Understanding Diarrhea during Menstruation: Causes and Management
Diarrhea, constipation, abdominal pain, or bloating – menstruation can undoubtedly affect our digestive system. Today, I will delve into the reasons behind the common occurrence of diarrhea during menstruation and offer insights on finding relief. We will also explore the connection between endometriosis and diarrhea.
How Frequently Does Diarrhea Occur During Menstruation?
Many of us compare our experiences with others to gauge whether what we go through each month is typical or possibly a cause for concern. Here is the good news: experiencing diarrhea during menstruation is not uncommon.
One study offers precise statistics on this issue. Researchers explored the connection between emotional symptoms and gastrointestinal complaints during the period leading up to and during menstruation. A total of 156 women participated in the survey, and a staggering 73% reported experiencing gastrointestinal symptoms before or during their period. Among these symptoms, abdominal pain and diarrhea were the most prevalent [1].
The following statistics were gathered:
- 58% experienced abdominal pain before their period, and 55% experienced it during menstruation [1].
- 24% reported having diarrhea before their period, with 28% experiencing it during menstruation [1].
Interestingly, the study also found that women who experienced emotional symptoms tended to have more frequent gastrointestinal issues [1].
Good to Know!
While diarrhea can indeed be a symptom of endometriosis, it is essential to note that it does not always indicate the presence of adhesions in the rectum. Endometriosis can trigger diarrhea as a reaction within your body, even if the lesions are in a different area.
Diarrhea and Hormones: The Culprits
The hormonal composition in your body varies throughout your menstrual cycle. During the non-fertile phase, your body produces a different hormonal mix than when it is gearing up for pregnancy. Hormones have a significant impact on our well-being, affecting not only our mental state but also leading to various practical symptoms. Regarding diarrhea, two specific hormones play a pivotal role – prostaglandins and progesterone.
Prostaglandins: Agents of Digestive Discomfort
Prostaglandins are tissue hormones produced by cells in various tissues throughout the body. They can heighten the perception of pain [2]. During menstruation, they serve a particular purpose – inducing the familiar abdominal cramps by signaling the uterus to contract [3]. This contraction is essential to expel the excess uterine lining if fertilization has not occurred, preparing the uterus for a new menstrual cycle. The increased muscular activity can also affect the intestines because, similar to the uterine wall, the intestinal wall contains smooth muscle. This heightened activity can accelerate the passage of food through the digestive tract, potentially causing abdominal discomfort and diarrhea. Whether prostaglandins are transported into the intestine, or the overall elevated prostaglandin levels stimulate digestive activity is still under investigation [1].
Progesterone: The Intestinal Drowsiness
Progesterone is the second hormone contributing to diarrhea, primarily during the luteal phase, the period between ovulation and menstruation. Its vital role is to prepare the uterine lining for optimal implantation of a fertilized egg [4]. However, there is a caveat: progesterone tends to slow down intestinal activity, potentially causing constipation. During menstruation, the body has significantly lower progesterone levels, rejuvenating the digestive process. The combination of lowered progesterone and prostaglandin levels can lead to softer stools or even diarrhea during this time.
Diarrhea as a Symptom of Endometriosis
Endometriosis involves the growth of endometrial tissue in locations outside the uterus. Alongside the typical uterine lining, endometriosis lesions can be found both within and outside the pelvic region [5]. This condition often presents classic symptoms, including pain and infertility [6]. However, it can manifest with menstrual irregularities, back pain, and digestive issues [5]. Notably, endometriosis is not only limited to common sites like the ovaries; it can also affect the intestines. Adhesions in the rectum, for instance, may lead to diarrhea. Endometriosis lesions tend to appear in the gastrointestinal tract, mainly when located outside the pelvis [7]. In one study involving 290 patients diagnosed with endometriosis through laparoscopy, 90% reported experiencing gastrointestinal symptoms. Intriguingly, only 7.6% of these individuals were found to have endometriosis in the bowel [8].
The exact causes of diarrhea and gastrointestinal symptoms in endometriosis remain to be definitively explained. Suspected factors include inflammatory processes and potential food intolerances contributing to gastrointestinal complaints in individuals with endometriosis.
Good to Know!
