Let’s talk about the endo belly. I know you know what I mean: How one minute you can fit into your jeans, and the next you need maternity wear. How you can actually be mistaken for being pregnant. How your stomach can swell up four dress sizes in the space of 10 minutes.

The endo belly seems to be a mysterious symptom of endometriosis that, from my experience, not many of our medical professionals address. I don’t recall having many conversations about my bloating with any doctors in relation to my endometriosis, and the only answer I’ve ever gotten from a GP is that it was simply gas.

Endo belly symptoms seem to vary from patient to patient and be triggered at different times by different things. I bloat more easily in my premenstrual phase, but also bloat after eating raw or gently cooked carrots, sweet potatoes, broccoli, apples, smoothies, certain nuts, gluten, and dairy. These are the most obvious culprits, but I often find I bloat mysteriously, and I can’t work out what the trigger was.

I’m pretty sure that I’m missing one or maybe a few digestive enzymes that would help me break down raw or lightly cooked vegetables. I’ve noticed that my symptoms are eased when I take digestive enzymes, though they don’t disappear. There’s also the chance I have low stomach acid, but what I’m most curious about exploring at present is a condition called small intestinal bacterial overgrowth (SIBO).

In a healthy gut, most of the bacteria is in the large intestine; however, with SIBO, there is excessive bacteria in the small intestine or abnormal bacteria living there when it shouldn’t be.

Misplaced bacteria or increased levels lead to symptoms such as bloating, burping, diarrhea and/or constipation, gas, pelvic pain, and fatigue, to name a few. These gut issues often lead to leaky gut, which triggers the immune system to create inflammation (on top of the inflammation we already have from endo). It can interfere with the absorption of nutrients, frequently resulting in vitamin D, iron, and B12 deficiencies, which can cause fatigue.

I’ve been learning about SIBO in my women’s health course, and I’ve found the link between it and endometriosis very interesting.

In their book “The Endometriosis Health & Diet Program,” Dr. Andrew Cook and Danielle Cook share research that shows an increased risk of SIBO in people with endometriosis, a finding that has been supported by observations made in their clinic. They discuss research showing that, in a group of 50 women diagnosed with endo, 40 had also had SIBO.

The Cooks explain how the inflammation induced by endometriosis can alter the bacteria in the gut, often leading to SIBO, among other problems. This finding is echoed in “Beating Endo,” by Dr. Iris Kerin Orbuch  and Amy Stein, DPT, who explain how endo-related inflammation and reduced or altered gut motility (thanks to a tight pelvic floor or adhesions) can result in SIBO.

Dr. Jessica Drummond also emphasizes the importance of gut health and healthy gut bacteria in her Endometriosis MasterClass The Gut-Immune Link. In the $497 program, geared to health professionals, she explains how organic acids testing can reveal whether a patient has a gut imbalance, though a breath test will determine whether that gut imbalance is SIBO.

To address SIBO, she pulls from research indicating that herbal therapy and a low-FODMAP diet will help starve the bacteria in the low intestine and address the root cause of the symptoms. She does take care to stress that, because of the restrictive nature of a low-FODMAP diet, the approach should be therapeutic rather than long-term, and recommends limiting it to three months.

In their book, Orbuch and Stein also suggest using a specific antibiotic that targets the small intestine and leaves the bacteria in the rest of the gut, which hopefully is healthy, unharmed.

While SIBO isn’t the only condition or issue to consider with endometriosis and gut health, it is an important one to consider and potentially address.

For further support, you could seek out the aid of a Women’s Health Coach or a functional nutritionist who can go through the testing with you and help create a diet plan that’s tailored to your needs.

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Note: Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Endometriosis News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to endometriosis.