Jessica Duffin is a a certified health coach specialised in endometriosis and small intestine bacterial overgrowth (a.k.a. SIBO; one of the key causes of endo belly!). @TheEndoBellyCoach
What is SIBO and why are endo warriors more prone?
SIBO stands for small intestine bacterial overgrowth. It is a condition where the bacteria which should be living in your large intestine are living in the small intestine too.
The small intestine typically houses a very tiny number of bacteria, but with SIBO, there’s lot of it. When we have all of this bacteria in our small intestine, it damages the intestinal lining, inhibits nutrient absorption and causes problems like bloating, diarrhea, constipation, full body inflammation and abdominal pain to name a few.
While we need more data, current research is suggesting SIBO may affect up to 80% of those with endometriosis. The issue is, what came first?
The adhesions caused from endo or surgeries can inhibit the gut from working properly, which allows a build-up of bacteria in the small intestine, causing SIBO.
However, toxins from gram-negative bacteria called lipopolysaccharides have been found in the pelvic cavity of people with endo and have been shown to contribute to disease development and progression. There are theories that these lipopolysaccharides are present in higher numbers and escaping from the gut (thanks to leaky gut) into the pelvic cavity, due to the presence of SIBO.
Why is my endo belly and gut health worse after surgery?
There are a number of factors that might be worsening your gut symptoms after surgery. Here are three of the most common:
Pelvic floor dysfunction: Most people with endo have something called a hypertonic pelvic floor, meaning a tight pelvic floor, after years of chronic pain. This can cause problems like constipation and urgency, and it can be worsened by surgery in some cases. Working with a pelvic floor physiotherapist who is versed in endometriosis is, in my opinion, a crucial part of recovery post-surgery.
Pain killers: Many pain killers are constipating and can also slow down something called the migrating motor complex in the small intestine. This results in a build-up of bacteria, gases and faeces, leading to bloating, abdominal pain and general IBS symptoms. The good news is that there are lots of evidenced-based alternatives to ease pain and actually improve gut function.
Adhesions and SIBO: Unfortunately, research shows us that in most cases, those who have abdominal surgery will develop adhesions. Adhesions are like spider webs that stick to the organs, muscles, and so on. They are incredibly strong, and can pull and distort organs, which may lead to restriction of function. If adhesions are affecting the gut, they may slow down the transit of food, gas or waste, creating IBS symptoms, but they can also inhibit the migrating motor complex in the small intestine, and when this is impaired, SIBO eventually follows, which could be the cause of your worsened or new endo belly symptoms.
Thankfully, you can see a practitioner who will assess you for adhesions and can work to break them down, and you can test and treat SIBO (though in some cases, SIBO is chronic).
Why is my endo belly/gut health worse in my luteal phase and during my period?
In the second half of our cycle, after ovulation, progesterone should be higher. Progesterone is a muscle relaxant, and because the gut is made of smooth muscle, it actually slows down motility. This results in slower transit times, potentially resulting in constipation, bloating and gas. However, we still want to be aiming for at least one bowel movement a day, and so if you’re not getting that, working with a practitioner can help.
Often people report ‘period diarrhea’ when menstruation starts. This is because of inflammatory chemicals known as prostaglandins. Prostaglandins play a crucial role in the breakdown and shedding of our uterine lining, but when levels are too high, they actually cause the colon to contract, creating accelerated bowel movements.
People with endometriosis (as well as people with heavy periods and painful periods) have been shown to have higher levels of prostaglandins in the menstrual blood and pelvic cavity. When we lower inflammation levels, we reduce these prostaglandins and can alleviate period diarrhea. You may still find you go a bit more, and your bowel movements might be a bit softer, but you shouldn’t be struggling with bad diarrhea that affects your daily life.