There are many different reasons why people might have digestive disturbances like chronic bloating. Common causes include lactose intolerance, inflammatory bowel disease, irritable bowel syndrome (IBS), and so on (the list can be pretty long).
Two of these disorders are frequently connected: endometriosis and SIBO (Small Intestinal Bacterial Overgrowth).
But what does SIBO and endometriosis connection mean? How can both contribute to the digestive symptoms that many don't suspect?
What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth. It means an increase in the number of bacteria and/or changes in the types of bacteria present in the small intestine. SIBO is commonly caused by an overgrowth of various bacteria that should generally be found in the large intestine. (1) So, the issue is with the location.
SIBO can cause classic symptoms similar to IBS (Irritable Bowel Syndrome). These include abdominal pain, discomfort, cramping, gas, bloating, reflux, diarrhea, and/or constipation.
According to studies, up to 84 % of IBS cases are caused by SIBO. (2)
Read more about the SIBO symptoms here.
What is Endometriosis?
It is a chronic inflammatory condition where the uterine tissue grows on other pelvic organs. It mainly affects the ovaries but can impact the fallopian tubes or the colon.
These tissues respond to the same hormonal changes during the menstrual cycle. They bleed similarly to the uterine lining, but the problem is that it doesn't have access to the outer world as the uterine. (It is called retrograde menstruation) (3)
According to studies, endometriosis can affect around 10–15% of all women of reproductive age and 70% of women with chronic pelvic pain. (4)
Endometriosis symptoms
Endometriosis can cause many symptoms, such as
- Chronic bloating (often called "endo-belly"),
- Abdominal pain,
- Chronic constipation
- Irregular, heavy, and painful periods,
- Infertility
- Mood changes
- Weight gain (especially the waist area and thighs)
- Pelvic pain, lower back pain
- Painful sexual intercourse
All these debilitating symptoms can take a toll on the mind, and many women experience some level of anxiety and depression. (4)
What about diagnosing endometriosis?
It is difficult to diagnose endometriosis and can mimic other gut conditions like IBS, SIBO, or IBD. This is one of the reasons why it takes up to 11 years to be diagnosed with endometriosis. (6)
The next challenge is that no established tool can quickly diagnose this condition. The currently accepted tool is a quite invasive laparoscopy surgical procedure.
The next problem is in the healthcare system, as many doctors are unfamiliar with this condition, miss the signs, or don't refer the patient to the right specialist. Unfortunately, they still commonly give some medications to the patients (like birth control pills) that mask the symptoms.
Many women realize the problem when they want to have a child and undergo a fertility evaluation and treatment. Unfortunately, more than 50% of women with endometriosis are infertile. (5)
What can cause endometriosis?
There are many theories about what eventually leads to this condition, but some of the reasons are hormonal imbalances, typically high estrogen and low progesterone levels, inflammation, genetics, etc. (7)
There is also a connection between environmental toxins (so-called endocrine-disrupting chemicals (EDCs)) and endometriosis. Women should review what they put on their skin daily, check the cleaning products, and avoid packaged foods, especially those containing chemicals such as benzophenones and phthalates. (8)
But any inflammation, gut inflammation, including SIBO, can cause hormonal imbalances. Inflammation is a stress on the body; it increases cortisol, estrogen, and 5 alpha-reductase (9), disrupting the delicate hormonal balance in the body.
Malabsorption is also a contributing factor; if you are not absorbing the necessary nutrients from the food, you won't be able to make the hormones or effectively clear them out.
The connection between endometriosis and SIBO
If you have had any abdominal surgeries in the past (maybe because of an injury or Endometriosis, C-section), then there is a high chance of adhesion formation. (10) Adhesions are irregular bands of scar tissue forming between two structures that are typically not bound together. (11) However, adhesions can form due to inflammatory conditions like IBD, infections, or radiation therapies. So, if you have been struggling with chronic SIBO for a while and underwent surgeries for Endo, then there is a significant connection here.
