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How to tell if you’ve got ‘endo belly’

Laura Harcourt

Written byLaura Harcourt

Dr Tania Adib

Reviewed byDr Tania Adib

Woman, heart and hands on stomach for fitness, weightloss diet or holistic gut wellness.
Endo belly is uncomfortable and painful bloating associated with endometriosis. Find out all about it with Holland & Barrett.
If you’re struggling with ‘endo belly’ (severe bloating during endometriosis), you’re not alone. In fact, during one study, 96% of people with endometriosis reported experiencing painful bloating regularly.1

But how exactly can you tell if you’ve got an ‘endo belly’? And if it’s not related to endometriosis, what might be the cause behind your painful bloating?

We’ve explained it all here, alongside some advice on how to reduce your ‘endo belly’ symptoms.

What is ‘endo belly’?

‘Endo belly’ is a non-medical term used by many people in the endometriosis community to describe the uncomfortable and often painful abdominal bloating that’s associated with endometriosis.

Endometriosis is a condition that causes the endometrial tissue (that normally grows inside the uterus each menstrual cycle) to grow outside of the uterus. This tissue can spread to the external lining of other organs in the abdomen and pelvis or other organs such as the intestines.

As a result, endometriosis can only be formally diagnosed through laparoscopic (keyhole) surgery to identify these lesions.2

As this endometrial tissue builds up over time, it causes inflammation in the abdomen. This inflammation leads to abdominal distension and bloating (known as ‘endo belly’), causing pain.4

‘Endo belly’ symptoms

As ‘endo belly’ (severe bloating) is a symptom of endometriosis, most of the time it accompanies other symptoms of endometriosis. For example, painful heavy periods, lower back or pelvic pain, pain when peeing or pooping during your period and blood in your pee or poop during your period.3

But what does ‘endo belly’ look like? 

'Endo belly’ is generally characterised by having a tight, swollen belly, that’s often hard to the touch.3 In some cases, it can even look like you’re pregnant.3

For some people, ‘endo belly’ crops up around the time they ovulate. But it usually starts to develop a few days before you get your period.4 It might last for a few hours, or it could go on for days or even weeks.3

This extreme bloating increases pressure around your abdomen and lower back. When combined with typical endometriosis pain, this bloating can be severe, uncomfortable and painful.

The irritation and inflammation can also affect the gastrointestinal tract, causing digestive issues such as gas, nausea, constipation, and diarrhoea.5

Causes of ‘endo belly’

The ultimate cause of severe bloating, or ‘endo belly’, in endometriosis is likely multifactorial and can occur due to several reasons.6

One of the main reasons is thought to be due to the endometrial tissue building up and causing inflammation. This inflammation can affect the reproductive organs or other places where the endometriosis tissue is found, including the digestive system, resulting in the swelling, constipation, gas, and bloating that contribute to ‘endo belly’.7

However, there are other factors that, in combination with endometriosis, are also thought to contribute to ‘endo belly’. Here are a few.

Gut dysbiosis

Our gut (otherwise known as our small and large intestine) contains our microbiome – a collection of bacteria, microorganisms and genes that support digestion, immune function and hormone balance.8

These bacteria usually exist in a delicate balance with one another, but when this is thrown off-kilter, you experience gut dysbiosis (or bacterial imbalance).9 Loads of things can upset your gut balance, from underlying medical conditions to changes in diet.

Gut dysbiosis can lead to bloating, gassiness, constipation and diarrhoea. Research has shown that endometriosis and gut dysbiosis are linked (although this relationship is poorly understood),11 which is one of the reasons why endometriosis can be misdiagnosed as irritable bowel syndrome (IBS).5

SIBO (small intestinal bacterial overgrowth)

Small intestinal bacterial overgrowth (SIBO) is a type of gut dysbiosis where bacteria accumulate in the small intestine. This leads to symptoms such as bloating, diarrhoea, constipation, acid reflux, excessive burping, and slower digestion.10

In a healthy gut, most bacteria are found in the large intestine. Because of the connection between gut dysbiosis and endometriosis, people with endometriosis may be more at risk of SIBO.11
Poor digestive health

On top of the above, (or due to a combination of all of them), people with endo regularly suffer from digestive issues. These include constipation, gas, irregular bowel movements and diarrhoea, all of which can contribute to the bloating caused by ‘endo belly’.5

‘Endo belly’ vs other causes of bloating

If you don’t think you have endometriosis and feel like your bloating isn’t connected to your menstrual cycle, it’s unlikely that you’re suffering from ‘endo belly’.

