Diet and nutrition are first line therapy for treating constipation. And with constipation a common symptom seen in people with endometriosis, eating for endometriosis and constipation can have a profound impact on your symptoms.
What is endometriosis
Endometriosis is a condition characterised by the presence of endometrial tissue outside the uterine lining. Typically on the uterus, ovaries, fallopian tubes, abdominal wall and intestines including the bowel.
Emerging research suggests the prevalence of endometriosis is much higher than originally thought, affecting about 1 in 7 women. Common symptoms like gut issues, pelvic pain, dysmenorrhea, dyspareunia, fertility complications, fatigue and back pain can range from mild to severe and do not always correlate with the severity of disease.
Gut symptoms like bloating, constipation and diarrhoea are regularly attributed to other conditions like Irritable Bowel Syndrome (IBS). As these conditions share similar presentations with endo, misdiagnosis can occur, potentially leading to a delay in treatment. But the stats do show higher rates of IBS amongst people with endometriosis.
What is constipation?
Constipation is defined as the infrequent passing of hard and dry poo that may be difficult to pass. Infrequent tends to mean fewer than 3 complete motions a week. I say ‘complete’ because constipation can also be a feeling of having an incomplete movement, IYKYK.
A common cause of constipation can be suboptimal fibre and fluid intake. However, any bowel changes should be assessed by your GP.
So how does dietary fibre does keep bowels regular? In a nutshell, it increases stool bulk creating weight and drawing water into the stool. There is a lot more to it, but for the sake of this article not becoming a novel, I’m moving on. Important note: dietary fibre without adequate fluids can make constipation worse, so don’t do that.
Constipation + Endometriosis
How endometriosis contributes to constipation isn’t 100% clear. Some research suggests the weight and pressure of endometrial lesions on, and around, the bowel including the rectum and anus lead to stiffness, which slows motility and leads to constipation and pain. There is also evidence of different microbiomes in people who have endometriosis, and lower fibre intake related to gut symptoms.
Fibre is routinely recommended as a nutrient to increase for everyone, but especially people with endometriosis. This is for variety of reasons, not limited to but including, improved bowel function, microbiome diversity and oestrogen clearance.
But too much fibre, or specific types of fibres can trigger symptoms like bloating, excessive gas, GI pain and even constipation and diarrhoea in some people with endometriosis and IBS.
In fact, Data suggests people with endometriosis report higher rates of food intolerances and GI symptoms including constipation. And unsurprisingly lower dietary fibre intake can be seen in this cohort.
I really empathise here because it can feel like a vicious circle where fibre causes gut issues, and reduced dietary fibre leads to constipation. The magic here is to find the perfect balance of eating for endometriosis and constipation which works best for you.
So where to start?
It depends. I really wish I could give you the one perfect diet to relieve all symptoms. But specific nutrition changes which will best benefit you will be based on your history, symptoms, goals, diet, lifestyle (and on and on).
But if you are here and reading this, I suspect you suspect you have endometriosis, or IBS, or gut issues and/or constipation, or you have a confirmed diagnosis. Either way, please speak to your healthcare team before changing their treatment plan based on information you read on the internet.
Or book a 1:1 consultation if you suspect something is not right or you would like to address your symptoms.
Things to consider
Clinically I screen for constipation. These are just a few of the things I consider:
- How much dietary fibre is regularly in the diet?
- What types of fibre is consumed and is there adequate prebiotic fibre?
- How much fluid from food and drinks is being consumed?
- Does coffee, spicy foods and alcohol relate to symptoms?
- Are high FODMAP or specific intolerance foods present, and at what quantity?
- Routine, is there a pattern to meals and bowel habits?
- What medications and supplements are taken?
- Fitness and rest, too much or too little of either?
- And about a million other things.
Eating for endometriosis and constipation: things to try before self-prescribing laxatives (unless you have allergies or intolerances to these foods)
- See your GP
- Book a 1:1 consult with a dietitian (it does not need to be me!)
- Eat more colourful fruit and veggies every day. Aim for at lest 7 serves
- Eat 2 kiwis every day
- Drink enough water. You don’t want to feel thirsty, and your urine should be a pale yellow colour
- Sprinkle seeds like chia and flax over your toast and cereals
- Eat legumes every day
- Snack on nuts
- Consider your sleep, fitness and bowel routines
- Read my related article on perinatal constipation
Constipation can be a red flag, a symptom, a one off, chronic, fleeting – but seeking healthcare guidance is always your step 1. With the right investigation and treatment strategies, you should be on your way to happier regular motions.