Chronic pelvic and digestive discomfort drastically affects daily life. The unpredictability of digestive issues and pain impacts nearly every facet of life, from school and work to relationships and social connections. Pinpointing the root cause is difficult, especially when the symptoms of endometriosis and Irritable Bowel Syndrome (IBS) overlap. Understanding each condition and its differences is essential for proper diagnosis and treatment.
What is IBS?
Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder that affects the large intestine. While it doesn’t cause structural damage to the intestines, it leads to a range of chronic symptoms.
Types of IBS:
- IBS-C (Constipation-predominant)- hard, difficult-to-pass stools
- IBS-D (Diarrhea-predominant)- Frequent loose or watery stools
- IBS-M (Mixed)- Alternating episodes of constipation and diarrhea
- IBS-U (Unsubtyped) Symptoms don’t fit into either category consistently
Common Symptoms of IBS include, but are not limited to:
- Abdominal pain or cramping, often relieved after a bowel movement
- Bloating and gas
- Changes in stool consistency or frequency
- Mucus in the stool
- Feeling of incomplete evacuation
Symptoms often worsen with stress or certain foods and may improve after a bowel movement.
What is Endometriosis?
According to the (Int’l Endometriosis Working Group, 2021), it is considered a spectrum disease with a wide variety of subtypes and clinical presentations. It is an inflammatory disease characterized at surgery by the presence of endometrial-like tissue. Endometriosis has been found in organ in the body, it is not a reproductive disorder. Endometriosis tissue produces its own hormones and causes inflammation, pain, and scar tissue (adhesion) formation.
Digestive, bloating, and bowel issues are symptoms of endometriosis—up to 80% of those with endometriosis report at least one bowel or digestive symptom.
Common Symptoms of Endometriosis include, but are not limited to
- Pelvic pain, especially during menstruation
- Pain during or after sex, in particular pain further back during penetrative sex
- Chronic lower back pain
- Urinary urgency, frequency, or urinary pain
- Heavy or irregular menstrual bleeding
- Fatigue
- Infertility
- Leg pain
- Hypertonic Pelvic Floor (chronic pelvic floor spasms)
Digestive and Bowel Symptoms of Endometriosis include, but are not limited to
- Constipation
- Diarrhea
- Bloating, especially bloating that has no recognizable trigger
- Endo Belly, pain, and pressure with bloating
- Food Intolerances
- Pain with bowel movements
- Pain with gas or peristalsis
- Blood in the stool
- Painful digestion
- Undigested food in the stool
- Heartburn
It is important to recognize that while initially bowel and digestive symptoms may be associated with menstruation or ovulation, many with endometriosis will have issues all month long.
HOW TO TELL IF YOU HAVE IBS OR ENDOMETRIOSIS
Mapping
For years, bowel endometriosis was notoriously difficult to diagnose. Colonoscopy is often negative because the camera sees inside the bowel, not the outside, and endometriosis is most often found on the outside. MRIs and other scans depend on who is reading them and on the protocol that is ordered.
Emerging techniques in imaging called mapping enhance our ability to see bowel endometriosis on scans. If the protocols are performed correctly and then read by someone educated to spot the disease, it is easier to see the disease on imaging than ever before. No imaging is fail-safe, but advances allow those trained in these newer techniques to have a much higher degree of suspicion than ever before. Full diagnosis is dependent on surgical pathology. Mapping is not a widely accepted technique, and many may still be positive for endometriosis but have negative scans.
Track Symptoms
Note when your symptoms occur. Do they coincide with meals, stress, or your menstrual cycle? Do they worsen before ovulation or menstruation and then improve when your cycle ends? Bowel endometriosis can cause issues all month long.
Many with endometriosis report needing to recover from a bowel movement for a few moments because endometriosis creates adhesions itself that make bowel movements painful. Whereas most with IBS will feel relief after they go to the bathroom.
Recognize Possibilities
Most with bowel endometriosis will go to the doctor repeatedly seeking help, only to be told to drink more water, eat better, lose weight, or stress less, especially when testing or pharmacological interventions for IBS are negative. However, if you have endometriosis, you are not to blame for your bowel issues, and your issues will not improve without proper diagnosis and treatment of the disease. It is not uncommon for people to feel that their bloating is their fault, and if only they were more pristine with their diet, the issues would go away. It isn’t you. It is a disease.
Additionally, if you have other symptoms of endometriosis that you may not have connected to your digestive issues, recognize that endometriosis is a multifaceted disease. This is particularly true with those facing supposedly silent infertility. Bowel issues and silent infertility together often add up to endometriosis.
Additionally, teens and young adults with stomach issues are often minimized or told that they’re pain is “just IBS” when endometriosis symptoms often arise in those age groups.
You can have both
Endometriosis and IBS often come together. Removing the disease, including the disease on the bowel and the hypogastric plexus through excision, can make a huge difference in bowel symptoms. However, aftershocks of central nervous system issues, pelvic floor dysfunction, and overall functioning of the bowel can result in ongoing bowel issues even after the endometriosis has been removed. A comprehensive multi-disciplinary endometriosis care team is essential for moving forward with endometriosis and IBS.
Dr. Sallie Sarrel, PT, ATC, DPT, is a pelvic physical therapist specializing in complex endometriosis. After a long battle with the disease, she joined forces with Dr Andrea Vidali to found The Endometriosis Summit. The Endometriosis Summit unites patients, practitioners, surgeons, and caregivers to drive endometriosis forward.
