Bowel Endometriosis Symptoms: A Natural Treatment Guide

Targeting Your Bowel Endometriosis Symptoms With Simple Solutions

• Bowel Endometriosis Symptoms|
• Natural Treatment Guide|
• Bowel Endometriosis Definition|
• The IBS Connection|
• The Bottom Line|

It sometimes takes years for a woman to receive an accurate bowel endometriosis diagnosis. This may be related to the fact that some bowel endometriosis symptoms such as diarrhea, constipation, bloating, and abdominal pain overlap those of other gastrointestinal (GI) conditions — like irritable bowel syndrome (IBS) — and there aren’t really any tests or biomarkers [1]. Plus, other symptoms of bowel endometriosis like painful periods, nausea, and vomiting can be mistakenly attributed to a variety of acute conditions.

Finally having a diagnosis can be a huge relief, but what’s the next step? Should you try conventional treatment options like medications or bowel surgery, or a more natural approach? While the conventional track may be necessary for some, there are several natural options like diet and probiotics to try first. You may find significant symptom relief without the side effects that can sometimes accompany other types of treatment. 

In this article, we’ll lay out what you need to know about the symptoms of bowel endometriosis and how they’re connected to your gut health. More importantly, we’ll provide a natural treatment guide that includes recommendations for diet, lifestyle changes, and probiotics that can soothe your most troubling bowel endometriosis symptoms.

What Are the Symptoms of Bowel Endometriosis?

Bowel endometriosis symptoms are often non-specific and can mimic those of other digestive disorders like IBS and inflammatory bowel disease (IBD), making accurate diagnosis difficult. Some women may have no symptoms at all, but others can experience [2, 3, 4]:

• Diarrhea
• Constipation
• Painful bowel movements
• Small bowel obstructions (this is rare)
• Painful periods
• Pain during sexual intercourse
• Chronic abdominal pain
• Blood in the stool
• Bloating
• Pain while sitting
• Radiation of pain to the perineum (the area between the anus and vagina)
• Mucus in the stool
• Rectal bleeding
• Nausea
• Vomiting
• Pain in the rectum

Natural Treatment Guide For Bowel Endometriosis Symptoms

Women with endometriosis have at least twice the risk of irritable bowel syndrome (IBS) compared to those without, even if they don’t have a diagnosis of bowel endometriosis [5, 6]. This overlap in symptoms means we can implement some of the same treatment strategies we use for IBS to target bowel endometriosis symptoms.

Diet For Bowel Endometriosis Symptoms

While research on diet and bowel endometriosis specifically is lacking, there are several diets that have shown to improve endometriosis symptoms. 

One 2017 observational study found women with IBS and endometriosis who followed a low FODMAP diet for four weeks were about three times more likely to have significant improvement in bowel symptoms when compared to women with IBS alone [7].

Other studies have found bowel endometriosis symptom improvement with the following diets [8]:

• Mediterranean
• Gluten-free
• Low nickel
• Elimination

There’s no one specific diet for bowel endometriosis and finding the right diet for you can take some work. A trial of a low FODMAP diet, which helps to starve bacterial overgrowths, may certainly improve your symptoms, especially if you’ve also got IBS. 

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The low FODMAP diet mainly restricts the carbohydrates that can feed bacteria or that can be difficult to digest. Many people with IBS have bacterial overgrowth, which can cause carbohydrate malabsorption. This type of diet addresses both of these issues to target your GI symptoms. 

The low FODMAP diet is a great place to start, but if you don’t notice symptom improvement after a few weeks you may want to try a different option like the Paleo diet, which removes many common food allergens and inflammatory foods. The Paleo diet is a well-rounded option that also helps to regulate blood sugar and promote hormone balance. 

Lifestyle Strategies for Bowel Endometriosis Symptoms

While you’re working on finding the right diet, you can also consider lifestyle factors that may be contributing to your bowel endometriosis symptoms. Ask yourself if disrupted sleep, excess stress, and lack of physical activity could be contributing to your symptoms. 

You can try the following lifestyle reset tips:

1. Make great quality sleep non-negotiable. Poor sleep can negatively affect gut function and exacerbate the symptoms of bowel endometriosis. Create a healthy sleep routine that works for you and stick with it.
2. Practice a daily stress-management technique. Unmanaged stress can also negatively impact your gut microbiota, leading to worse digestive symptoms. Deep breathing and meditation are both great options. Two systematic reviews and meta-analyses have found women with endometriosis who performed Hatha yoga for eight weeks experienced improvement in quality of life and had less pain [9, 10].
3. Move your body every day. Of course exercise has a myriad of health benefits, but it can also improve your gut microbiome diversity. Walking is the foundation of fitness, so if you’re new to exercise, simply add a 30-minute walk every day and branch out from there. Other types of exercise like strength training and cardiovascular training may also improve a variety of endometriosis symptoms, including those related to mental health [9, 10].

If you’ve had some improvement with diet and lifestyle, but are still experiencing bowel endometriosis symptoms, consider adding probiotic therapy.

