The 6 Main Culprits of Endometriosis Bloating (ie endo belly)
Admit it, you’re dying to know. WHY DO I BLOAT LIKE THIS?????? Your doc may have told you it’s just your endo, the internet may have told you it’s your hormones, your vegan friend says its meat, your keto friend says it’s carbs, and you’re still stuck in embarrassing agony looking for a solution.
The truth is, there are most often real issues we can point to far beyond endometriosis or hormones. So - aside from your bloating being caused by real organic disease presentation (think endo, IBD, cancer, etc) - here are the 6 most probable reasons you’re as bloated as a balloon with all the little details to follow in my much-too-long-almost-100-page—e-book-on-endo-belly coming soon.
1) Mal-Digestion and your Four Fecta
You eat food, it goes through a series of processes to break down into teeny tiny morsels that make it to your small intestine and either feed your body, or feed your gut bacteria. The four parties namely responsible for this switch-a-roo are your mouth, stomach, pancreas, and gallbladder (which I call the Four-Fecta). If these 4 aren’t working properly, serious bloat may seriously ensue because your main digestive organs have seriously failed to digest (ie breakdown to a cellular level) the food you ate.
When the fail to break your food down, you have now introduced fully formed fats, proteins, sugars, and starches where they should never exist in their full form: your intestines! Let me repeat, proteins, fats, and carbohydrates don’t belong in your intestines. Scratching your head wondering, “What do belong there then”? Their broken down counterparts: amino acids, fatty acids, and glucose. It’s the job of your Four Fecta to make this magical transformation happen.
Because so many of you have a poorly functioning system here (think, do you even chew OR salivate?? And that’s just the tip of the Four-Fecta iceberg) ) this is a particular problem that feeds #2, dysbiosis.
Your gut microbiome is the entirety of the 500-1000 different species of bacteria, yeasts, fungi, viruses, and archaea that live in your digestive tract. They need to be in balance for you to feel your best, and the more diverse + robust your microbiome, the more healthy you are! In fact, loss of diversity is associated with many common and chronic diseases we see today. As more and more studies look at the microbiome in relation to chronic disease, scientists are able to pick out the recurring theme that a rich, healthy, and diverse microbiome is directly related to your vibrant health and a sad sickly microbiome = a sad sickly you. In fact, New research is even hypothesizing that the gut microbiota may be “involved crucially in the onset and progression of endometriosis”!
See, if your microbiome is as diverse as the amazon rainforest it will be more resilient in the face of toxins, stress, antibiotics, birth control, and dietary triggers. Although somewhat pathogenic species are a normal part of the ecosystem - like scary leopards in the jungle - when things are askew the balance easily becomes tipped. This can lead to to more pathogenic species than there should be (think candida or e. coli overgrowth) or perfectly helpful bacteria in the wrong locations (like SIBO). I’ll nestle parasite infection under this umbrella too. At the same time a lack or diversity is like desertification of forest land: extinction, starvation, dehydration, and no resilience in the face of emergency. In human terms this means chronic disease. Oh, and endo-belly.
Unfortunately for us, the Western microbiome as a whole is suffering due to environmental, medical, dietary, and mental (such as stress and anxiety) issues. From our fear of bacteria, our lack of playing in nature, the sanitization of food, the addition of preservatives, lack of diversity in the diet, antibiotics, birth control, pain killers, and more. Each one of these act as a lawnmower over these delicate creatures, while all of them together act like an atomic bomb, slowly driving this diverse ecosystem extinct and allowing other, more sinister varieties the opportunity to thrive.
When you have dysbiosis or infections acting like war in your delicate intestinal tract you develop #3, leaky gut.
3) Leaky Gut + Food Intolerances
If you have gut hyper-permeability (i.e. leaky gut) you will automatically be reacting to certain foods more than the average bear. For some of you that may mean extreme bloating or gastro distress with certain foods, and you have no idea which foods or why - because you can even react up to 3 days after contamination!. Leaky gut also means toxic byproducts from pathogenic bacteria (called endotoxins) are able to leak through your intestinal tract into your blood stream, which may cause a painful immune response and with accompanying systemic inflammation we all just love. The annoying thing is that no two endo-warriors will always react to the same foods, so this takes sleuthing on your own part. However, through targeted diet and lifestyle work, you can help your poor body mend and rebuild that delicate gut barrier to keep the intestinal contents (basically poop) from leaking into your body.
Remember, in one study by EndoFound 100% of test participants diagnosed with endo tested positive for leaky gut. Kind of conclusive isn’t it?
