Bowel endometriosis symptoms can mimic those of other gastrointestinal disorders like IBS and IBD, and can include diarrhea, constipation, bloating, abdominal pain, and painful bowel movements.
If your gastrointestinal symptoms don’t improve with defecation, or if nausea, vomiting, painful periods, and pain while sitting are present, bowel endometriosis may be the cause.
Diet, lifestyle, and probiotics may be very helpful for improving bowel endometriosis symptoms.
Bowel endometriosis occurs when endometrial tissue implants itself into the GI tract, usually the large intestine.
Women with endometriosis are at an increased risk of IBS because the two conditions share similar disease mechanisms such as dysbiosis and leaky gut.
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 . 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]:
Painful bowel movements
Small bowel obstructions (this is rare)
Pain during sexual intercourse
Chronic abdominal pain
Blood in the stool
Pain while sitting
Radiation of pain to the perineum (the area between the anus and vagina)
Mucus in the stool
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 .
Other studies have found bowel endometriosis symptom improvement with the following diets :
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:
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.
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].
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 .
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 .
Acupuncture has been associated with a significant reduction in pelvic pain .
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 :
Free radicals (reactive atoms that can damage cells, proteins, and DNA)
Diagnosis can be tricky and take many years . 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 .
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) . Women with deeper, infiltrating bowel wall lesions often have more severe symptoms, and these lesions are less likely to resolve .
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  and the two conditions have similar disease mechanisms that include :
Stimulation of pain receptors
Mast cell activation
Dysbiosis (which can disturb estrogen levels) 
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]:
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 .
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.
The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.
Tsamantioti ES, Mahdy H. Endometriosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 33620854.
Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int J Womens Health. 2020 Jan 29;12:35–47. DOI: 10.2147/IJWH.S190326. PMID: 32099483. PMCID: PMC6996110.
Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018 Jun;218(6):549–62. DOI: 10.1016/j.ajog.2017.09.023. PMID: 29032051.
Ferrero S, Camerini G, Leone Roberti Maggiore U, Venturini PL, Biscaldi E, Remorgida V. Bowel endometriosis: Recent insights and unsolved problems. World J Gastrointest Surg. 2011 Mar 27;3(3):31–8. DOI: 10.4240/wjgs.v3.i3.31. PMID: 30689680. PMCID: PMC3069336.
Saidi K, Sharma S, Ohlsson B. A systematic review and meta-analysis of the associations between endometriosis and irritable bowel syndrome. Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:99–105. DOI: 10.1016/j.ejogrb.2020.01.031. PMID: 32004880.
Chiaffarino F, Cipriani S, Ricci E, Mauri PA, Esposito G, Barretta M, et al. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Jan;303(1):17–25. DOI: 10.1007/s00404-020-05797-8. PMID: 32949284.
Moore JS, Gibson PR, Perry RE, Burgell RE. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201–5. DOI: 10.1111/ajo.12594. PMID: 28303579.
Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Bally L, Mueller MD. Effectiveness of dietary interventions in the treatment of endometriosis: a systematic review. Reprod Sci. 2022 Jan;29(1):26–42. DOI: 10.1007/s43032-020-00418-w. PMID: 33761124. PMCID: PMC8677647.
Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet. 2018 Oct;143(1):2–9. DOI: 10.1002/ijgo.12576. PMID: 29944729.
Tennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Womens Health. 2021 Oct 9;21(1):355. DOI: 10.1186/s12905-021-01500-4. PMID: 34627209. PMCID: PMC8502311.
Khodaverdi S, Mohammadbeigi R, Khaledi M, Mesdaghinia L, Sharifzadeh F, Nasiripour S, et al. Beneficial Effects of Oral Lactobacillus on Pain Severity in Women Suffering from Endometriosis: A Pilot Placebo-Controlled Randomized Clinical Trial. Int J Fertil Steril. 2019 Oct;13(3):178–83. DOI: 10.22074/ijfs.2019.5584. PMID: 31310070. PMCID: PMC6642422.
Itoh H, Uchida M, Sashihara T, Ji Z-S, Li J, Tang Q, et al. Lactobacillus gasseri OLL2809 is effective especially on the menstrual pain and dysmenorrhea in endometriosis patients: randomized, double-blind, placebo-controlled study. Cytotechnology. 2011 Mar;63(2):153–61. DOI: 10.1007/s10616-010-9326-5. PMID: 21153437. PMCID: PMC3080472.
Wurn BF, Wurn LJ, Patterson K, King CR, Scharf ES. Decreasing Dyspareunia and Dysmenorrhea in Women with Endometriosis via a Manual Physical Therapy: Results from Two Independent Studies. Journal of Endometriosis. 2011 Jan;3(4):188–96. DOI: 10.5301/JE.2012.9088. PMCID: PMC6154826.
Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P. Endometriosis. Nat Rev Dis Primers. 2018 Jul 19;4(1):9. DOI: 10.1038/s41572-018-0008-5. PMID: 30026507.
Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E. The involvement of the interstitial Cajal cells and the enteric nervous system in bowel endometriosis. Hum Reprod. 2005 Jan;20(1):264–71. DOI: 10.1093/humrep/deh568. PMID: 15576386.
Viganò D, Zara F, Usai P. Irritable bowel syndrome and endometriosis: New insights for old diseases. Dig Liver Dis. 2018 Mar;50(3):213–9. DOI: 10.1016/j.dld.2017.12.017. PMID: 29396128.
Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45–53. DOI: 10.1016/j.maturitas.2017.06.025. PMID: 28778332.
Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007 Jul;62(7):461–70. DOI: 10.1097/01.ogx.0000268688.55653.5c. PMID: 17572918.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
Transform your health
Every product is science-based, validated by real-world use, and personally vetted by Dr. Ruscio, DC.