How is this connected to the gastrointestinal tract? Adhesions can interfere with gut motility, the way food particles, fluid, and bacteria move through the intestines by creating blockages. This may lead to symptoms such as changed bowel movements, chronic bloating, abdominal pain, incomplete or even painful evacuation, nausea, etc. In some instances, adhesions can cause complete bowel obstructions when they entirely block the way and require urgent medical care. (12)
In terms of SIBO, your body has its defense mechanisms against bacterial overgrowth, and one of them is well-functioning gut motility. But when blockages start to happen due to adhesion formation, they block the way how the food particles move through, allowing bacteria to feed on them and grow, leading to various symptoms. (13)
So, if you are dealing with chronic SIBO, meaning that you have relapsed every time despite several treatment rounds and have had any abdominal surgeries in the past, then it's worth looking into adhesions.
The second significant connection is that the gut microbiome plays a crucial role in regulating estrogen. Estrobolome is a composition of gut microbes that metabolize and modulate estrogen in the body. (14) These microbes produce an enzyme, beta-glucuronidase, that can unbind estrogen and recirculate it into its active forms, binding to estrogen receptors and affecting estrogen-related processes.
Why is this important? Because many women with endometriosis may have higher levels of beta-glucuronidase production, causing elevated levels of estrogen that may contribute to the endo symptoms.
What causes this elevated enzyme production is usually gut dysbiosis (an increase in pathogenic gut bacteria and a decrease in "good gut bugs" like Lactobacilli.). There are various reasons why dysbiosis can happen, like frequent antibiotic usage, anti-baby pills, chronic stress, diet, lifestyle, etc.
Liver health and endometriosis
As we may know, the liver is the largest organ in the body. It is responsible for many functions: detoxification processes, immune support, blood sugar management, metabolism, and hormonal health. (15)
Supporting the liver is very important for proper hormonal balance and detoxification. Phase I and phase II detoxification are essential when the body wants to get rid of excess estrogen, for example. These detox pathways require many nutrients, such as B vitamins, glutathione, and so on, for activation.
What about endometriosis treatment?
Endometriosis is a complex condition, and the exact root causes are not known (yet). However, there are some methods of managing symptoms.
Since it's an inflammatory condition, it is essential to reduce inflammation with diet by following an anti-inflammatory diet, adding the necessary nutrients, and managing your lifestyle.
Let's see some helpful ways:
- Removing the big offenders like gluten, dairy, sugar, processed foods, trans fats, and hydrogenated oils due to their inflammatory properties. (16)
- Adding anti-inflammatory nutrients like herbs: ginger, rosemary, turmeric, green tea
- Following a whole food diet includes a lot of colorful vegetables, fruits, and fibers, possibly from organic sources. You can go to the Environmental Working Group's Dirty Dozen list to see the worst offenders if buying all organic produce isn't possible.
- Opting for grass-fed, pasture-raised, wild-caught animal protein sources
- Increasing omega-3 fatty acids intake with fish oils or eating fatty fish. A study found that a higher amount of omega-3 ratio can decrease inflammation in endometriosis. (17)
- Supplementing with antioxidants was shown to reduce chronic pelvic pain in women with endometriosis and inflammatory markers. (18)
- Removing environmental toxins from the household is very important, mainly plastic, because it contains xenoestrogens (synthetic estrogens) that can disrupt your hormonal balance. (19) Instead, use stainless steel or glass water bottles or food containers, switch to non-toxic beauty products, ditch Teflon cookware, and use ceramic or cast iron pans.
- Ensuring that you have daily bowel movements is crucial for estrogen detoxification
- Opening your detoxification pathways to improve detox, such as saunas, rebounding, dry skin brushing, etc.
- Focusing on the other lifestyle factors such as stress management, exercise, sleep, mindset, relationships, and having a support system
Still, it is crucial to test for SIBO, see if that plays a role in the symptoms, and have a plan to reduce the overgrowth. Additionally, finding and possibly addressing the root causes & contributing factors to SIBO and Endometriosis can help elevate the symptoms long-term.
Should you consider manual therapy for SIBO and endometriosis?
Those who've recently undergone abdominal or pelvic surgeries might experience adhesions as their bodies are trying to heal.
So, if you've been struggling with SIBO or chronic bloating, often feeling heavy without overeating, chronic constipation, or unexplained digestive discomfort despite previous treatments, the culprits might be physical blockages.
Let's imagine if someone could skilfully 'unknot' that hose, restoring the flow in your intestines. This is where manual therapy for gut issues can enter the scene!
