Is there a link between Irritable Bowel Syndrome (IBS) and endometriosis?

Is there a link between Irritable Bowel Syndrome (IBS) and endometriosis? Dr. Jessica García from Clinica Tambre explains

Can you first start by explaining what IBS is? 

IBS is a common functional gastrointestinal disorder in the absence of structural gastrointestinal disease, infection, or biochemical disturbance.

It causes symptoms like stomach cramps, bloating and flatulence, chronic abdominal pain or discomfort, associated with diarrhoea, constipation , or both.

Can you give us a brief description of endometriosis?

Endometriosis is a medical condition where endometrial tissue, similar to the one that normally is inside of the uterus, grows outside of the uterus in other organs, such as the fallopian tubes, ovaries, intestines, etc.

It can affect women from any age and the main symptom is chronic abdominal pain especially during the menstruation.

What are the links between IBS and endometriosis? 

IBS and endometriosis share a lot of symptoms, and it seems that patients with endometriosis have higher risk of IBS than the normal population. Endometriosis may be a major contributor to IBS in women.

Does endometriosis cause IBS or can IBS symptoms be worsened by endometriosis?

Endometriosis doesn’t cause IBS, patients with endometriosis are often misdiagnosed with IBS. When the endometrial tissue is in the bowel it causes symptoms that are difficult to distinguish from IBS. The main difference is that in endometriosis the symptoms are related to the menstrual cycle and usually get worse during the menstruation.

Other patients can have the two conditions together, and in that case IBS symptoms could be worsened by endometriosis.

What symptoms should people be aware of for both IBS and endometriosis?

The symptoms in both diseases can be very similar.   

People should be aware of chronic abdominal pain or discomfort, bloating, painful periods (especially if the pain tends to increase with the pace of time), periods of diarrhoea and constipation, etc.

If someone is suffering from IBS symptoms, does that mean the endometriosis is most likely to be present in the bowel?

The endometriosis can be present in different severities. Some patients can be even asymptomatic. In the most severe cases of endometriosis, we can find endometrial tissue present in the bowl, these patients usually are very symptomatic. So if one patient is suffering from IBS symptoms is more likely to have bowel endometriosis.

How can you manage these symptoms?

Patients with diagnosis of endometriosis, depending on the severity and the associated symptoms, can be treated with hormonal treatments such as the contraceptive pill, analgesic medication, antioxidants supplements or even some of them with more severe cases may need a surgery.

For IBS symptoms the treatment, depending on the severity, requires a special diet, many research supports the low FOODMAP diet. Also, when the diet is not enough, we can use medicine such as antidepressants, probiotics, antidiarrheals, laxatives, etc

What should people do if they think they have endometriosis, but are being told they have IBS?

They should consult a gynaecologist, preferably if it is specialist in endometriosis.

How do you test for IBS and endometriosis?

For the diagnosis of IBS the diagnosis is done after ruling out other diseases with similar symptoms. Usually we need to test for gluten or lactose intolerance, infections and structural alterations. Some patients will have to do endoscopy or colonoscopy.

The diagnosis of endometriosis is usually done with pelvic scans or MRI, in some patients it is necessary to perform a laparoscopy to make the diagnosis and at the same time treat the lesions.

How much research is going on into endometriosis and IBS?

 In the last couple of years there was more attention  to this association and some studies were done but the truth is that we still don’t fully know the connection between endometriosis and IBS. There is some research going on at this moment on this matter.

If you have IBS and/or endometriosis, will you need fertility treatment to help you conceive?

Not necessarily. For IBS, the link with infertility is not common. For endometriosis there is a strong association, it seems that around half of the patients with endometriosis have infertility difficulties.

If you are diagnosed with endometriosis and you want to get pregnant it is recommended that you consult your gynaecologist for fertility advice.