4) Your MMC is Broke
Your migrating motor complex (MMC) is an incredible piece of the endo-belly puzzle most of you have never heard of - so gather round the fire while I tell you the story of your long lost friend, the MMC.
Your small intestine is about 20 feet long, crinkled with many pockets and folds (mucosal folds), and lined with microscopic nutrient absorbing “seaweed” called villi. In order for your body to distribute the now pre-digested food passed on from your Four-Fecta all the way down that 20 feet of tubing, requires a process called the MMC, also known as peristalsis. This wave of contraction and distention that moves the inner contents along, churning it along the way in order to continuously present nutrients to the villi and simultaneously shake off any pockets of bacteria, yeasts, or viruses that might otherwise to set up shop where they shouldn’t. It’s like a toilet flushing every 90 minutes so grossies don’t take over and your villi always have nutrients to feast on.
The thing is, your small intestinal MMC only functions in a fasting state, then at 90 minute intervals. That means about 90 min after you finish eating, you have your first MMC flush, then at 180 min your second, etc (you do the math). Problem: you eat all the time. No no, I’m not calling you a pig, just that most people can’t stop munching on food or drinks all day long, even a bite of almond or a sip of green juice will shoot your MMC timer back to zero. For some, that means your MMC doesn’t flush your belly-toilet alllll day long (think, when was the last time you ate 3 square meals/day without snacking AT ALL), and if this is consistent then your whole MMC can break - more professionally known as MMC down regulation.
That’s why rehabbing your MMC is utterly important to your bloat, your dysbiosis, your leaky gut, and your endo.
**Note, women with intestinal or bowel endo should be particularly aware of this issue, as endometriosis growths in the intestinal tract can also contribute to MMC down regulation.
Diet play an enormous role in mitigating bloating, but for many of you will be need to be addressed alongside your Four-Fecta, your dysbiosis, and your leaky gut to truly see the shifts you want. Otherwise, these are the 2 main diet culprits I see most often with my clients:
1) Way too much sugar, starches, or carbohydrates in general
I write a lot about blood sugar regulation and how us endo-gals are often stuffed to the brim with excess glucose. EVEN WITH THE WOMEN THAT SAY THEY DON’T EAT SUGAR, I often see them eating tons upon tons of starches in the form of grains, beans, gluten free items and fruit. The goal isn’t to swing the pendulum to the opposite end of the spectrum (per the ever popular keto diet), it’s to shoot for a moderate amount of carbohydrates, well digested. Think of this as getting your carbs from veggies of all kinds! And then making sure those carbs are processed beautifully through your Four-Fecta! And do note, if you can’t seem to tolerate carbohydrates well at all, this is often a big ‘ol sign of more serious dysbiosis.
FODMAPs are highly fermentable carbohydrates, and if you react to them you may be blowing up like a balloon from perfectly healthy (and even low carb) foods. The main reason you react to FODMAP foods is because of - you guessed it - dysbiosis!! And especially SIBO. SIBO stands for Small Intestinal Bacterial Overgrowth, and means there’s a big ocean of bacteria living where it shouldn’t be: your small intestines. When you feed this misplaced bacteria, it reacts as usual (ie ferments the food) but when that’s happening in your small intestine it’s a horror story. This is why you should always get tested for SIBO and other patterns of serious dysbiosis if you’re reacting to high FODMAP foods. Also, for those of you with IBS, SIBO has been shown to be the root cause for up to 84% of all IBS cases (and why a lowFODMAP diet is often recommended for IBS suffers).
Cutting out high FODMAP foods will not fix the dysbiosis, but it will help mitigate symptoms until you can get tested and fixed up. In the meantime, cutting them out can be beneficial for some folk to further investigate to see if these foods are problematic. It’s not easy, per say, because high FODMAP foods are random! For example cauliflower is high, while broccoli is not. Onions are high, mustard is low. Fermented dairy is high, fresh milk is not. But remember, you should only consider a lowFODMAP diet if your symptoms are severe and you’ve tried some other easier steps first. Then, if you find you react please go. get. tested. to find out more about your particular type of dysbiosis and how to address it so you can eat high FODMAPs again (they’re really healthy foods is why)
6) Core Dysfunction
In 2013 the NYTimes asked readers’ opinions about a 15-year-old gymnast who suddenly developed an absurdly distended belly and chronic constipation. 500 specialists submitted possibilities and only 6 were in the ballpark of correct: pelvic floor dysfunction and abdominal phrenic dyssynergia. Basically, her core musculature was not functioning correctly. at all. But because there wasn’t any “organic disease” present, doctors were scratching their heads. She almost got the “IBS” diagnosis…
The core can become dysfunctional in numerous ways, mostly because of you though. Yup, you ;) See, your diaphragm is supposed to naturally lower when you breathe in and your ribs open, your pelvic floor relax when you squat, fart, or poop yet be strong when you’re sitting, walking, or standing up. All this should happen synergistically without you ever having to think about it.
