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Endo belly: what is it and why does it happen?

Updated: Jul 5, 2023

The term “endo belly” describes the painful and often severe abdominal bloating associated with endometriosis. This severe bloating is likely due to inflammation, growths, or other digestive issues resulting from endometriosis.

Learn more about endometriosis bloat and what can be done to get relief from it in this post.

In this blog we will cover:

  • What exactly is endometriosis?

  • What is endo belly?

  • What causes endo belly?

  • Gut bacteria & endo belly: why do I look & feel so bloated

  • What are the treatment options?

  • Other causes of a bloated belly

What exactly is endometriosis?

Endometriosis is an inflammatory disease where tissue that is similar to the uterine lining begins growing in other internal places in the body.

These other spots can include the ovaries, fallopian tubes, bowels, or bladder—even your lungs.

The tissue still behaves like it's in the uterus, so the tissue cells bleed when your period comes around.

But since they're in the wrong spot, the blood is stuck inside your body, and it's incredibly painful.

What is endo belly?

Endometriosis bloat or endo belly is one of the most unpleasant endometriosis symptoms.

On any given day, the lower abdomen can swell, setting off physical and mental anguish.

"Women in the general public may get bloating a day or two before their cycle," said Karli Goldstein, DO, consulting surgeon and medical advisory board member for the Endometriosis Foundation of America, "but endometriosis bloat can be more drastic and persist longer."

The bloating can stay for days, weeks, or just a few hours.

Endo belly typically gets worse as the day goes on. "Frequently, patients will be fine in the morning, and it will get bigger and bigger until the evening when they can't button their pants," Dr. Goldstein explained. "You can look six months pregnant by the end of the day."

Beyond causing physical discomfort, endo belly is also emotionally troubling.

Since endometriosis can make it difficult to conceive, looking like you're in your second trimester can feel like a cruel side effect.

Plus, there can be body image ramifications. Individuals with endometriosis are told to eat healthily, exercise frequently, and maintain ideal body weight to help with their symptoms.

When an endo belly surges forward, it can feel frustrating, upsetting, and demoralizing.

What causes endo belly?

With endometriosis, the endometrial-like tissue that’s located in places outside the uterus acts in the same way the endometrium does: It builds up then breaks down and bleeds each month, just like the lining of your uterus.

But because this tissue doesn’t have a way to leave your body, it gets trapped. The surrounding tissue can become inflamed and irritated, which can cause scar tissue to form.

It can also cause the tissues inside the pelvis to stick together.

Bloating and fluid retention are common endometriosis symptoms. One study, for example, found that 96 percent of people with endometriosis experienced belly bloating compared with 64 percent of people who didn’t have the condition.

There are several reasons why endometriosis may cause abdominal bloating:

  • A buildup of endometrial-like tissue can cause inflammation in the abdomen, resulting in swelling, water retention, and bloating.

  • The endometrial-like tissue can cover or grow into the ovaries. Trapped blood can form cysts when this happens, which may cause bloating.

  • Those with endometriosis are more prone to small intestinal bacterial overgrowth (SIBO) and fibroids, which may also lead to bloating.

  • Endometriosis often causes issues with digestion, such as constipation and gas.

Gut bacteria & endo belly: why do I look & feel so bloated?

What does your gut bacteria have to do with that annoying bloating and gastrointestinal discomfort? A lot!

We have more bacteria living in our guts than we do human cells in our body.

We have a balance of beneficial (commensal) bacteria and potentially pathogenic bacteria (disease-causing unfriendly bacteria).

This is actually one of the most complex ecosystems in nature. It is important to maintain a healthy balance of bacteria in the gut.

These beneficial bacteria are not simply along for the ride, but rather, they play a critical role in our health.

For example, they are involved in digesting food that we eat, producing vitamins such as vitamin K2 and biotin, converting thyroid hormone into its active form, detoxification, reducing inflammation, reducing pathogenic forms of bacteria, and energy production.

These are only a few of their important jobs! We also have yeasts and viruses in our guts. It’s important to keep a healthy balance of these microorganisms in our guts too.

