Bowel Symptoms in Endometriosis: What’s Normal, What’s Not.
It’s one of the most common- yet least talked about- challenges of living with endometriosis: bowel symptoms.
Many people with endometriosis experience bloating, constipation, diarrhoea, pain with bowel movements, or a sensation of incomplete emptying. These symptoms can occur even without endometriosis directly affecting the bowel, because of the condition’s links with inflammation, nerve sensitisation, and pelvic floor dysfunction.
Let’s consider what healthy bowel habits typically look like, how endometriosis may contribute to bowel changes, and what you can do to help.
What Are Normal Bowel Habits?
There’s a wide range of “normal” when it comes to bowel habits- and no one pattern fits everyone:
Frequency: anywhere from 3 times per week to 3 times per day can be considered normal.
Texture: soft, sausage-shaped stools that are easy to pass, without straining.
Colour: typically brown, due to bile pigments.
Effort: bowel motions should not require excessive time or effort — ideally within about a minute.
Stools that are consistently hard, dry, lumpy (suggestive of constipation), or loose and watery (suggestive of diarrhoea) may indicate something’s amiss- especially when associated with pain, straining, urgency, or bloating. These are all good reasons to check in with your GP.
Common Bowel Concerns in Endometriosis
Research shows that bowel-related symptoms are highly prevalent in people with endometriosis.
These can include:
Constipation- often linked with pelvic floor muscle dysfunction, altered nerve signalling, or medications such as opioids or hormones.
Pain with bowel movements (dyschezia)- particularly if deep infiltrating endometriosis is affecting the bowel wall.
Bloating- linked to inflammation, visceral hypersensitivity, and sometimes dietary factors.
Alternating constipation and diarrhoea- due to hormonal changes, or overlapping irritable bowel syndrome (IBS) is more common in endometriosis.
It’s also very common for people to feel their bowel symptoms worsen around their menstrual period, due to hormonal influences on gut motility.
Red Flags — When to See Your Doctor
🚩 Blood in the stool (red, maroon, or black)
🚩 Severe pain with bowel movements
🚩 Unexplained weight loss
🚩 Bowel habits changing suddenly or significantly
🚩 Night-time bowel motions disrupting sleep
3 Tips to Support Better Bowel Habits
1- Posture on the toilet:
Sit with feet flat on a small footstool, knees slightly higher than hips, leaning forward with a straight back. This helps open up the rectum and reduce straining. Relax your belly, and make a “ssss” sound with your mouth to gently splint without straining.
2- Respond to the urge:
Try to go when you first feel the urge, rather than delaying- holding on can lead to harder stools and more straining. This may feel tricky if you don’t like going out and about. Trying to form some sort of routine may help with predictability, for example, starting the day with a hot drink and walk.
3- Include enough fibre:
Aim for a balance of soluble (oats, fruits, veggies) and insoluble (whole grains, seeds) fibre, unless advised otherwise by your healthcare team- fibre helps regulate stool consistency.
In Summary
Changes in bowel habits are very common with endometriosis. Understanding what’s normal, and what may indicate an issue, helps you take control and seek the right support. If you’re struggling with bowel symptoms, talk to your healthcare team- pelvic physiotherapy, diet changes guided by a nutritionist or dietitian, and appropriate medications can all help.
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