Constipation, SIBO & Other GI Issues Can Be A Red Flag For This Condition
How endometriosis can seriously mess with your digestion.
The main organs of digestion—namely, the colon or large intestine, the small intestine or small bowel, and the rectum—sit together, functioning in continuity, in the crowded abdomino-pelvic cavity. And endometriosis can have a massively disruptive impact on this area.
Unlike the cells of the uterine lining, which flow out of the body during menstruation, endo cells do not dissipate through a natural exit; rather, they thicken and expand. As they do, these endo implants (i.e., the clumps of tissue that grow outside your uterus) affect both the organs they are growing on or adjacent to and the muscles and fascia that underlie the organs. Their presence can make organs adhere to one another or tense and tighten disproportionately to one side.
The anatomical distortion caused by endo implants on or near the GI tract can trigger symptoms like diarrhea, constipation, bloating, painful bowel movements, and abdominal pain, all of which can be incredibly uncomfortable and unpredictable. The pulling and tugging on the fascia and muscles can prevent the bowel's normal peristalsis (the contraction and relaxation that prompts you to poop) and can slow its motility, causing constipation. Sometimes, the constipation becomes so bad that women are only able to release the rare watery stool, with some patients even needing to use their finger to "trigger" a bowel movement.
Meanwhile, the inflammation of endometriosis plus the slowdown of bowel motility mean that the bacteria of the small intestine stay there for a long time, during which they fester and grow well beyond what is normal. That condition is called small intestinal bacterial overgrowth (SIBO), and it can impede the absorption of nutrients into the bloodstream and release enzymes and gases that cause bloat and pain as well as diarrhea.
In some women, these symptoms occur at random. In others, they occur in sync with a woman's cycle—after being constipated for two or three weeks, the arrival of the menstrual flow metaphorically pops a cork in these women, and liquid stool just pours out of them. And then the cycle begins again. And even if these events occur only sporadically, the fact of their recurrence is a signal that endo could well be the cause.
Additionally, pelvic and abdominal muscle aches from straining in the bathroom, phantom urges to poop, and any lower GI pain that feels disproportionately severe can also all be indicators you may be dealing with endometriosis.
How common are GI issues in women with endometriosis?
Some gynecologists who specialize in endometriosis have said that, for their endo patients, the most common non-gynecological symptoms they present with are GI symptoms. In one key study, a full 90% of women with endo presented with GI symptoms—and, it is important to note, only 7.6% of the women had implants on the bowel itself. Thus, some experts say, the diagnosis of GI disorders, especially SIBO, should be considered a "red flag" by health care providers, signaling the possibility—if not the likelihood—of endometriosis as an underlying cause.
But this connection is all too often missed. Women with these GI symptoms typically first see their internist, are then referred to a gastroenterologist who performs endoscopy that is typically normal, after which they are diagnosed with irritable bowel syndrome (IBS) and are prescribed medications that decrease their bloating or increase their bowel motility. The relief tends to be temporary, but the underlying cause has actually gone unrecognized, leaving the poor patient blind to what is fundamentally wrong. The problem is that the view through the specialist's lens too often results in treating only symptoms, not in ascertaining their cause.
For women—especially young women, since IBS presents early in life—an IBS diagnosis should therefore reverberate as an important signal that other, deeper causes may also be at issue, and any young woman with painful periods who has received a diagnosis of IBS should insist on further investigation. Patients have an obligation to question a diagnosis and to educate themselves about what doctors tell them. You have only one body and one life—and you deserve to find out what is really going on.
Tips to ease digestive issues associated with endometriosis.
While you'll want to work with a practitioner to come up with an overall game plan to manage your endometriosis, here are a few ways you can start managing your GI-related symptoms:
1. Eat the right foods.
Overall, beating endo will call for an anti-inflammatory nutrition plan, but there are also certain foods to avoid and others to embrace to calm down a troubled GI tract. Obviously, the list of foods that will help a condition characterized by constipation will be very different from the list of foods that will help a condition of diarrhea.
- If constipation is your problem, you want to eat more fiber, but make it organic, soluble fiber foods like the inside of fruits—avoid the skin—and cooked vegetables, only adding such insoluble, gas-producing fiber foods as beans and legumes, oat bran, and cruciferous vegetables once your gut has begun to calm down. And any time you increase your intake of fiber, it is important to increase your intake of water as well.
- If diarrhea is the issue, you can take a supplement that bulks the stool—psyllium husk, for example—and drink plenty of water. Milk products, fried or greasy foods, caffeine, alcohol, acidic foods, even eggs and chocolate can irritate the bowel. Some foods can thicken the stool and slow bowel motility; others loosen the stool and may stimulate the bowels. Your physician or a range of internet sites can supply you with lists of these categories of food.
2. Change your pooping position.
There are some simple ways to help alleviate the pain and discomfort far too many women experience in conjunction with bowel movements. One old standby of pain relief is a simple heating pad placed on the abdomen. Another is to adjust your bowel habits to those of our foremothers—and to much of the contemporary non-Western world—and assume a squatting position when you defecate. A toilet stool can be useful for this, the best-known commercial variant being the Squatty Potty. But however you approach it, the squatting position beats sitting as a way to ease the process and ensure that it is completed efficiently. The reason is simple: Sitting on a toilet kinks the puborectalis muscle, puts pressure on the rectum, effectively plugs the pathway out of the rectum, and forces you to strain. Squatting keeps the puborectalis muscle in line and enables complete elimination.
3. Squeeze and release your abdominals.
If circumstances don't let you manage a squatting position, at least try to avoid straining. Instead, tighten your abdominal muscles. There's a process we call hardbelly-softbelly. Basically, while seated on the toilet, take a deep breath, and as you exhale, tighten your abdominal wall and then instantly mimic what happens when you release your urine; this opens the sphincters. Repeat this alternating hardbelly-softbelly movement until you successfully empty your bowels.
Excerpted from Beating Endo: How To Reclaim Your Life From Endometriosis. Copyright © 2019 by Iris Kerin Orbuch, M.D., and Amy Stein, DPT. Reprinted with permission of Harper Collins Publishers. All rights reserved.
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