Cramping, bloating, gas, diarrhea or constipation, chronic pelvic pain. Are these symptoms due to endometriosis, irritable bowel syndrome (IBS) or both? IBS — a gastrointestinal disorder of the large intestine — has similar symptoms to endometriosis, making it hard to tell the difference between the two conditions or get a proper diagnosis.

“I was diagnosed with IBS, but most of my symptoms later turned out to be endo,” explained one member of MyEndometriosisTeam. “It’s pretty tricky to tell what's causing what.”

It’s no secret that endometriosis and IBS share some similar symptoms. Whether you have one or both conditions, diagnosing endometriosis and IBS can be challenging. Their similarities may result in incorrect diagnoses and delays in getting the care you need.

In this article, we’ll review key differences between IBS and endometriosis and their impact.

Causes and Risk Factors of IBS

While the cause of irritable bowel syndrome isn’t fully understood, it’s thought to result from a disturbance in how the gut, brain, and nervous system interact. This can cause changes in normal bowel movements and sensations that feel similar to endometriosis — diarrhea or constipation (or both), as well as abdominal pain and bloating.

According to the medical journal BMC Gastroenterology, both IBS and endometriosis are more common in women under age 50. More than 1,800 members of MyEndometriosisTeam report also being diagnosed with IBS. IBS is also linked to trauma during childhood and severe infections of the digestive system.

There may be other reasons why individuals with endometriosis experience IBS. Up to 30 percent of people who contract bacterial intestinal infections develop IBS symptoms in their lifetime. Genetics are also a factor. The risk of developing IBS is two to three times as high if a family member has the condition.

How Does Endometriosis Cause Bowel Symptoms?

Endometriosis can also spread to the bowel or surrounding areas, directly causing tummy troubles. Between 8 percent and 12 percent of people with endometriosis have bowel lesions, which can cause gastrointestinal symptoms. “I only get IBS ‘symptoms’ during a bad flare,” reported one MyEndometriosisTeam member with bowel endometriosis.

Endometriosis symptoms tend to be linked to menstrual periods. Many individuals with IBS self-report increased symptoms during their menstrual cycles too.

“I get horrible attacks, constipation, and sharp pain before my period,” explained one MyEndometriosisTeam member. “They’re only relieved by having a bowel movement.” Another member said, “Hormonal changes cause a bunch of bowel issues for me. I can time my digestive problems to ovulation and my periods.”

Can Endometriosis Cause IBS?

Endometriosis increases your risk for IBS, suggesting a relationship between the two diseases. Research shows that if you have endometriosis, you are about three times more likely to develop IBS than if you did not. According to BMC Gastroenterology, women are more likely to experience gastrointestinal issues than men, and they are twice as likely to experience IBS.

Sorting Out Symptoms of Endometriosis and IBS

Irritable bowel syndrome and endometriosis are typically diagnosed through the process of elimination. Understanding how the two conditions work can help you monitor symptoms and discuss them with your doctor.

Common Symptoms of Endometriosis

Endometriosis occurs when cells that usually line the uterus spread to other parts of the body, such as the ovaries, fallopian tubes, and bowel. Primary symptoms are:

• Chronic pelvic pain
• Painful periods
• Pain during sex

When endometriosis spreads to other parts of the body, the cells swell and bleed as they would during menstruation. They can’t easily shed, however, which can lead endometriosis to cause GI issues like pain, bloating, and cramping.

“I have a lot of adhesions and scarring on my bowels and, each month, they bleed and cramp,” explained one MyEndometriosisTeam member. “I get IBS-like symptoms, but I was told it’s the endo manifesting in a different way.”

Common Symptoms of IBS

You may have IBS if you’ve experienced abdominal discomfort or pain that includes two of these three symptoms at least one day a week for the past three months:

• Change in bowel movement frequency
• Change in appearance of stool
• Symptom improvement with bowel movement

The type of symptoms you experience determines the type of IBS you have. Some people primarily experience constipation, while others mostly experience diarrhea. Some people have mixed or unclassified IBS. “My symptoms alternate between diarrhea and constipation,” shared one MyEndometriosisTeam member.

Visceral Sensitivity — A Shared Symptom

In addition to cramping, bloating, diarrhea, nausea, and painful bowel movements, both endometriosis and IBS share a common symptom: visceral sensitivity. People who have this symptom are more sensitive to pain in their stomach or pelvic area. They might also have irritable bowel syndrome (IBS) if their bowel function is significantly affected.

Impact of IBS and Endometriosis

Misdiagnoses are common for these two conditions. One study found that 10 percent of individuals with endometriosis were treated for IBS before their diagnosis, and that number decreased after the proper condition was identified. The absence of diagnostic guidelines or coordination between gynecologists and gastroenterologists can delay diagnosis of endometriosis in the U.S. by an average of six to 11 years.