However, your painful bloating could be a sign of something else. For example:
  • food intolerances – intolerance to certain food groups, including lactose and gluten, can often result in symptoms similar to IBS, including painful bloating12 
  • infection – stomach infections or viruses, like giardiasis, are really common causes of painful abdominal bloating.13 They’re usually accompanied by diarrhoea or vomiting and should pass by themselves in a few days 
  • perimenopause – research has shown that the hormonal changes associated with perimenopause could be linked to an increase in digestive health issues. These may contribute to bloating14 
  • ovarian cancer – painful bloating is a symptom associated with ovarian cancer, when a fluid known as ascites builds up in the abdomen.15 In fact, it’s one of the most common symptoms reported by patients15
If you’re experiencing painful bloating, see your GP as they’ll be able to advise you on your potential next steps.

How to get rid of ‘endo belly’

If you’re wondering how to improve your ‘endo belly’, the best method is to manage the underlying endometriosis that’s causing your symptoms.

However, pain medications that may work to ease the discomfort of endometriosis won’t prevent the build-up of endometrial tissue and are unlikely to be effective at treating ‘endo belly’.

As such, some of the main treatments that your doctor might suggest could include:16

Hormone treatment

Oestrogen contributes to the build-up of endometrial tissue. So, the aim of hormone treatment is to limit the production of oestrogen in your body, hopefully shrinking the tissue.

Some of the main hormone-based treatments for endometriosis include:16 
  • the combined oral contraceptive pill 
  • progestogens, including the intrauterine system (IUS), contraceptive injection, contraceptive implant, and progestogen-only pill 
  • gonadotropin-releasing hormone (GnRH) analogues

Surgery

Endometrial tissue can only be removed or destroyed through surgery. By removing the tissue, symptoms of endometriosis and ‘endo belly’ should be improved.16 Some of the options are laparoscopy (the most commonly used technique) or hysterectomy.16

Is there an ‘endo belly’ diet?

There’s no specific ‘endo belly’ diet. However, if you have endometriosis, looking after your digestive health is one of the best things you can do to beat the bloat.

Here are a few tips for doing just that.

Introduce a range of anti-inflammatory foods

As inflammation is a key symptom of endometriosis,7 eating an anti-inflammatory diet may potentially help with the symptoms.17

‘Eating the rainbow’ is an easy way to remember to add anti-inflammatory foods to your plate. This means focusing on vegetables and fruits in a range of colours.

Omega-3-rich oily fish like sardines, haddock, herring, and salmon are also all known for their anti-inflammatory properties.18

Try low-FODMAP foods

Some research has shown that following a low-FODMAP diet may help with digestive endometriosis symptoms, including ‘endo belly’.17,19 

FODMAPs are carbohydrates or sugars that your body may find difficult to digest. So a low-FODMAP diet involves avoiding foods that aren’t easily broken down by the gut, such as milk and wheat products.20

A low-FODMAP diet aims to reduce carbs that are harder to digest. This is because high-FODMAP foods, like dairy products and beans, can contribute to abdominal bloating.21

However, the current data and studies into this area are lacking so, at the moment, no single diet can be recommended.17

Make food easier to digest

This means, slow down! Try to eat mindfully and calmly, and chew each bite properly. When you break your food down effectively, you make it easier to digest and reduce gastrointestinal issues.22

Identify trigger foods

Specific foods will trigger bloating in certain people. For example, some people are particularly sensitive to lactose.23 Pay attention to what you eat, maybe keep a food diary and see whether your symptoms are worse after eating a particular food.

The final say

Whatever the root cause, if you’re constantly struggling with painful abdominal pain, we would always recommend seeking medical advice. 

Whether it’s ‘endo belly’ or another digestive health condition, you don’t have to put up with the pain.

Alongside any medical interventions you may decide on with your doctor, you can try to manage your symptoms with a diet rich in probiotics22 and low in inflammatory foods.

This article is for information only and does not constitute providing medical advice or professional services. Please speak to your GP if you are suffering from this condition.

