21-03-2025
Your IBS symptoms might actually be endometriosis – here's how to tell
IBS symptoms, like bloating, diarrhea and constipation, aren't always down to what you eat. In fact, they could also be signs of endometriosis: a disease where tissue like the lining of your womb grows outside of the uterus.
While endometriosis is often considered a reproductive disorder, with symptoms mostly related to the menstrual cycle like extremely painful periods, it can also impact other organs such as your bowel.
One study found that women with endometriosis were 3.5 times more likely to have received a diagnosis of IBS compared to women without the disease. Other research shows 60% of people with the condition experienced functional bowel symptoms.
Of course, IBS and bowel symptoms are complex and have causes ranging from stress to SIBO (small intestinal bacterial overgrowth), so it doesn't mean your gut struggles are definitely down to endo. However, getting to the bottom of your symptoms matters – so if you're worried about the link, we asked experts from Nuffield Health to dig into the link.
There are two main reasons IBS symptoms and endometriosis are linked, explains James Tibbott, a consultant gynaecologist at Nuffield Health.
Pelvic inflammation: 'Endometriosis can be thought of as an inflammatory condition of the pelvis,' he explains. The bowel also sits within the pelvis, and when the environment is inflammed, 'the bowel can become dysfunctional.' It's why women without the condition also experience digestive issues around their period. The luteal – the two weeks after ovulation and before your period – is considered 'pro-inflammatory', and the hormones at play at this point can impact your gut with symptoms like 'period poos'.
Bowel endometriosis: 'Another scenario occurs when endometriosis invades the small and large bowel,' Tibbott adds. Known as bowel endometriosis, it's where the tissue is foung growing around or in the organ itself.
According to Dr Ramakrishnan, a consultant physician and gastroenterologist at Nuffield Health, 'Bowel-related symptoms of endometriosis include bloating, abdominal pain, changes in bowel habits and bleeding from the back passage at the same time as periods.'
These symptoms can occur for bowel endometriosis specifically, as well as other types of endometriosis. However, some people can have endometriosis with no bowel symptoms. 'Endometriosis is an incredibly varied condition, and some patients with severe endometriosis may have virtually no symptoms,' says Mr Tibbott.
Endometriosis is hard to diagnose – those with the condition wait on average 10 years for a diagnosis. Often, bowel symptoms also can mean people are misdiagnosed, says Dr Ramakrishnan: 'Endometriosis involving the lining of the bowel is rare, but endometriosis affecting the bowel in other ways can be misdiagnosed as IBS and is very common.
'When patients with apparent digestive issues are referred to me but likely have endometriosis, the key factors that help differentiate and make a concrete diagnosis include: taking a detailed history, focusing on the chronology of symptoms, and identifying any correlation (or lack thereof) with the menstrual cycle.'
'Interestingly, most treatments for endometriosis such as hormone therapy can help bowel and digestive symptoms,' says Dr Ramakrishnan. 'However, surgery [to remove the endometriosis lesions] may be necessary in some cases, especially if response to conventional treatment fails.
'For better digestive health and to help manage endometriosis, I advise avoiding ultra-processed foods and following a healthy, balanced diet – predominantly Mediterranean in style – with adequate protein, fats, and carbohydrates. Additionally, sticking to regular mealtimes and dedicating time to eat without distractions are beneficial steps for improving gut health.'
Mr Tibbott adds that you could trial a FODMAP diet (under the careful watch of a dietitian) to find any potential trigger foods for your symptoms. 'Probiotics like Symprove have also been shown to help with IBS symptoms and are safe to trial,' he adds.
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