Constipation, SIBO & Other GI Issues Can Be A Red Flag For This Condition

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 digital manipulation to "trigger" a bowel movement. 

Meanwhile, the inflammation of endometriosis plus the slowdown of bowel motility could mean that the bacteria of the small intestine stay there for a longer 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.

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, in the appropriate setting, should trigger consideration for 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.

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.