Understanding endobelly: the severe bloating experienced by women with endometriosis

First, it is important to provide a clear definition of endometriosis: affecting between 10 and 15% of women, endometriosis is a condition characterised by the presence, outside the uterine cavity, of tissue that is similar — but not identical — to the lining of the uterus (known as the endometrium).

It is a chronic systemic disease that is not purely gynaecological, given the wide range of symptoms and mechanisms involved: it affects the immune system, the hormonal system, and also the digestive system, among others.

Bloating has long been considered an atypical symptom of endometriosis [2] and continues to be viewed as such by a large number of doctors who are not aware of the systemic nature of the condition [3]. However, this outdated assertion can probably be attributed to a lack of awareness of this common symptom.

Indeed, bloating is in fact widely recognised as a major symptom in many of those affected by endometriosis [4]. It is among the most commonly reported symptoms: chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e.g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue or lower back pain [5].

More than 90% of women with endometriosis report gastrointestinal problems among their symptoms [6]. And among those who experience gastrointestinal disorders, 82.8% report that bloating is the most frequent symptom [7].

Another study [8], which reviewed the characteristics of intestinal endometriosis (endometriosis lesions located on the digestive tract – sigmoid colon, rectum, etc.), found that abdominal bloating was predominant.

An earlier study [9] even indicates that 96% of women with endometriosis have experienced abdominal bloating, compared with 64% of women without the condition. 

A model developed to predict the risk of endometriosis in infertile women [10] has also demonstrated that bloating was an indicator of the disease.

Unfortunately, it is a symptom that receives very little attention and is rarely taken into account by the medical community, as it is not considered a gynaecological symptom. No female fertility booster does not contain any targeted active ingredients for this symptom. 

Whilst endometriosis and bloating are very strongly correlated, it appears that endobelly, like other digestive symptoms, can occur independently of the area or areas affected by endometriosis.

Bloating is therefore not specifically linked to endometriosis lesions on the digestive tract[11]. A study[12] indeed demonstrated that patients with endometriosis showed "a significant worsening of abdominal pain, constipation, bloating and flatulence, urgency of defecation, and the sensation of incomplete evacuation", whilst noting that the specific location of the lesions was not associated with the symptoms (with the exception of increased nausea and vomiting in those who had endometriosis in or near the bowel).

Women without lesions on the digestive tract can therefore also be affected by endobelly. Thus, of the 90% of women with endometriosis who experience gastrointestinal problems, only 7.6% of them have endometriosis lesions on the digestive tract[13].

The causes of endobelly are complex and vary from woman to woman: inflammation and certain digestive conditions appear to be the most likely causes, but to date there is no single cause unanimously agreed upon by all specialists that would explain the phenomenon in all women with endometriosis.
 

Here is a summary of the theories currently put forward to explain endometriosis, which may be worth exploring to identify the cause or causes of digestive difficulties and find ways to address them.
 

The impact of diet
 

The way one eats — whether in terms of how meals are taken or the type of food consumed — may not be well adapted, as good digestion requires thorough chewing and a number of foods can in themselves generate gas.

Food intolerance or allergy: the foods that can trigger endobelly vary from person to person and may change in the same individual over time. Among those that may be worth investigating are gluten, lactose, FODMAPs, nightshades, and spices containing piperine.
 

Disruption of intestinal transit
 

Constipation: the longer food matter remains in the colon (the final section of the intestine), the more time bacteria have to ferment and produce gas, and therefore bloating.
 

A note on medications
 

Medications taken for endometriosis pain can cause digestive difficulties. 
 

Inflammation
 

The accumulation of endometriosis lesions can cause inflammation in the abdomen.

Endometriosis lesions
 

Endometriosis lesions can affect the ovaries. When this occurs, trapped blood can lead to cysts that cause bloating. Fibroids may also be responsible for digestive bloating.
 

Endometriosis lesions on the digestive tract can cause a slowing of the passage of food through the intestines, thereby disrupting normal peristalsis and causing digestive difficulties.
 

Pelvic floor dysfunction can also disrupt the normal functioning of the intestines.
 

A hormonal imbalance
 

A hormonal imbalance: oestrogen excess (elevated oestrogen levels — whether absolute or relative) can lead to water retention, which in turn causes bloating.
 

Furthermore, oestrogen production stimulates the release of histamine and inhibits the activity of the enzymes responsible for breaking it down. Histamine intolerance is closely linked to high oestrogen levels and can cause bloating.

An imbalanced microbiome
 

People with endometriosis are more prone to small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and intestinal permeability, all of which can also lead to bloating. The microbiome may be disrupted and dysbiosis may have set in. 

Chronic stress
 

Emotions and stress also play an important role in endobelly flare-ups. For example, chronic stress can lead to slowed digestion and therefore cause fermentation and bloating.
 

Additional conditions alongside endometriosis
 

Although endometriosis can, on its own, be the cause of digestive difficulties for the various reasons discussed above, other conditions may be associated with endometriosis and cause bloating and, therefore, endobelly.

As a result, many diagnoses (and misdiagnoses, as endometriosis has a tendency to mimic other intestinal conditions) may be made in patients with endometriosis alongside the condition itself. These include, among others:
irritable bowel syndrome (IBS),
small intestinal bacterial overgrowth (SIBO)
candidiasis (or SIFO),
chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis)
coeliac disease.

Pink Balance 

Our red berry powder for hormonal balance may be beneficial in cases of endometriosis, helping to contribute to rebalancing hormones and thereby easing symptoms associated with hormonal imbalance. It also contains beetroot, an antioxidant that helps reduce inflammation and has beneficial effects on the liver — and liver detoxification helps maintain good hormonal balance, particularly by eliminating excess oestrogens.

To discover natural keys and a precise, detailed roadmap to reduce or even eliminate endobelly, you can download the dedicated ebook " Endobelly: the guide to understanding the causes and acting quickly to make peace with your belly ».

This ebook is a simple, clear guide that brings together the essentials. It contains both:

A practical approach to give you the opportunity to quickly apply solutions to make peace with your belly and with endometriosis;

And practical resources: massages, art therapy exercises, phyto-aromatherapy solutions… as well as reading material and documentary resources to go further and do yourself even more good.

Find out more about the endobelly ebook

For more information, see our article endometriosis and pregnancy.