Is It Endometriosis or IBS?

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Many women find that their IBS symptoms worsen around the time of their period. When this happens, it is not too much of a stretch to wonder if perhaps the problem has to do with the reproductive organs and not the bowel. Endometriosis is a gynecological disorder that like IBS, can result in symptoms of abdominal pain and cramping. This overview of endometriosis and its possible overlap with IBS can help you to determine if you have been diagnosed accurately.

What Is Endometriosis?

To best understand what endometriosis is, let me bring you back to high school biology. As you may recall, as part of a woman's menstrual cycle, the endometrial tissue lining the inside of her uterus thickens each month. If no pregnancy occurs, this tissue is shed when a woman has her period.

Endometriosis is a condition in which this endometrial tissue grows in parts of the body outside the uterus. Because this tissue is outside of the uterus, it cannot be expelled out through the vagina during a woman's period. This tissue may become inflamed and/or result in adhesions and cysts. To make matters worse, this tissue will be stimulated to grow by the same hormones that encourage the lining of the uterus to build up each month.

When endometriosis is present, tissue growths are most commonly found in the lower abdomen and the pelvic area. Growths may be seen on the outside of the uterus, the ovaries, the bladder, the rectum, and the large intestine.

Symptoms of Endometriosis

For some women, endometriosis may be present without any symptoms. Others may see the pain from the condition as a normal part getting one's period.

Here are the main symptoms of endometriosis:

  • Strong abdominal pain and cramping, particularly during one's period (dysmenorrhea), but may be present throughout the cycle
  • Pain experienced during or after sexual intercourse (dyspareunia)
  • For some women, infertility
  • Bladder difficulties

Relevant to our present discussion of the relationship of endometriosis to IBS, endometriosis may result in the following digestive symptoms:

  • Pain during bowel movements
  • Difficulty having a bowel movement
  • At times, the severe abdominal pain resulting from endometriosis may be accompanied by nausea, diarrhea, and/or vomiting

Overlap with IBS

Women who have endometriosis are at higher risk for receiving a diagnosis of IBS. Interestingly, this higher risk occurs both before and after the endometriosis is identified. This suggests that IBS is not merely a misdiagnosis of endometriosis.

Why the overlap? In many cases, the misplaced endometrial tissue is located alongside the large intestine. Inflammation associated with this tissue may contribute to bowel problems.

Differences Between the IBS and Endometriosis

Although both disorders result in abdominal pain and cramping, there appear to be some important differences between the two health disorders.

One research study did a head-to-head comparison of the two conditions, including pelvic inflammatory disorder in the mix. The researchers found that IBS patients were more likely to report the following symptoms as compared to the endometriosis patients:

  • Bowel habit changes, i.e. constipation, and/or diarrhea
  • Colicky pain
  • Distension
  • Nausea
  • Upper abdominal pain
  • Pain worsened by food and/or stress

Women who had endometriosis were more likely than the IBS patients to experience:

  • Bleeding between periods
  • Increased pain during the premenstrual phase of the menstrual cycle
  • Tenderness within the vagina

Do You Have Endometriosis?

If your IBS worsens during the time around your menstrual period, it is understandable that you may be concerned that you have been misdiagnosed. If this is the case, it is essential that you speak with your gynecologist. Studies have found that there is often quite a long delay between the onset of endometriosis symptoms and a diagnosis. Part of the problem is that endometriosis can only be definitively diagnosed through laparoscopy.

Sources:

Ballard, K., Seaman, H., De Vries, C. & Wright, J. "Can symptomatology help in the diagnosis of endometriosis? Findings from a national case–control study—Part 1" BJOG: An International Journal of Obstetrics & Gynaecology 2008 115:1382-1391.

"Endometriosis" PubMed Health Accessed November 8, 2012.

"Fact sheet: Endometriosis" PubMed Health Accessed November 8, 2012.

Lea, R., Bancroft, K., & Whorwell, P. "Irritable bowel syndrome, chronic pelvic inflammatory disease, and endometriosis: a comparison of symptomatology" European Journal of Gastroenterology & Hepatology 2004 16:1269-1272

Seaman, H., Ballard, K., Wright, J. & De Vries, C. "Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case–control study—Part 2" BJOG: An International Journal of Obstetrics & Gynaecology 2008 115: 1392-1396.

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