Probiotics for Bowel Endometriosis Symptoms

There’s no specific research evaluating probiotics and bowel endometriosis specifically, but we do know probiotics have shown to improve a variety of gut-related conditions. As I discuss in my book Healthy Gut, Healthy You, probiotics have consistently shown to be an effective treatment for IBS, small intestine bacterial overgrowth (SIBO), and celiac disease, among others. A few studies have examined probiotics in women with an endometriosis diagnosis:

• One randomized controlled trial found six months of probiotics (in combination with a multivitamin/mineral supplement and fish oil) to be effective for relieving endometriosis-associated pain [8].
• Two randomized controlled trials found probiotics significantly decreased menstrual pain and overall pain [11, 12].

Since probiotics are extremely safe, have been extensively studied, and provide benefits for a variety of GI conditions, it’s worth it to trial this therapy. 

Other Complementary and Alternative Therapies for Bowel Endometriosis Symptoms

If you’ve worked through the above guide but still want additional options, consider manual physical therapy and/or acupuncture, which have both been shown to improve symptoms in women with endometriosis:

• Manual physical therapy to address adhesions and restrictions in soft tissue mobility in the abdomen and pelvic floor has been found to improve pain during both sexual intercourse and menstruation [13].
• Acupuncture has been associated with a significant reduction in pelvic pain [9].

What is Bowel Endometriosis?

To better understand bowel endometriosis, let’s review endometriosis. This chronic, inflammatory disease occurs when tissue resembling the innermost lining of the uterus (endometrium) implants itself outside the uterus [1, 14, 15]. While the most common location for this to happen is in the ovaries, endometrial tissue can also find its way to the GI tract.

The specific cause of endometriosis is unknown, but it probably occurs from a combination of [1]:

• Oxidative stress
• Inflammation
• Free radicals (reactive atoms that can damage cells, proteins, and DNA)
• Hormonal disturbances (high estrogen and/or low progesterone)
• Genetics 
• Epigenetics (modification of gene expression)
• Environment

Diagnosis can be tricky and take many years [1]. The gold standard is visual laparoscopic inspection by a surgeon or surgical gynecologist to look for lesions or growths.

When endometrial-like tissue infiltrates the GI tract, it’s referred to as bowel endometriosis. This is the most common type of endometriosis that occurs outside the pelvis and can affect up to 37% of women with endometriosis [3].

Bowel endometriosis manifests as deep or superficial lesions in the wall of the small bowel and/or large bowel (most commonly the rectum and sigmoid colon) [2]. Women with deeper, infiltrating bowel wall lesions often have more severe symptoms, and these lesions are less likely to resolve [3].

Conventional Treatment

Conventional medical advice can include a variety of pharmaceuticals like oral birth control pills, non-steroidal anti-inflammatories, and progestins (hormone replacement). For more severe cases, laparoscopy to excise endometrial tissue or even bowel resection to remove part of the bowel may be considered.

The Bowel Endometriosis–IBS Connection

There’s a strong connection between gut health and endometriosis. Of course, certain drugs used to treat endometriosis, such as opioids and GnRH (gonadotropin-releasing hormone) analogs, can increase the severity of GI symptoms. But infiltrating bowel endometriosis nodules may also damage parts of the enteric nervous system (the second brain of the body located in the GI tract) and the interstitial cells of Cajal (ICC — the pacemaker of the intestine) [3, 16].

Not surprisingly, women with endometriosis have up to a three-fold increased risk for IBS [5] and the two conditions have similar disease mechanisms that include [17]:

• Chronic inflammation
• Stimulation of pain receptors
• Mast cell activation
• Dysbiosis (which can disturb estrogen levels) [18] 
• Leaky gut

Patients with bowel endometriosis can experience the following symptoms that mimic IBS or IBD, possibly related to the size of endometriosis bowel nodules (larger nodules cause more symptoms) [4, 19]:

• Diarrhea
• Constipation
• Abdominal pain
• Bloating
• Painful bowel movements
• Mucus in the stool
• Cyclical rectal bleeding

In one 2007 review, the authors noted bowel movements in patients with IBS often relieve many of the above symptoms, but that doesn’t seem to be the case for those with bowel endometriosis [19].

Diet, Lifestyle, and Probiotics Can Soothe Bowel Endometriosis Symptoms

Bowel endometriosis can cause common gastrointestinal symptoms like diarrhea, constipation, abdominal pain, and bloating. Other symptoms may include nausea, vomiting, painful periods, painful bowel movements, and blood in the stool. The good news here is the symptoms of bowel endometriosis don’t have to derail your daily life. You may need conventional treatment, but before taking prescription medications or considering endometriosis surgery, you may want to try our natural treatment guide. 

Targeting your gut health by focusing on an anti-inflammatory diet, probiotics, and lifestyle changes will most likely lead to significant symptom improvement. And even if you’re already taking medication for endometriosis, these types of changes can help you better control symptoms and/or allow you to reduce or discontinue medication use. However, you should speak with your provider before making any medication changes. 

Contact us at the Ruscio Institute for Functional Medicine if you desire a more personalized plan to address your bowel endometriosis symptoms.

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