Endo belly is a term used to describe uncomfortable abdominal bloating that’s associated with endometriosis. Now, we’re not talking about the short-term bloating that you might experience after a big meal! Endo belly can be a distressing and, at times, debilitating symptom of endometriosis that can impact all areas of your wellbeing — both mental and physical.
If you are struggling with endo belly, you are not alone — in one study, 96% of people with endometriosis reported regular painful bloating. But how can you tell if what you’re experiencing is endo belly? And what might be behind your painful bloating if it’s not related to endometriosis? We’ve explained it all here, alongside some advice on how to break up with endo belly.
How to tell if you have endo belly
Endo belly is a symptom of endometriosis. Often, but not always, it comes along with other symptoms, like painful heavy periods, back or pelvic pain, or extreme fatigue.
Endo belly is generally characterised by having a tight, swollen belly full of gas, that is often hard to the touch. Some people describe it as feeling uncomfortable or painful, or a bit like you’re full from eating a large meal. Although for others it can feel more extreme. You can read more about how endo warriors describe their pain here.
For some people, it happens around the time they ovulate, but usually it occurs a few days before you get your period. It might last for a few hours, or it could go on for days or even weeks.
Extreme bloating is usually painful, and increases pressure around your abdomen and lower back. When combined with pain due to lesions caused by endometriosis, this bloating can be severe and very uncomfortable. In some cases, it can almost look like you are pregnant. People who experience endo belly often have other digestive issues alongside it, from nausea to constipation and diarrhoea.
Why does endo belly happen?
Inflammation
Endometriosis is when tissue that acts like the lining of the womb (called the “endometrium”) grows elsewhere in the body. This causes ongoing (chronic) inflammation, which is when the immune system reacts to defend the body against a perceived threat. Inflammation can affect the reproductive organs or other places where the endometriosis tissue is found — including the digestive system. This can result in swelling — of the colon, appendix, and lining of the stomach — that contributes to endo belly.
Gut dysbiosis
Our gut, otherwise known as our small and large intestine, contains our microbiome — a collection of bacteria that support digestion, immune function, mental health and hormone balance.
These bacteria usually exist in a delicate balance with one another, but when this is thrown off-kilter, you experience gut dysbiosis (or bacterial imbalance). Loads of things can upset your gut balance, from underlying medical conditions to changes in diet.
Gut dysbiosis can lead to bloating, gassiness, constipation and diarrhoea. Research has shown that endometriosis and gut dysbiosis are linked, which is one of the reasons why endometriosis can be misdiagnosed as IBS.
SIBO (small intestinal bacterial overgrowth)
Small intestinal bacterial overgrowth (SIBO) is a type of gut dysbiosis where bacteria accumulate in the small intestine, leading to symptoms such as bloating, diarrhoea, constipation, acid reflux, excessive burping and slower digestion. In a healthy gut, most bacteria are found in the large intestine. Because of the connection between gut dysbiosis and endometriosis, people with endo may be more at risk of SIBO.
Poor digestive health
On top of all of the above, (or due to a combination of all of them) people with endo regularly suffer from digestive issues, from constipation to trapped wind, irregular bowel movements and diarrhoea — all of which can trigger bloating.
Other causes of abdominal bloating
If you don’t think you have endometriosis and feel like your bloating is not connected to your menstrual cycle, it’s unlikely that you are suffering from an endo belly. However, it could still be that you are living with one of the digestive health issues listed above — or perhaps your painful bloating could be a sign of something else.
Food intolerances
As we mentioned, intolerances to certain food groups — particularly lactose and gluten — will often result in symptoms similar to IBS, including painful bloating. Keep a symptom log so you can start to notice patterns between what you eat and how your body reacts. There are also lots of affordable tests you can do now to understand any allergies or intolerances you may have.
Infection
A stomach infection or virus — such as norovirus — are really common causes of painful abdominal bloating. They are usually accompanied by diarrhoea or vomiting and should pass by themselves in a few days. If you notice blood in your stools or your vomiting becomes severe, it’s time to seek medical advice!
Perimenopause
Research has shown that the hormonal changes associated with perimenopause could be linked to an increase in digestive health issues, which may contribute to bloating. Perimenopause can start a lot earlier, and last a lot longer, than you may think.
If you’re over 35 and are struggling with frequent bloating alongside symptoms like increased anxiety, period irregularities or sleep issues, it might be with considering that you could be entering perimenopause.
Ovarian cancer
Painful bloating is a symptom associated with ovarian cancer, when a fluid known as ascites builds up in the abdomen. In fact, it is one of the most common symptoms reported by patients. Other signs to be aware of are a lack of appetite or feeling full quickly, an urgent need to go to the toilet, having issues with bowel movements, losing weight fast without trying and bleeding in between periods or after menopause.
If you are experiencing some of the above symptoms, try not to panic. Go and see your doctor and they will be able to advise you on next steps.
How can I manage my endo belly?
If you are living with endometriosis, looking after your digestive health is one of the best things you can do to beat endo belly.
Introduce a range of anti-inflammatory and low FODMAP foods
As endometriosis is a condition characterised by inflammation, eating an anti-inflammatory diet can potentially help with its symptoms. Research has also shown that an anti-inflammatory diet can help support good gut health.
“Eating the rainbow” is an easy way to remember to add anti-inflammatory foods to your plate. This means focusing on vegetables and fruits in a range of colours. Omega-3-rich oily fish like sardines, haddock, herring and salmon are all known for their anti-inflammatory properties.
Research has also shown that following a low FODMAP diet — which aims to reduce carbs that are harder to digest — is also thought to help with digestive endometriosis symptoms, including endo belly. This is because high FODMAP foods like dairy products and beans can increase gas production, which can contribute to painful abdominal bloating.
Make food easier to digest
This means, slow down! Try to eat mindfully and calmly, chewing each bite properly. This can aid digestion because the food is broken down into pieces that are easier to absorb.
Identify trigger foods
Specific foods will trigger endo belly in certain people. For some, wheat, gluten or dairy can be major triggers, but it could also be a specific food within these categories. Think about starting a food journal where you note down how you feel after each meal and if any symptoms crop up.
Whatever the root cause, if you are constantly struggling with painful abdominal pain, we would always recommend that you seek medical advice. Whether it’s endo belly or another digestive health condition, you don’t have to put up with the pain and your doctor will be able to help you!
