Endo Belly: How to Find Stomach and Bloating Relief

People say endometriosis swelling makes them look pregnant

Endo belly is a term that people with endometriosis and specialists use to refer to the painful abdominal bloating that accompanies endometriosis.

Abdominal bloating and distention (stretching) are more common among people with endometriosis than those without it. In addition to pain and discomfort, endo belly can also affect self-image and quality of life.

In this article, learn more about endo belly, why it happens, and how to manage this common endometriosis symptom.

A young woman lying on the couch holding her belly in pain.

Moyo Studio / Getty Images

Endometriosis is a disease that affects 10% to 15% of people assigned female at birth. It occurs when tissue similar to the uterus lining grows elsewhere in the body.

Endo Belly Inflammation: Effect on Digestion and Bloating

Endo belly inflammation can affect your appearance, cause abdominal pain, and lead to other issues depending on its cause.

Appearance

People with endometriosis often say that their endo belly makes them appear pregnant. This can be emotionally difficult for several reasons, but infertility can also be a symptom of endometriosis.

Many endometriosis advocates have shared photos of their endo bellies across social media to illustrate how severe this bloating can be. Endo belly typically looks like a large, distended abdomen from the ribs down to the pelvis.

Pain From Abdominal Tightness 

People with endometriosis frequently report that their endo bellies are hard, tight, and painful to the touch. As the abdomen is distended, the skin is pulled tight, organs feel like they are pushing into the ribs, and clothes become uncomfortable.

An older but important study found that 96% of participants with endometriosis had abdominal bloating compared to only 64% of healthy controls. It also found that among participants with abdominal bloating, only those with endometriosis had associated severe discomfort. People with endometriosis were also more likely to wear loose clothes due to bloating.

Why Does It Happen?

Researchers still haven't figured out precisely what causes endo belly. This is an ongoing area of study. There are likely multiple factors contributing to bloating with endometriosis, some of which include:

  • Inflammation: Endometriosis lesions release large amounts of inflammatory mediators, including prostaglandins, tumor necrosis factor, nerve growth factor, interleukins, and vascular endothelial growth factor. This inflammation can irritate the organs and tissues in the abdomen, and even slow intestinal motility (how fast stool travels), all leading to bloating.
  • Adhesions: Endometriosis can cause adhesions (scar tissue) to form, essentially tethering or "gluing" organs, such as the large intestine, in place. In some cases, this may even obstruct or narrow the intestines, causing cause pain and bloating.
  • Altered gut microbiome: One recent study found that people with endometriosis have less gut bacteria diversity than healthy controls. This altered microbiome may contribute to bloating, though it is not entirely clear why this is the case.
  • Small intestine bacteria overgrowth (SIBO): SIBO is more common among people with endometriosis. This condition can cause significant bloating, diarrhea, and constipation.
  • Opioids: Opioids are strong painkillers that may be prescribed in some cases for endometriosis-related pain. One study found that current opioid use was associated with more severe gastrointestinal symptoms, including bloating.
  • GnRH analogs: GnRH analogs are a group of medications that may be prescribed to suppress endometriosis symptoms in the short term by inducing false menopause. One study found that both current and previous GnRH use was associated with more severe gastrointestinal symptoms, including bloating.

Myth vs. Fact: Endometriosis Lesions Do Not Always Bleed

Many articles state that endo belly results from endometriosis lesions bleeding each month because the blood has nowhere to go. However, this is incorrect and would be a severe medical emergency if it were true.

Endometriosis lesions themselves do not always bleed. It is a common myth that they bleed each month, like the lining of the uterus (endometrium). Endometriosis is similar but not the same as endometrium.

Endometriosis lesions can irritate and inflame their surrounding healthy tissue and may cause bleeding. This can happen at any time of the month, which may be why people report endo belly all month long.

Any Endometriosis Stage Can Cause Stomach Swelling

Endometriosis is classified into stages I-IV using the American Society of Reproductive Medicine's (ASRM) staging system based on the extent of the condition and how many lesions are present.

There is no relationship between the stage of endometriosis and symptoms such as bloating, distention, and pain. Someone with only a few superficial endometriosis lesions classified as stage I could still have severe, life-impacting endo belly.

How to Talk to a Healthcare Provider About Endo Belly

If you are experiencing endo belly, it's important to know that it's not just "in your head;" abdominal bloating is only now known to be one of the most common symptoms of endometriosis. Historically, it was not recognized as a typical symptom of endometriosis until as recently as the 1990s. As a result, some healthcare providers may not realize how pervasive and devastating this symptom can be.

Abdominal bloating, particularly when accompanied by symptoms such as painful sex, referred pain (pain felt at a location other than the initial site of pain), bowel symptoms that worsen during menstruation, and a family history of endometriosis, may be indicative of endometriosis. Even if you have already seen a general obstetrician-gynecologist (OB-GYN), a second opinion by a healthcare provider specializing in endometriosis can help.

You may also consider speaking to a gastroenterologist to help rule out other conditions or explanations for your bloating. However, remember that endometriosis diagnosis and treatment are outside the scope of gastroenterologists.

