Constipation with endometriosis

Constipation, diarrhea, flatulence and nausea – digestive complaints are not uncommon with endometriosis. For example, some sufferers feel they cannot empty their bowels properly. But why does the gastrointestinal passage behave so conspicuously when endometrial tissue grows outside the uterine cavity? Today we tell you how endometriosis can lead to constipation and what can help.

How endometriosis and constipation are related

By definition, people suffer from constipation when they are able to pass stool less than three times a week. However, the accompanying symptoms are much more important than the frequency. Do you have trouble passing stool, does your bowel feel blocked, or is your stool hard and dry? These are all signs of constipation. [1]. In addition to the numerous causes such as lack of fluids or exercise, endometriosis can also lead to constipation. Doctors use various theories, which I would like to present to you.

Good to know!

Affected individuals report not only constipation but also Diarrhea with endometriosis.   You may also have intermittent episodes of diarrhea and constipation.

  1. Constipation due to adhesions: In fact, adhesions in the rectum can cause problems with bowel movements. If endometrial nodes block the final passage and do not allow stool to pass freely, this can cause constipation. However, this is much less common than you might think. In one study, 90% of all endometriosis patients experienced digestive problems. However, endometriosis lesions in the bowel were found in only 7.6% of patients. This suggests that it is not only adhesions due to endometriosis that lead to constipation in endometriosis.[2].Adhesions after repeated operations can also lead to digestive problems. Fortunately, this is also rarely the case.
  2. Constipation due to concomitant diseases: Many patients report that they have to deal with other diseases. Irritable bowel syndrome is particularly prevalent among endometriosis patients. According to studies, those affected have at least twice the risk of developing irritable bowel syndrome [3]. The dysfunction of the intestine, the cause of which is still not completely understood, can also promote constipation.
  3. Constipation due to dysbiosis: Did you know that your largest internal organ, the intestine, is home to trillions of microorganisms? Researchers have identified around 1400 different species with the help of gene sequences. At least 160 species are found in your intestine alone [4]. The good representatives take care of the splitting of food components, support your immune defense or help with the synthesis of messenger substances. Harmful intestinal bacteria, however, can cause digestive problems and inflammation. If the delicate balance in the intestine gets out of whack, doctors call this dysbiosis. According to one study, endometriosis patients can exhibit altered microbial diversity. They are home to more Streptococcus, Escherichia coli, Proteobacteria and Enterobacteriaceae. [5]. Imbalance in the intestines can also contribute to diarrhea or constipation.

Whatever the cause of constipation, plenty of fluids and exercise, as well as talking to your doctor, are always a good idea!

When your lifestyle determines your bowel movements

As you can see, there are already some attempts at explanation that sound conclusive. However, doctors do not always succeed in explaining the constipation in endometriosis. Then it helps to take a look at your lifestyle habits. Your intestines need enough fluids to make bowel movements smooth and eliminate them. That’s why a lack of fluids leads to constipation. In addition, dietary fiber is important for digestion. These are indigestible food components that increase the volume of the food pulp – this exerts a stimulus on the intestinal walls, which in turn stimulates bowel activity. A very important point is exercise. If you have a predominantly sedentary job, digestion can really “fall asleep”. According to a study, stress and delaying visits to the toilet can also significantly promote constipation. [6].

Based on the risk factors, I have the following quick tips for you:

  • Drink enough: The German Society for Nutrition advises drinking at least 1.5 liters of fluid daily [7]. Water and unsweetened herbal teas are best. A real insider tip is warm water with lemon and ginger to stimulate digestion.
  • Consume enough dietary fiber: Here, too, the German Nutrition Society has a recommendation. According to this, you should include at least 30 g of dietary fiber in your diet.[8]. Fresh fruits and vegetables as well as whole grain products contribute to the supply of dietary fiber. By the way: swelling agents such as psyllium, flaxseed and bran can stimulate digestion. You should always include an extra glass of water (250 ml) so that the aids can swell.
  • Move regularly: If you move regularly, you get your circulation going and thus also your digestion. But how much exercise is actually enough? In its guidelines, the World Health Organization advises 150-300 minutes of moderate-intensity exercise or 75-150 minutes of intense exercise. [9].In one study, researchers found that 30-40 minutes a day is enough to reduce the risk of death and offset a desk day [10].
  • Reduce your stress: A hectic daily routine and the suppression of bowel movements can push the “pause button” on digestion. To prevent this from happening, you should examine your daily routine for stressors and eliminate them – as best you can. Of course, this is not always successful. In that case, relaxation techniques can support your stress management.

Constipation in endometriosis. What does the doctor do?