Gastrointestinal problems can be a result of bacterial problems in the small and/or large bowel. Most of the bacteria are in the large bowel.

A little is in the small bowel, but not nearly as much as in the large bowel.

Dysbiosis is a condition where an imbalance in beneficial and potentially disease-producing pathogenic bacteria occur in the bowel.

Dysbiosis is also not uncommon in those with endo.

SIBO (Small Bowel Intestinal Overgrowth) is a condition where the bacteria from the large bowel migrate up into the small bowel.

Recent studies have demonstrated the presence of Small Intestinal Bacterial Overgrowth (SIBO) in women with endometriosis.

With SIBO, the disease-producing of bacteria in the wrong location is exposed to undigested food, which it eats and turns into a large amount of gas (bloating, pain, indigestion).

Factors that may negatively alter the sensitive bacterial balance lead to dysbiosis or SIBO and include:

  • Antibiotics (with certain antibiotics it can take up to 2 years to regain a healthy microbial balance in your gut)

  • Chronic stress

  • Non-steroidal anti-inflammatories (NSAIDS)

  • Constipation

  • Standard American Diet (SAD diet – high in unhealthy fats, processed carbohydrates, and sugar and low in fiber and vegetables)

  • Food allergies and Sensitivities

  • A weakened immune system

  • Intestinal infections (such as yeast overgrowth) and parasites

  • Inflammation

  • Poor function or removal of the ileocecal valve (valve between the small and large intestine)

There are several common symptoms of dysbiosis and SIBO. You may be experiencing several of them. They include :

  • Bloating, belching, burning, flatulence after eating

  • A sense of fullness after eating

  • Indigestion, diarrhea, constipation

  • Systemic reactions after eating (such as headaches and joint pain)

  • Nausea or diarrhea after taking supplements (especially multivitamins and B vitamins)

  • Weak or cracked finger nails

  • Dilated capillaries in the cheeks and nose (in a non-alcoholic)

  • Iron deficiency

  • Chronic intestinal infections, parasites, yeast, unfriendly bacteria

  • Undigested food in stools

  • Greasy stools

  • Skin that bruises easily

  • Fatigue

  • Amenorrhea (absence of menstruation)

  • Chronic vaginitis (vaginal irritation)

  • Pelvic pain

What are the treatment options?

Although there is no cure for endo belly you can relieve endo belly by managing endometriosis, the underlying condition that can cause your abdomen to swell.

Treatment options for endometriosis include the following:

  • Supplemental hormones or birth control pills may help regulate monthly hormonal changes that promote tissue growth outside the uterus.

  • Gonadotropin-releasing hormones (GnRH) may help block the production of estrogen, which stimulates the ovaries.

  • Danazol (Danocrine) is a synthetic androgen that may help inhibit certain types of hormones.

  • Laparoscopy is a minimally invasive surgery to remove the tissue growing outside the uterus.

  • Hysterectomy and oophorectomy (removing the uterus or the ovaries, respectively) are typically only done for those with severe, untreatable pain who don’t want to get pregnant in the future.

Other causes of a bloated belly

Even if you’ve received a diagnosis of endometriosis, many conditions can cause a bloated belly. These include:

  • irritable bowel syndrome (IBS)

  • ulcerative colitis

  • Crohn’s disease

  • food intolerance

  • gallstones

  • ovarian cysts

  • celiac disease

  • premenstrual syndrome (PMS)

  • Pregnancy

Gas in your digestive tract often leads to bloating. This happens when your body breaks down undigested food. Foods that may cause a lot of gas include:

  • beans

  • whole grains, like wheat or oats

  • dairy products

  • vegetables, such as broccoli, cabbage, Brussels sprouts, and cauliflower

  • sodas

  • fruits

Managing endometriosis, the underlying condition, can also help treat endo belly.

If you have abdominal bloating that’s painful, frequent, or lasts longer than a few days, be sure to speak with your doctor or ELANZA care navigator.

It’s also important to keep in mind that other conditions can cause a bloated or swollen belly.


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