“I was misdiagnosed with IBS. I didn’t receive the correct diagnosis until five years later,” shared one MyEndometriosisTeam member. Another said, “I was initially diagnosed with IBS, but after two years of symptoms coming and going each month, it looked more like endometriosis. After two surgeries, the doctors concluded it’s intestinal endometriosis and haven't wanted to touch it.”

After closely monitoring her own symptoms, one member of MyEndometriosisTeam shared, “My IBS pain feels more like an urge to go to the restroom. My endo pain is deep and constant.”

What Helps IBS and Endometriosis Symptoms?

There are many treatment options to ease the IBS symptoms that may exist alongside endometriosis. Some are lifestyle-based, while others require prescription medication or surgery. Because both IBS and endometriosis are chronic conditions, the goal of the treatments is to improve as many symptoms as possible and to improve your quality of life. You may need to talk to your gynecology and gastroenterology teams to come up with a treatment plan.

Surgery

Surgically removing endometrial tissue can bring relief from bowel symptoms. Members of MyEndometriosisTeam report similar experiences. “I had excision surgery to remove the lesions. Since then, I haven't had IBS symptoms, even once,” wrote one member. Another wrote, “After excision five months ago, my symptoms are virtually gone.”

Medication

Various hormonal therapies can reduce symptoms from IBS and endometriosis. One MyEndometriosisTeam member who takes a hormonal drug commented, “It stops endo cells from growing. The upside: No more death-grip period pains. Side effects are a bit rough. Insomnia, dry skin, and thrush — I'm embarrassed to say — are the new norms. I don't know which is the lesser of two evils.”

Some members also take an IBS medication. “I got a prescription for dicyclomine (Bentyl) and it worked. This med is for spasms of the intestines/colon. Most of the time I cannot distinguish if my pain is because of the IBS or endo.”

Diet for Endometriosis and IBS

There’s good evidence that a healthy diet can help painful IBS. “I follow the FODMAP diet and have been symptom-free for over a year!” shared one MyEndometriosisTeam member with IBS and endo, adding, “My last cycle was PAIN-FREE! Healing my gut was the best thing I’ve ever done.”

"Eliminating gluten, dairy, and soy solved 90 percent of my pain,” said another member of MyEndometriosisTeam. Another said, “I still get mini attacks the week before my period, but they last only minutes and don’t completely debilitate me anymore.”

Food Journaling

Keeping a food diary has helped some MyEndometriosisTeam members identify what’s causing their stomach distress. “Having a record to show my doctors has steered them away from the automatic IBS diagnosis (the ‘it’s just your stomach’ argument) and focus on treating the endometriosis,” shared a member.

Medical Marijuana and Cannabidiol

Some members of MyEndometriosisTeam have found relief with cannabis-based medicines like cannabidiol (CBD) oil and marijuana, where legally available. “I get horrible pains 98 percent of the time when I have to ‘BM,’” shared one member, who added, “A super-hot bath and good old Mary Jane (marijuana) is a game changer for me. It takes care of the pain and allows me to wean off the painkillers I’ve taken for nine years (prescribed by my doctors).”

Stool Softeners

“Hydrate with a lot of water to make sure your bowels are MOVING,” one member advised. “Use stool softeners and/or MiraLAX if you’re not regular. Constipation can SO intensify your belly/back/flank pain.”

Hot Baths and Heating Pads

Heat is highly beneficial to ease the cramping, tension, and pain of endometriosis and IBS. Some members relax in an Epsom salts bath with essential oils, surrounded by candles. Others prefer curling up in bed with a heating pad. “That really helps my pain,” said one member.

Massage

One member, who swears by pain-relieving massages, shared some do-it-yourself techniques from a massage therapist: “Massage your quadriceps (upper thighs) and ankles. (They hold a lot of nerves leading to ovaries and uterus.) Use castor oil specifically. It has a lot of anti-inflammatory properties. Also massage your belly, in a circular motion, to help with pain and scars there. I feel much better … and you can too!”

Behavioral Therapies

Cognitive behavioral therapy (CBT), psychotherapy, and hypnotherapy have all been shown to have a positive mind-body effect on IBS. “Dialectical behavioral therapy (DBT), a form of CBT, really helps me,” revealed one member. “It has given me control of my emotions.”

Always check with your doctors before starting any medical or therapeutic regimen for endometriosis and IBS pain.

Talk With Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis and their loved ones. On MyEndometriosisTeam, more than 136,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

Do you experience bowel symptoms with endometriosis? Have you also been diagnosed with IBS? Share your experience in the comments below, or start a conversation by posting on your Activities page.