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Doctor explains causes and symptoms of endometriosis

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Bloating caused by endometriosis, loratadine 24 hours commonly known by sufferers as ‘endo belly’, is one of the main symptoms of the condition. Besides potential fertility problems and painful periods and sex, endo belly is one of the worst parts of endometriosis because it impacts all areas of life. Express.co.uk chatted to Dr Suzanne Gilberg from Enzymedica UK to find out how to get rid of endometriosis bloating.

Endometriosis can be debilitating for women who have the condition, causing discomfort that some say rivals labour and delivery.

This chronic illness is often misunderstood because the symptoms vary so much from person to person and the average waiting time for diagnosis in the UK is around eight years.

Endometriosis belly is the term for the severe and uncomfortable bloating experienced as a result of the condition.

Endometriosis bloating isn’t like regular bloating after eating a large meal or around your period.

Dr Gillberg explains: “Endometriosis belly is severe and uncomfortable bloating that can last for days.

“This isn’t the ‘when you eat too much and feel a little windy’ type of bloating.

“It is the kind of bloating and swelling where people routinely ask you if you’re six months pregnant and you can’t wear trousers comfortably. It doesn’t go away by morning.”

Endometriosis belly also comes with other life-disrupting symptoms including nausea, diarrhoea and constipation – not to mention fertility challenges and heavy periods.

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Why does endometriosis cause bloating?

Endometriosis is a condition in which the same type of tissue that lines the uterus ends up elsewhere in the abdomen, on the ovaries, in the bowel, on the pelvic lining, in and around the bladder, and sometimes even beyond.

Hormonal changes throughout the menstrual cycle impact that tissue.

As with the uterine lining, it thickens and grows in preparation for fertilisation, and eventually breaks down if pregnancy doesn’t happen.

In the uterus, the tissue is shed during your period. But outside the uterus? It has nowhere to go, so it gets stuck, causing discomfort, an inflammatory response, irritation and sometimes adhesions and scar tissue.

Dr Gillberg explained: “That leads us to endometriosis belly – which is more complicated than a build-up of excess tissue.

“It can happen regardless of where endometriosis shows up in the body, often in tandem with GI symptoms.

“In fact, endometriosis often presents with conditions such as irritable bowel syndrome, coeliac, or SIBO (small intestine bacterial overgrowth), creating a double whammy of discomfort and symptoms.

“A January 2021 review found that women with endometriosis were about twice as likely to also experience IBS.”

The discomfort of endometriosis belly is often written off as period cramps, routine digestive issues, psychosomatic in nature, poor diet choices, or “not that bad.”

However, endometriosis is the second most common gynaecological condition in the UK, affecting one in every 10 people with a uterus who are of reproductive age.

To put it in perspective: Endometriosis is about as common as diabetes, according to Endometriosis UK.

Dr Gillberg said: “While there is no shortage of treatment options, public awareness campaigns, and the like for diabetes, endometriosis has no known cause – and no cure.

“That’s unacceptable and a sign of how our patriarchal-centred health care system fails women.

“It’s time for those living with endometriosis to feel comfortable speaking up and sharing their stories – to get the help they need and end the stigma of “over” sharing about women’s health conditions.

“If your best friend was your doctor, would you hold back information? This is my motto with my patients.”

How to alleviate painful bloating caused by endometriosis

We can’t pinpoint a specific cause of endo belly, but according to Dr Gillberg, we do know that the immune system plays a role in endometriosis and gut issues.

She added: “We also know that the gut microbiome plays a key role in both immune and digestive health, so it too influences endometriosis.

“A 2019 systematic review found a complex bidirectional interaction between the microbiome and endometriosis. (Think of it as a “chicken or egg” kind of situation.)”

In a healthy microbiome, the “good” bacteria and microbes keep the “bad” ones in check.

But when the microbiome gets off-balance – which is called “dysbiosis” – the bad ones run wild.

That same 2019 review found that those living with endometriosis were more likely to have increased levels of certain bacteria, including Proteobacteria, Enterobacteriaceae, Streptococcus and E. coli. And for over 20 years, we have known of a connection between SIBO and endometriosis.

While having a healthy microbiome isn’t the cure for endometriosis, it can go a long way in helping create overall balance and boost digestive and immune health.

This can even boost mood since the bulk of our serotonin (aka the happy hormone) is made in our gut.

Gut issues and endometriosis create a vicious cycle: The stress and discomfort from endometriosis turn up the fire on the body’s natural inflammatory responses, which can impact the integrity of the gut lining.

Dr Gillberg said: “Once there’s a breach in that protective lining (we call this leaky gut), things that shouldn’t make their way out of the gut (like undigested foods) head out into the abdomen and bloodstream, further turning up the heat.

“Remember, there’s already irritating endometrial tissue in the abdomen that shouldn’t be there.

“Endometriosis-induced adhesions and scar tissue can physically impair digestion as well.”

So how do we nurture the microbiome to ease endometriosis? Just like you would take care of your garden, according to Dr Gillberg.

The doctor said: “Think of your microbiome like the vegetable gardens many of us planted last year.

“You can’t just go and scatter seeds across your lawn and expect organic vegetables to grow and thrive, you have to till the land, turn the soil, nourish it for optimal health, then tend your crops, water and fertilise them regularly and pull the weeds.

“Think of your “good” microbes as vegetables and probiotics and fermented foods like seeds.

“A healthy, balanced diet packed with anti-inflammatory foods further nourishes the microbiome, helping give it what it needs to recalibrate balance.”

We also have digestive enzymes, which can play a beneficial role in both easing bloat and achieving homeostasis in the gut.

Dr Gillberg explained: “Enzymes are necessary catalysts for all the chemical reactions in our bodies. In the gut, we naturally produce enzymes to break down nutrients at specific points in the GI tract.

“However, as we age and as life, well, happens to us, we don’t always produce sufficient amounts of the digestive enzymes we need to keep things running smoothly.

“A gut with adequate digestive enzymes is like a garden where the soil is turned regularly and the weeds are kept in check.

“Those enzymes are the first line of natural detoxification in the gut – when food moves through at the optimal pace, it doesn’t ferment and breaks down, leaving metaphorical clutter or weeds for the microbiome to have to work around and compete with.”

You can buy digestive enzymes in capsule form to help reduce endo belly.

Dr Gillberg said: “Digestive enzymes like Enzymedica’s Digest Gold should be part of a programme to support relief from endometriosis belly bloating.
“The enzymes in Digest Gold break down all the parts of a typical meal, like fats, fibres, proteins and carbohydrates.

“This formula is designed to assist with digestion and the assimilation of nutrients, and it gives relief for occasional gas, bloating and indigestion.

“Beyond helping the microbiome by giving it a clean slate, enzymes assist with nutrient assimilation, helping put those nourishing foods to work in the body. In the case of food sensitivities, it can help ease the discomfort they cause, so the body can instead focus energy on dealing with endometriosis symptoms.

“With the microbiome and gut in check, they support the liver in its role, breaking down and detoxifying the body of medications, toxins and hormones, promoting a healthy balance to further support endometriosis treatment.”

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