What is endo belly and how can you manage it?

Endo belly occurs when you have endometriosis and your tummy becomes bloated. It is also called endometriosis bloating. Medications and changes to your diet can help ease your symptoms, as well as treating the underlying condition, endometriosis. 

If your abdominal bloating occurs frequently, for longer than a few days and/or is painful, see your GP. You may have endo belly but there are also other conditions that can cause abdominal bloating. Your doctor will examine you and discuss your symptoms to help identify the cause and recommend appropriate treatment. 

If you have endo belly, the abdominal bloating can last for just a few hours, days or weeks. 

What is endo belly / endometriosis bloating?

Endo belly refers to abdominal bloating linked to endometriosis and can cause discomfort, pain and swelling. 

Endometriosis is a condition where tissue similar to the lining of your womb (endometrium) starts to grow elsewhere and attaches to other organs, such as your ovaries and fallopian tubes. It is estimated to affect one in 10 women of child-bearing age.  

Endometriosis symptoms include heavy bleeding during your periods, pelvic and/or abdominal pain, infertility and gastrointestinal symptoms, such as endo belly. Endo belly is not a commonly discussed symptom of endometriosis despite it often being distressing.

What causes endometriosis belly?

The exact cause of endo belly is unclear although there are several theories. 

One theory suggests that the endometrial tissue growing outside your womb causes pain as it still bleeds during your periods but the blood has no way to exit your body and becomes trapped. 

Another theory suggests that the endometrial tissue growing outside your womb causes other nearby tissues to become inflamed. This can cause swelling, bloating, water retention and the formation of scar tissue, as well as causing tissues in your pelvis to stick together when they shouldn’t.

It has also been suggested that if you have endometriosis, your gut is more sensitive. This makes it more likely that your intestines will become overworked and increases your risk of digestive problems, such as constipation and bloating. 

If you have endometriosis, you are also more likely to develop fibroids and small intestinal bacterial overgrowth (SIBO), which can both cause bloating.

If the endometrial tissue growing outside your womb grows over or into your ovaries, blood produced by this tissue during your periods can become trapped in the form of cysts. These cysts can also cause bloating. 

What are the symptoms of endo belly?

The most common symptom is severe abdominal bloating, particularly just before or during your period. Abdominal bloating occurs when your tummy fills with gas and consequently swells — this can last for hours, days or weeks. This can make your tummy feel tight or hard when you touch it. 

Other symptoms include discomfort, pain and pressure in your abdomen and back. 

Why am I so bloated I look pregnant?

Endo belly causes extreme abdominal bloating, which can make you appear pregnant, even though you aren’t. If you have endometriosis and endo belly, you are also more likely to have other gastrointestinal conditions that can worsen your bloating and make your tummy swell even more. 

Other gastrointestinal symptoms

If you have endo belly, you are more likely to have other gastrointestinal conditions, including: 

• Constipation
• Diarrhoea
• Nausea
• Stomach gurgling — you may notice your stomach making sounds, such as gurgling, or feel as if it’s bubbling or fluttering inside
• Trapped gas

When should you see a doctor?

If you have abdominal bloating that occurs frequently, lasts longer than a few days and/or is causing you pain, it is important to see your doctor to get a diagnosis.

Your doctor will perform a physical examination of your tummy and pelvis to feel for cysts or scars behind your womb. They may also recommend you have a transvaginal ultrasound or an abdominal ultrasound so they can see images of the inside of your pelvis. This can help them better identify any cysts, scars or other abnormalities, which may be causing your bloating. 

How to reduce endo belly

What home endo belly remedies can help?

Changing your diet can help reduce endo belly symptoms, such as bloating and other gastrointestinal symptoms, which can reduce your discomfort and pain. You can try to: 

• Avoid foods known to cause inflammation eg alcohol, caffeine, dairy, gluten, processed foods and red meat
• Drink peppermint tea or ginger tea 
• Eat more fibre to reduce your risk of constipation
• Follow a low FODMAP diet — this means avoiding high FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) foods eg certain fruits (eg apricots, apples, peaches, plums, nectarines), dairy, legumes, certain vegetables (eg broccoli, cabbage, cauliflower and onions) and wheat

There is no specific endo belly diet, so you will need to try out different changes to your diet to find out what works best for you. 

