarrhea, constipation, nausea, vomiting. According to a study, there is no relationship between GI symptoms and the location of endometriosis lesions, except for lesions that are close or within the bowel which were shown to be associated with increased nausea and vomiting. Therefore, GI symptoms can present itself, essentially, without endometriosis infiltrating the bowel.

There are many patients with endometriosis primarily presenting with GI symptoms, who are frequently misdiagnosed with irritable bowel syndrome (IBS) and do not get complete relief with the treatment. It could be that endometriosis is the cause of the IBS symptoms; therefore, it is important to consider endometriosis in the differential diagnosis for women, especially those who experience GI symptoms with her menstrual cycle.

Endometriosis has another comorbid GI condition called Small Intestinal Bacterial Overgrowth (SIBO), which is also closely related to IBS. The increased risk for SIBO in endometriosis patients is likely due to inflammation from endometriosis causing a reduction or alteration of intestinal motility and bacteria. While SIBO is one of the many problems associated with endometriosis, it is an important one to address.

Author Fiona Miao Patient Care Coordinator