But then one day, you probably did think about it. You thought your tummy was fat so you sucked it in, you thought the kegal was king and starting tensing your pelvic floor in every position thinking this was “strengthening” it, you thought a six pack was sexy so did a lot of crunches and ab flexing that led you to have overly strong upper abs and nada below.
The other BIG issues that contributes to core dysfunction is sitting in a chair-like fashion the majority of your life. Your core, glutes, and pelvic floor are all amigas, you see, and by using a chair to keep you upright instead of your core musculature, you train these muscles to behave incorrectly. Because now when you stand up, these muscles have forgotten how to hold you up (their main job). Instead you rely on your ligaments, your back, your quads, all the things that shouldn’t be holding you up all the time. Welcome to bad knees, hips, ankles, and everything else, and a poochy lower belly
If this is you, your belly might look like these images on the right. From these pics you can tell each righthand woman is breathing incorrectly, tensing her upper abdomen, and has atrophied lower abdominal muscles that “pooch” out. See, nothing to do with dysbiosis, this is purely a mechanical issue, but still a serious one that will continue to damage her lower abdominal tissue and pressurize her uterus downward, causing pelvic pain, gastro pain, and lower abdominal bloating of course.
Just to bring it home, it’s estimated a whopping 1 in 3 Americans have some sort of pelvic floor or core dysfunction. For the endo community I would argue it’s 100%… so, yes, you ;)
Last) Everything else
There are definitely other reasons you may have endo-belly, but they’re actually less common to be “THE” culprit than you’d think.
Of course, there’s the endo itself. If you have severe endometriosis, it may have made it into your bowel, obliterated (even the word “obliterated “sounds painful!) your cul-de-sac, or frozen your pelvis. My own cul-de-sac area was destroyed and going #2 could be intensely painful. Endo can wrap around and through tissues, it can appear on your intestines, it can sear tissues together that are supposed to be mobile and free to move food through your system. When this happens, endometriosis is definitely a piece of your endo-belly puzzle. You need mobility in your abdominal organs to function properly, and bleeding in your intestinal tract is never a good thing. Plus, if it’s messing up normal function, you’re much more likely to develop other issues such a SIBO, dysbiosis, etc. So this all goes hand in hand.
As far as adeno, a healthy woman is near menstruation, her uterus may grow 10-15% of its normal size as the uterine lining thickens in preparation for a potential pregnancy. This can be what causes a slightly heavy feeling in your pelvis around flow-time. For women with adeno, it’s another story. As the adeno responds to monthly hormone fluctuations, blood can swell in the myometrium, enlarging the uterus even more. The bloating feeling that comes from this is quite literally your abdomen swelling from this abnormally large uterus pushing your other organs out of place. This wouldn’t be considered bloating, but instead distention or abdominal swelling.
Then there’s stress or anxiety (yup, they can cause serious bloating if you’re chronically stressed) or even serious disease presentations such as Coeliac, Crone’s or Colitis, or - not to scare you - cancer. [Did you notice how I didn’t say IBS? That’s because I think an IBS diagnosis is usually B.S. since most doctors haven’t ruled out all other possibilities, but I’ll rant about that later]. For now know this “everything else” is worth considering if your endo-belly bloat comes with truly terrible symptoms of digestive pain, ceaseless diarrhea or constipation, fever, blood in your stool, weight-loss or anything else freaky.
It’s important to understand there are often many issues contributing to your endo belly, and although some of you may have issues beyond your control (like stage 4 endo or adeno), many women haven’t even begun to address their Four-Fecta, dysbiosis, or leaky gut. In fact, you may be surprised that even if you do have stage 4 endo, just how much better you feel via pain, fatigue, etc when you start to address this INCREDIBLY important part of the puzzle.
As for the above 1 through 5, all the Four-Fecta, Dysbiosis, Leaky Gut, MMC function, and Diet are connected! So even though it may seem like a lot of information at first glance, methods to bring this system back into balance are all tightly woven together.
If you’re curious about how to even BEGIN to address issues 1-5 from above, stay tuned for my ebook that goes into each of these in detail!!