Track what you eat daily

Keep a food diary to track what you eat and drink, including how much water you drink, alongside your endo belly symptoms and how much sleep you get. This will help you identify patterns that may suggest what makes your endo belly symptoms worse.

You can also try using smartphone apps designed to track menstrual cycle symptoms and gastrointestinal symptoms.

This information may help in getting a diagnosis and making changes to your diet that will reduce your symptoms.

Exercise and massage

Regular exercise can reduce pain caused by endo belly over time. This is because exercise improves your blood flow, which ensures your body gets all the oxygen and nutrients it needs, and reduces stress, which can worsen endo belly symptoms.

You can try gentle twisting actions to improve blood flow and movement through your tummy, and reduce bloating and pain. You can also try going for a short walk before bedtime to help food move through your digestive system and/or a gentle tummy massage to reduce bloating.

Sleep well

Your body needs sleep to repair and restore itself. Lack of sleep can cause hormonal and metabolic changes, which can increase your body’s stress responses. This can worsen pain and cause bloating. Women with endo belly are more likely to have insomnia.

Relax your pelvic floor

The pain caused by endo belly causes your pelvic floor to contract and become hypertonic ie your pelvic floor muscles become too toned. To prevent this happening, try relaxing your pelvic floor by performing specific pelvic floor relaxation exercises, lower abdominal muscle relaxation exercises, deep belly breathing and total body relaxation exercises. You can speak to your GP or a physiotherapist for more information on these exercises.

Reduce stress, find a sustainable self-care routine and stick to it

Stress can worsen the symptoms of endometriosis. Reducing your stress levels can therefore help reduce your endo belly symptoms, as well as other symptoms caused by endometriosis.

People relax in different ways, so find what works for you and stick to it. Make sure you set personal boundaries and a sustainable self-care routine.

Endo belly treatment and management options

Treating endometriosis and managing its symptoms can reduce your endo belly symptoms. 

Medications for endometriosis include: 

• Gonadotropin-releasing hormone (GnRH) to block oestrogen production, which can worsen endometriosis symptoms, such as inflammation and pain
• Supplemental hormones or birth control pills — these help regulate the monthly changes in your hormones, which can cause endometrial tissue to grow outside your womb
• Synthetic androgen capsules to inhibit certain hormones that can worsen endometriosis symptoms

Surgical treatments for endometriosis include: 

• Hysterectomy and oophorectomy — major surgery to remove your womb (hysterectomy) and ovaries (oophorectomy); this is only recommended if you have severe pain that does not improve with any other treatments and you do not want to become pregnant in the future
• Laparoscopy — a minimally invasive surgery to remove endometrial tissue growing outside your womb

Other causes of a bloated belly

There are many other conditions, in addition to endo belly, which can cause abdominal bloating. This includes: 

• Gastrointestinal conditions such as: 
• Coeliac disease
• Food intolerances
• Gallstones
• Inflammatory bowel disease — this includes ulcerative colitis and Crohn’s disease
• Irritable bowel syndrome (IBS)
• Ovarian cysts
• Pregnancy
• Premenstrual syndrome (PMS)

The types of food you eat can also cause bloating as certain foods produce more gas when they are broken down in your digestive system. This includes: 

• Beans
• Certain fruits eg apples and pears
• Certain vegetables eg broccoli, Brussels sprouts, cabbage and cauliflower
• Dairy products
• Whole grains eg oats and wheat 

Drinking fizzy drinks can also cause bloating.

If you experience bloating frequently that lasts more than a few days and/or causes you pain, you should see your GP. You should also see your GP if your bloating occurs alongside: 

• Blood in your stools
• Fever
• Severe stomach pain, particularly after you have eaten
• Unintentional weight loss
• Vomiting

Endometriosis resources

There are many charities and non-profit organisations that provide free resources and information about endometriosis, as well as support if you have endometriosis. This includes: 

• Endometriosis UK
• Endo Warriors 
• International Pelvic Pain Society 
• My Endometriosis Team 
• Pelvic Pain UK
• World Endometriosis Society