Understanding and Managing Endo Belly: Tips for Relief

endo belly

Endo belly is a term used to describe digestive symptoms of endometriosis. It can also cause emotional distress because it can be difficult to alleviate the endo belly simply through working out or cutting calories, and it may appear to an onlooker to be a pregnancy when in fact it is just endo belly bloating.

endo belly

Disclaimer: This post is not intended to serve as medical advice, or diagnose, or treat any medical conditions. Please seek a qualified medical professional for assistance in those areas.

What is Endo Belly?

“Endo belly” is a common term for the digestive symptoms of endometriosis and can encompass small intestinal bacterial or fungal overgrowth syndromes (SIBO or SIFO), or changes to the large bowel, including dysbiosis. Endo belly is just one symptom of endometriosis.

Symptoms of endo belly may appear clinically including:

  • slow motility
  • bowel or rectal endometriosis
  • pelvic inflammation that impacts digestive function
  • gut microbiome dysbiosis

What does endo belly feel like? Endo belly may feel like a sense of fullness or bloating in your abdomen.

Can you have endo belly without a uterus? Yes, because endo belly deals primarily with digestive issues in the small and/or large intestine.

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Recognizing Triggers and Patterns

Gastrointestinal symptoms affect up to 90% of patients with endometriosis. The most common gastrointestinal symptom in endometriosis is bloating, followed by nausea, constipation, diarrhea and vomiting.

A balanced gut microbiome promotes proper digestion and nutrient absorption and also plays a key role in maintaining gut barrier integrity. Without gut barrier integrity the risk of increased intestinal permeability or “leaky gut” increases.

In the very least, leaky gut can lead to inflammation. The inflammatory microenvironment is closely related to the occurrence of endometriosis. An unhealthy microbiome contributes to immune dysregulation involved in endo and immune dysregulation in endo can contribute to gut dysbiosis (including uterine, vaginal and peritoneal dysbiosis).

Some women can pinpoint a certain food or food group that was eaten and resulted in endo belly, but many women are not able to pinpoint the cause. This is because it may be only partially related to what foods you eat and other factors are at play.

The Role of Inflammation in Endo Belly Symptoms

The gut microbiota is a major regulator of inflammatory processes outside the gastrointestinal tract, which may be involved in the progression of endometriosis.

The cytoplasmic protein AXIN1 is involved in the regulation of apoptosis and has been reported to be a potential new biomarker for endometriosis. (It is also involved in cancer signaling and bone mineral density).

Further, the microbes and bacteria found in the gut microbiota of women with endometriosis differ from women’s gut of those who do not have endometriosis. Escherichia coli (e-coli) is significantly increased in women with endo for example. (Escherichia and Shigella belong to the family Enterobacteriaceae). A less healthy and diverse gut microbiota can lead to higher circulating estrogen levels which can lead to the progression of endometriosis.

Managing Endo-Belly Through Diet

Focusing on optimizing the digestive function, immune function and gut microbiome health will improve all non-specific symptoms of “endo belly.”

Fasting Between Meals

Currently there is research which demonstrates that autophagy is down regulated by endometriosis and that autophagy is suppressed by an inflammatory pathway contributing to endometriosis progression.

So, it is not clear whether fasting could improve endometriosis symptoms but fasting is a strategy to consider using to support improvement of appropriate immune functioning. I wrote a post about fasting in between meals (meal spacing) which will help you learn more about this.

Improving Digesting

Furthermore, people with endometriosis typically present with nutritional deficiencies and food intolerances.

As chewing, stomach acidity, and enzyme and bile activity, motility and small intestine barrier function improve, nutrients will be better absorbed as the immune system becomes less reactive to natural, un-processed foods.

Chewing your food is a simple place to start improving your digestion. 30-40 chews per bite is a standard rule of thumb.

Lifestyle Changes for Endo Belly Treatment

Two lifestyle changes were just addressed which may help indirectly with endo belly: fasting in between meals and ensuring adequate chewing of bites of food. (Though, for women with issues with blood sugar regulation always consult your doctor before starting any fasts in-between meals).

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Herbal Supplements and Endo Belly Remedies

Are herbal supplements helpful in treating this digestive issue? The answer is it’s complicated.

Supplements can’t really fix a bad diet, and all supplements are not created equal. What’s more, each individual may have something slightly nuanced and different going on physiologically so a one-size treats all approach may not be the best.

For example, women who have had bowel surgery for endometriosis may have more reports of constipation and longer evacuation time in any case.

I would personally advocate for the establishment of a whole foods diet with plenty of vegetables, soups, broths and healthy fats and proteins. Even then, what each woman’s body can tolerate may not be the same. Doing your own homework and assessment is important as is finding a provider to help you with your special issues.

I personally noticed that my bloating lessened after I began eliminating processed foods, sugars, gluten and dairy and increased salads, plant based foods and healthy sourced fats and proteins. I noticed a big change after about 30-90 days of eating like that. Now, everybody is different and you may be eating this way already and still have severe bloating and other digestive complaints. Your digestive tract may have other things going on with it than mine did.

Now, you may be asking how do you know if you have bacteria imbalances in your gut at all? Well, if you are symptomatic, chances are there is something going on that is not ideal. The most commonly used functional test to determine the integrity of the intestinal barrier in the small intestine is the Mannitol-Lactulose test. Other tests such as food sensitivity tests or testing the reactivity of the immune system to certain toxins can give further clues in the intestinal barrier function.

Seeking Professional Advice

It is important to consult with healthcare providers for personal medical advise when dealing with endometriosis and symptoms that may be associated with endo-belly.

Achieving good outcomes with bowel endometriosis or endometriosis in general requires proper evaluation and experienced surgical care.


Dysbiosis of the gut can wreak havok on your life in many ways, but hopefully after learning a bit more you can find resources to help you rebalance your gut and assess for any other conditions. Wishing you light and life!

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