Heat, staying well-hydrated, avoiding fatty, sweet, and spicy foods and alcohol, and incorporating meditation and relaxation exercises can be especially beneficial in alleviating diarrhea.
SOS Tips for Managing Diarrhea During Menstruation
Menstruation can be physically and mentally taxing, so taking good care of yourself during this time is crucial. If you are grappling with diarrhea, the following tips may offer relief:
- Apply Heat to Your Abdomen: Heat can be soothing for cramps and discomfort. It can help calm your intestines, providing some much-needed comfort.
- Stay Hydrated: Diarrhea can lead to significant fluid loss, so it is essential to stay well-hydrated. Drink plenty of water or unsweetened herbal teas, with fennel and chamomile ones being excellent choices.
- Avoid Irritating Foods and Drinks: Your body may struggle to process fatty, sugary, spicy foods and alcohol during menstruation. Opt for gentle, easy-to-digest produce like cooked carrots, grated apples, or mashed potatoes. Avoid sugary drinks like cola and salt sticks, as they exacerbate diarrhea.
- Practice Meditation: Your body craves rest during this time, so consider incorporating short meditation exercises into your routine. Just 10 minutes of meditation can help you find balance and temporarily relieve discomfort. Furthermore, relaxation can have a calming effect on your intestines, which are connected to the nervous system.
When to Seek Medical Attention for Diarrhea During Menstruation?
Consult a doctor if your diarrhea is severe or persists beyond your menstruation period. It is essential to rule out infections or underlying health issues. If diarrhea consistently occurs during menstruation or between menstrual cycles AND is accompanied by other symptoms like menstrual irregularities or severe pain, discussing the possibility of endometriosis with your gynecologist is advisable. They can guide you through relevant examinations and evaluations.
In a Nutshell
Diarrhea is common during menstruation, often influenced by hormones like prostaglandins and progesterone. However, when it occurs alongside other symptoms, it may signal endometriosis. Remember that endometriosis lesions do not have to be confined to the intestine. If you experience recurring diarrhea in conjunction with pain or menstrual irregularities, consider consulting a doctor to explore the possibility of endometriosis.
For more information on endometriosis and its common symptoms, you can explore the Endo-App and benefit from the expertise of our endometriosis specialists.
References
- Bernstein MT, Graff LA, Avery L, Palatnick C, Parnerowski K, Targownik LE. Gastrointestinale Symptome vor und während der Menstruation bei gesunden Frauen. BMC Womens Health. 2014 Jan 22;14:14. doi: 10.1186/1472-6874-14-14. PMID: 24450290; PMCID: PMC3901893.
- Gesundheitsinformation.de: Prostaglandin
- Reavey J et al. Physiologie der Menstruation. Inherited Bleeding Disorders in Women (2019): 29-44.
- Diedrich, Klaus. Gynäkologie und Geburtshilfe (Springer-Lehrbuch) (German Edition) (S.65). Springer Berlin Heidelberg. Kindle-Version.
- Diedrich, Klaus. Gynäkologie und Geburtshilfe (Springer-Lehrbuch) (German Edition) (S.303). Springer Berlin Heidelberg. Kindle-Version.
- Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, Schweppe KW. Interdisziplinäre S2k-Leitlinie zur Diagnostik und Therapie der Endometriose: Kurzfassung – AWMF-Register-Nr. 015-045, August 2013. Geburtshilfe Frauenheilkd. 2013 Sep;73(9):890-898. doi: 10.1055/s-0033-1350810. PMID: 24771938; PMCID: PMC3975317.
- Charatsi D, Koukoura O, Ntavela IG, Chintziou F, Gkorila G, Tsagkoulis M, Mikos T, Pistofidis G, Hajiioannou J, Daponte A. Gastrointestinal and Urinary Tract Endometriosis: Ein Überblick über die häufigsten Lokalisationen der extrapelvinen Endometriose. Adv Med. 2018 Sep 26;2018:3461209. doi: 10.1155/2018/3461209. PMID: 30363647; PMCID: PMC6180923.
- Maroun P, Cooper MJ, Reid GD, Keirse MJ. Relevanz von gastrointestinalen Symptomen bei Endometriose. Aust N Z J Obstet Gynaecol. 2009 Aug;49(4):411-4. doi: 10.1111/j.1479-828X.2009.01030.x. PMID: 19694698.
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