Current Treatment Options

Excision surgery is the current gold standard treatment for endometriosis. Endometriosis lesions are cut out (removed) and sent to pathology to confirm an endometriosis diagnosis.

Alternatively, an OB-GYN can perform an ablation surgery to burn the surface of endometriosis lesions.

Other treatment options for endometriosis do not stop the progression of the disease but can help manage symptoms. Other endometriosis treatments may include:

  • Over-the-counter (OTC) pain medication
  • Birth control pills
  • Progesterone or progestin 
  • Gonadotropin-releasing hormone (GnRH) agonists
  • Danazol

Holistic Relief and Complementary Therapies for Flares

More holistic therapies and lifestyle changes may not stop the progression of endometriosis lesions, but they can offer relief in the short term.

Regarding endo belly, lifestyle changes such as adopting a low FODMAP (a group of carbohydrates) diet may help. For example, one study found that 72% of people with endometriosis had a greater than 50% improvement in bowel symptoms, including bloating, after four weeks of the low FODMAP diet.

Some other tips for coping with an endo belly flare include:

  • Heating pads
  • Mindfulness and meditation
  • Deep breathing exercises
  • Hot baths
  • Gentle pelvic and abdominal stretches
  • Stress management
  • Peppermint tea
  • Wearing loose, flowy clothing without waistbands

Endometriosis Support Groups

Living with endometriosis and its symptoms like endo belly can be painful and exhausting. Joining a support group may help you let off some steam and feel connected to others going through the same challenges.

Look into any local, in-person endometriosis support groups. Online endometriosis support groups, including those on Facebook and Instagram, may also be helpful.

Summary

Endo belly refers to the painful abdominal bloating that frequently accompanies endometriosis. More research needs to be done to understand endo belly's exact causes. However, causes likely include a combination of factors, such as lesion inflammation, adhesions, lack of gut microbiome diversity, overgrowth of small intestine bacteria, and even from certain endometriosis medications, such as opioids and GnRH agonists.

A Word From Verywell

The impact of endo belly is often understated. However, this is not just typical bloating after eating a large meal. Endo belly is hard and painful and can impact everything from your wardrobe to your self-image and quality of life. Talk to an endometriosis specialist about available treatments if you have painful bloating associated with endometriosis.

Frequently Asked Questions

  • Do all people living with endometriosis have endo belly?

    While it's unclear exactly how many people with endometriosis experience endo belly, one study found that 96% experience abdominal bloating.

  • How long does endo belly last?

    Endo belly could last anywhere from a few hours to multiple days. However, anecdotally, it's often reported as occurring later in the day.

  • What else could be making me look pregnant?

    Many people with endometriosis report that their endo belly makes them look pregnant. This kind of severe bloating may also result from small intestine bacterial overgrowth (SIBO) or irritable bowel syndrome (IBS).

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ek M, Roth B, Ekström P, et al. Gastrointestinal symptoms among endometriosis patients—a case-cohort studyBMC Women’s Health. 2015;15(1):59. doi:10.1186/s12905-015-0213-2

  2. World Health Organization. Endometriosis.

  3. Luscombe GM, Markham R, Judio M, et al. Abdominal bloating: an under-recognized endometriosis symptomJ Obstet Gynaecol Can. 2009;31(12):1159-1171. doi:10.1016/s1701-2163(16)34377-8

  4. Machairiotis N, Vasilakaki S, Thomakos N. Inflammatory mediators and pain in endometriosis: a systematic reviewBiomedicines. 2021;9(1):54. doi:10.3390/biomedicines9010054

  5. Svensson A, Brunkwall L, Roth B, et al. Associations between endometriosis and gut microbiotaReprod Sci. 2021;28(8):2367-2377. doi:10.1007/s43032-021-00506-5

  6. Hurd WW, Redwine DB. Endometriosis. In: Bieber EJ, Horowitz IR, Sanfilippo JS, Shafi MI, eds. Clinical Gynecology. 2nd ed. Cambridge University Press; 2015:203-222.

  7. Tomassetti C, Johnson NP, Petrozza J, et al. An international terminology for endometriosis, 2021†,‡Hum Reprod Open. 2021;2021(4):hoab029. doi:10.1093/hropen/hoab029

  8. Johnson NP, Hummelshoj L, Adamson GD, et al. World endometriosis society consensus on the classification of endometriosisHum Reprod. 2017;32(2):315-324. doi:10.1093/humrep/dew293

  9. So KA, Hong SR, Kim NR, et al. Association between atypical endometriosis and ovarian malignancies in the real worldJournal of Ovarian Research. 2021;14(1):110. doi:10.1186/s13048-021-00865-2

  10. Moore JS, Gibson PR, Perry RE, et al. Endometriosis in patients with irritable bowel syndrome: specific symptomatic and demographic profile, and response to the low FODMAP dietAust N Z J Obstet Gynaecol. 2017;57(2):201-205. doi:10.1111/ajo.12594

By Sarah Bence
Sarah Bence, OTR/L, is an occupational therapist and freelance writer. She specializes in a variety of health topics including mental health, dementia, celiac disease, and endometriosis.