Sources

1. Luscombe, G. Abdominal Bloating: An Under-recognized Endometriosis Symptom. Journal of Obstetrics and Gynaecology Canada. 2009;31(12):1159–1171. https://doi.org/10.1016/S1701-2163(16)34377-8
2. Tsamantioti, E. Endometriosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567777/.
3. Velho RV, et al. ‘Endo Belly: What Is It and Why Does It Happen?—A Narrative Review.’ Journal of Clinical Medicine. 2023;12(22):7176. Available from: https://doi.org/10.3390/jcm12227176
4. NHS. Overview - Endometriosis [Internet]. [Cited 2024 Feb 10]. NHS. Available from: https://www.nhs.uk/conditions/endometriosis/
5. Malin Ek, et al. ‘Gastrointestinal symptoms among endometriosis patients—A case-cohort study.’ BMC Women’s Health. 2015;15(1). Available from: https://doi.org/10.1186/s12905-015-0213-2
6. World Health Organization. Endometriosis [Internet]. [Cited 2024 Feb 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis 
7. Endometriosis Foundation of America. Managing 'Endo Belly' (Severe Bloating) [Internet]. [cited 2024 Apr 12]. Available from: https://www.endofound.org/managing-endo-belly-severe-bloating.
8. Belizário JE, et al. ‘Microbiome and Gut Dysbiosis.’ Experientia Supplementum. 2018;109:459–76. Available from: https://doi.org/10.1007/978-3-319-74932-7_13
9. Zizolfi B, et al. ‘Endometriosis and dysbiosis: State of art.’ Frontiers in Endocrinology. 2023;14(14). Available from: https://doi.org/10.3389/fendo.2023.1140774
10. Ghoshal UC, et al. ‘Small intestinal bacterial overgrowth and irritable bowel syndrome: A bridge between functional organic dichotomy.’ Gut and Liver. 2017;11(2):196–208. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/
11. Chadchan SB, et al. ‘Gut microbiota and microbiota-derived metabolites promotes endometriosis.’ Cell Death Discovery. 2023;9(1). Available from: https://doi.org/10.1038/s41420-023-01309-0
12. Crowe SE. ‘Food Allergy Vs Food Intolerance in Patients With Irritable Bowel Syndrome.’ Gastroenterology & hepatology. 2019;15(1):38–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423694/
13. NHS. Giardiasis [Internet]. [Cited 2024 Feb 10]. Available from: https://www.nhs.uk/conditions/giardiasis /
14. Heitkemper MM, et al. ‘Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?’ Gender Medicine. 2009 Jan;6(2):152–67. Available from: https://doi.org/10.1016/j.genm.2009.03.004
15. Dilley J, et al. ‘Ovarian cancer symptoms, routes to diagnosis and survival – Population cohort study in the “no screen” arm of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).’ Gynecologic Oncology. 2020 Aug;158(2):316–22. Available from: https://doi.org/10.1016/j.ygyno.2020.05.002
16. NHS. Endometriosis - Treatment [Internet]. [Cited 2024 Feb 10]. Available from: https://www.nhs.uk/conditions/endometriosis/treatment/
17. Nap A, et al. ‘Endometriosis and the effects of dietary interventions: what are we looking for?’ Reproduction and Fertility. 2022;3(2):C14–22. Available from: https://doi.org/10.1530/raf-21-0110
18. Simopoulos AP. ‘Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases.’ Journal of the American College of Nutrition [Internet]. 2002;21(6):495–505. Available from: https://doi.org/10.1080/07315724.2002.10719248
19. Moore JS, et al. ‘Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet.’ Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017;57(2):201–5. Available from: https://doi.org/10.1111/ajo.12594
20. NHS. Irritable bowel syndrome [Internet]. [Cited 2024 Feb 10]. Available from: https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/further-help-and-support/
21. Magge, S, et al. ‘Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome.’ Gastroenterology & hepatology. 2012;8(11):739–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966170/
22. Cherpak, CE. ‘Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function.’ Integrative Medicine: A Clinician’s Journal. 2019;18(4):48. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219460/
23. NHS. Good foods to help your digestion [Internet]. [Cited 2024 Feb 10]. Available from: https://www.nhs.uk/live-well/eat-well/digestive-health/good-foods-to-help-your-digestion/
 
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