Digestive problems can indicate endometriosis. Regardless of whether you have already been diagnosed with endometriosis or not, we advise you to contact your treating physician with your complaints. Especially if you have pain and there is blood or mucus in your stool. Endometriosis patients with adhesions in the intestines report traces of blood in their stool, especially during menstruation. This is because the endometriosis lesions develop according to the menstrual cycle and “bleed” during the period. If there are actually foci in your digestive tract, they will be detected by experienced doctors during a gynecological examination or palpation (vaginal and rectal). An ultrasound of the intestinal wall, a magnetic resonance tomography or a laparoscopy will also confirm the diagnosis. [11]. These examination methods also make it possible to detect endometriosis in general.

Targeted treatment procedures can relieve constipation

After diagnosis, your doctor will draw up a treatment plan. Depending on where the endometriosis lesions are located and how pronounced they are, they are treated surgically or with the help of medication.[12]. With treatment, digestive problems also often improve. In one study, 29% of endometriosis patients suffered from irritable bowel syndrome or constipation. With referral to a gastroenterologist (gastrointestinal specialist), 86% of study participants achieved better defecation and 64% had less pain [13]. In addition, you can counteract digestive problems yourself to a certain extent, for example, with the right diet as well as Relaxation and stress reduction.

Short and to the point

Digestive problems are associated with endometriosis. In addition to diarrhea, constipation may also occur. Adhesions in the rectum can block the intestinal passage and thus become constipated. In addition, concomitant diseases such as irritable bowel syndrome or an imbalance in the intestinal flora can promote constipation. In case of constipation, especially in connection with mucous or bloody stools, you should consult your attending physician. By palpation, ultrasound, MRI or a laparoscopy he can determine whether you have adhesions in your intestine. A lifestyle with too little exercise, insufficient fiber, and stress can also tire your digestion. Therefore, general tips to aid digestion are recommended. After diagnosis, your doctor will decide whether to treat your endometriosis with the help of medication and/or surgery. This will give you a good chance that the digestive problems will subside.

Referenzen

  1. Gesundheit.GV.AT: Constipation (Obstipation)
  2. Maroun P, Cooper MJ, Reid GD, Keirse MJ. Relevance of gastrointestinal symptoms in endometriosis. Aust N Z J Obstet Gynaecol. 2009 Aug;49(4):411-4. doi: 10.1111/j.1479-828X.2009.01030.x. PMID: 19694698.
  3. Chiaffarino F, Cipriani S, Ricci E, Mauri PA, Esposito G, Barretta M, Vercellini P, Parazzini F. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Jan;303(1):17-25. doi: 10.1007/s00404-020-05797-8. Epub 2020 Sep 19. PMID: 32949284.
  4. Federal Ministry of Education and Research: We are colonized: Gut bacteria influence our health
  5. Leonardi M, Hicks C, El-Assaad F, El-Omar E, Condous G. Endometriosis and the microbiome: a systematic review. BJOG. 2020 Jan;127(2):239-249. doi: 10.1111/1471-0528.15916. Epub 2019 Sep 19. PMID: 31454452.
  6. Santacruz CC, López MO, García MV, Pérez CF, Miguel JC. Do bad habits bring a double constipation risk? Turk J Gastroenterol. 2018 Sep;29(5):580-587. doi: 10.5152/tjg.2018.17533. PMID: 30260781; PMCID: PMC6284617.
  7. Deutsche Gesellschaft für Ernährung: Not only in summer: It’s best to drink water
  8. German Nutrition Society: Carbohydrates, Dietary Fiber – DGE
  9. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451-1462. doi: 10.1136/bjsports-2020-102955. PMID: 33239350; PMCID: PMC7719906.
  10. Ekelund U, Tarp J, Fagerland MW, Johannessen JS, Hansen BH, Jefferis BJ, Whincup PH, Diaz KM, Hooker S, Howard VJ, Chernofsky A, Larson MG, Spartano N, Vasan RS, Dohrn IM, Hagströmer M, Edwardson C, Yates T, Shiroma EJ, Dempsey P, Wijndaele K, Anderssen SA, Lee IM. Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med. 2020 Dec;54(24):1499-1506. doi: 10.1136/bjsports-2020-103270. PMID: 33239356; PMCID: PMC7719907.
  11. Endo App: digestive symptoms in endometriosis
  12. German Society of Gynecology and Obstetrics: Guideline Program. Diagnosis and therapy of endometriosis. August 2020.
  13. Meurs-Szojda MM, Mijatovic V, Felt-Bersma RJ, Hompes PG. Irritable bowel syndrome and chronic constipation in patients with endometriosis. Colorectal Dis. 2011 Jan;13(1):67-71. doi: 10.1111/j.1463-1318.2009.02055.x. PMID: 19832874.

Check out our Symptom Explorer if you want to know more about constipation in endometriosis.

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Dipl.-Ges.oec. Jennifer Ann Steinort
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