Endometriosis and IBS

It’s fairly common for people to be diagnosed with both endometriosis and irritable bowel syndrome (IBS). While the evidence does not point to one condition directly causing the other, those who have both may notice that when one flares up, symptoms of the other are harder to manage.

IBS is a gastrointestinal (GI) disorder that causes abdominal pain, cramps, bloating, and other symptoms. Endometriosis is when tissue that's similar to what lines the uterus grows outside of it, often on the ovaries and fallopian tubes.

This tissue can also grow in or on the intestine or other parts of the bowel. Because of this, endometriosis alone can cause IBS-like symptoms even if IBS is not also present.

This article discusses how these two conditions relate to one another, how symptoms overlap and differ, and how a healthcare provider can differentiate one from the other to recommend appropriate treatment.

Symptoms of Endometriosis vs. IBS

The symptoms of endometriosis and IBS have some overlap. For example, both conditions can cause abdominal pain, cramping, diarrhea, or trouble having bowel movements.

But there are also some differences between the two. Endometriosis may cause painful urination, IBS does not. And while IBS can cause mucus in stool, that is not present with endometriosis.

In reviewing the following symptom comparison chart, it's clear how having both endometriosis and IBS can lead to a compounding of symptoms. It's also easy to see how having endometriosis alone may lead you to believe you might also have IBS, even if you don't.

How Endometriosis Can Cause IBS-Like Symptoms

There are a couple of ways that endometriosis growths (lesions) could lead to IBS-type symptoms:

• Tissue that's not in the uterus cannot be shed during a period. Over time, it can get inflamed and/or cause scar tissue (adhesions) and cysts.
• The same hormones that prompt the lining of the uterus to build up each month stimulate endometrial lesion tissue. This encourages tissue growth, spread to other parts of the body, and more (or worsening) symptoms. Lesions that are removed can come back if the hormones in the body are still active.
  

How Can You Tell Endometriosis From IBS?

If you have endometriosis but have not yet been given an IBS diagnosis, know that only a healthcare provider can tell you if you have both conditions or if your gastrointestinal symptoms are due to endometriosis in your bowel.

If you have already been diagnosed with both, tuning into the timing and triggers of your symptoms may help you determine which may be to blame at any given time.

Timing of Symptoms

You can have endometriosis symptoms all month, but some people find that flares follow a cyclical pattern depending on where in their menstrual cycle they are.

For example, you might notice your symptoms tend to peak right before you bleed. If you have mostly regular menstrual cycles and you consistently get a certain symptom (like pelvic pain) at around the same time every month, that can be a clue that it’s endometriosis flaring up.

Symptom Triggers

Your IBS symptoms might be worse at certain times in your menstrual cycle, too. However, you may also find that factors at other times of the month (like your diet and stress) can also lead to IBS flare-ups.

That said, some people with endometriosis also notice that stress and diet seem to affect their symptoms. One clue that it's your IBS flaring up is if there's a specific food (e.g., onions, nuts) that always gives you GI symptoms no matter what time of the month it is.

Getting Evaluated for IBS

If you have endometriosis and symptoms that you think could be from IBS, it's important to mention them to your healthcare provider. You may have been diagnosed with endometriosis through surgery, but that’s not how IBS is diagnosed, and further investigation is needed.

They will ask you about your overall health, family medical history, the symptoms you are experiencing, and whether they get worse when you're on your period.

You will also be asked about whether you have specific signs and symptoms that align with the Rome criteria, which practitioners use to help diagnose IBS and similar gastrointestinal disorders.

Testing

There are no specific blood tests or scans to diagnose IBS. The condition is diagnosed by excluding all other possible causes of your symptoms.

As such, tests like a rectal exam, stool culture, or colonoscopy will likely be ordered to check for other conditions that could explain how you are feeling.

Your practitioner will be able to diagnose you with, or rule out, IBS based on your conversation and the results of the tests. If you have both conditions, they might also be able to give you a better idea of which symptoms are more likely to be from one versus the other.

Symptom Tracking

If they feel they need more information to help you sort out your symptoms, you may be asked to track them over a period of time using an app or journal.

This can help identify patterns that may help you manage both conditions more effectively. 

Can Endometriosis Treatment Help With IBS?

If you have both endometriosis and IBS, treating one may help the other or at least help you determine what may be causing specific symptoms.

If you are treated for endometriosis and notice many but not all of your GI symptoms go away, you can deduce that any remaining ones are more likely to be from IBS (and vice versa).

IBS management and endometriosis treatment require very different approaches.

IBS Treatment

GI symptoms suspected to be due to IBS may be improved with a combination of prescription medications, over-the-counter (OTC) products, home remedies, and lifestyle changes.

For example, some people use medications that help relax the gut (antispasmodics), avoid certain foods that trigger symptoms, and get regular exercise. Your healthcare provider can advise you on the best treatment plan for you.

You may find that certain changes in your diet and lifestyle that are recommended for IBS end up helping both conditions. For example, increasing your fiber intake can both improve bowel movement issues related to IBS and help remove excess estrogen that may be present with endometriosis.

Endometriosis Treatment

If your GI symptoms are instead due to endometrial lesions in the bowel, the growths may need to be removed surgically. Surgery can also remove any scarring (adhesions) that can cause the organ tissue to stick together, leading to complications and infections.

If someone has severe damage to their intestines from endometriosis or has had complications, they may need to have part of their bowel taken out as well. This is typically done in severe endometriosis cases that also involve removal of the reproductive organs (uterus, fallopian tubes, and/or ovaries).

Summary

Endometriosis can cause GI symptoms similar to those of IBS, including abdominal pain and cramping. These conditions require different treatment approaches, so it's important to know if you do, in fact, have both, or if shared symptoms are instead due to endometrial lesions in the bowel.

Anyone with endometriosis who is experiencing IBS-like symptoms should mention them to a healthcare provider so they can be properly evaluated.