Manual therapy techniques involve hands-on manipulation and movement of bodily structures.
When it comes to the gut, such therapies can:
- Break down adhesions: Gentle and targeted pressure can help break down internal scar tissues, facilitating better organ movement and function.
- Enhance vagus nerve function: The vagus nerve is pivotal to digestion. Cervical instability can impair it. Manual therapy can help realign structures, indirectly benefiting the vagus nerve and enhancing digestion.
- Improve bowel transit time: By facilitating smoother organ function and breaking down blockages, manual therapy, such as visceral manipulation, can support better bowel movement, reducing symptoms of conditions like SIBO.
- Improved circulation: With better movement and lessened restrictions, blood circulation to these organs can improve, enhancing healing and function.
- Lymphatic drainage: Enhanced manual movement can help drain toxins and excess fluid from the abdominal region, supporting overall gut health.
Incorporating manual therapy into your SIBO and endometriosis healing journey
If you suspect blockages may be an issue, finding a certified and experienced therapist is crucial if you're considering adding manual therapy to your healing regime.
International Association of Healthcare Practitioners lists their recognized practitioners on their site, but make sure to find a therapist trained for Visceral manipulation techniques.
If you are based in the USA, check out Clear Passage's website, which thoroughly explains how manual therapy works and its effect on the gut and other conditions.
The Bottom Line
Endometriosis is a poorly understood condition that affects about 10% of menstruating women. The implications and scope of this disease are far-reaching as it can affect many different parts of the body, from the brain to the digestive system.
Functional lab testing may help you detect any underlying issues contributing to your endometriosis. Having the right information has never been more critical in finding lasting relief.
A holistic approach to dealing with endometriosis is always the best way to ensure that the body is supported from multiple angles.
We need to understand that this condition affects each individual differently.
I hope this information will encourage you to be creative in addressing the symptoms and causes of endometriosis and lead you toward optimal health and wellness.
This post is only for informational purposes and is not meant to diagnose, treat, or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.
- Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., & Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World journal of gastroenterology, 16(24), 2978–2990. https://doi.org/10.3748/wjg.v16.i24.2978
- Reddymasu, S.C., Sostarich, S. & McCallum, R.W. Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?. BMC Gastroenterol 10, 23 (2010). doi.org/10.1186/1471-230X-10-23
- Bulun, S. E., Yilmaz, B. D., Sison, C., Miyazaki, K., Bernardi, L., Liu, S., Kohlmeier, A., Yin, P., Milad, M., & Wei, J. (2019). Endometriosis. Endocrine reviews, 40(4), 1048–1079. https://doi.org/10.1210/er.2018-00242
- Parasar, P., Ozcan, P., & Terry, K. L. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current obstetrics and gynecology reports, 6(1), 34–41. https://doi.org/10.1007/s13669-017-0187-1
- Holoch, K. J., & Lessey, B. A. (2010). Endometriosis and infertility. Clinical obstetrics and gynecology, 53(2), 429–438. https://doi.org/10.1097/GRF.0b013e3181db7d71
- Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh, S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: a call to action. American journal of obstetrics and gynecology, 220(4), 354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039
- Chantalat, E., Valera, M. C., Vaysse, C., Noirrit, E., Rusidze, M., Weyl, A., Vergriete, K., Buscail, E., Lluel, P., Fontaine, C., Arnal, J. F., & Lenfant, F. (2020). Estrogen Receptors and Endometriosis. International journal of molecular sciences, 21(8), 2815. https://doi.org/10.3390/ijms21082815
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- Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53. https://doi.org/10.1016/j.maturitas.2017.06.025
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- Welle, N. J., Sajjad, H., Adkins, A., & Burns, B. (2022). Bowel Adhesions. In StatPearls. StatPearls Publishing. - https://pubmed.ncbi.nlm.nih.gov/29262174/
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Alexandra is a Functional Medicine Certified Health Coach & Holistic Nutritionist specializing in IBS, SIBO, and Gut Health. She helps her clients identify the root causes of their chronic gut issues with functional testing, supporting their bodies holistically and implementing the necessary lifestyle changes long-term to regain control of their bodies and enjoy food freedom. Book your FREE SIBO Assessment call now >>>