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Suffering from IBS? You Also Should Get Checked for Endometriosis

May 19, 2015

About 15 percent of adults in the U.S. suffer from irritable bowel syndrome (IBS), the majority of whom are women.

Women account for nearly 65 percent of all cases of IBS, a condition that affects the large intestine and leads to painful symptoms such as cramping, abdominal pain, constipation, diarrhea and bloating.

IBS causes a lot of discomfort for many women, and its symptoms often resemble another serious women’s health issue—endometriosis.

Endometriosis is a gynecological disorder in which the tissue that normally lines the inside of the uterus begins to grow outside of it, leading to severe abdominal and pelvic pain. Endometriosis sometimes involves the ovaries and can affect your reproductive health.

Aside from painful periods, some of the most common symptoms of endometriosis are constipation and painful bowel movements, especially during your period.

The Link Between IBS and Endometriosis

According to the UNC Center for Functional GI and Motility Disorders, women with IBS are more likely than women with other bowel symptoms to be diagnosed with endometriosis.  But conversely, some women who experience bowel issues may be misdiagnosed with IBS when in fact they have endometriosis.

There’s some overlap between the two conditions, and doctors are still in the process of learning why. However, one reason for the confusion could be that some women suffer from bowel endometriosis, which affects both the abdomen and pelvis. Though endometriosis mostly affects the uterus, misplaced endometrial tissue can appear near the large intestine and progress to the surface of the bowel or penetrate the bowel wall. This causes inflammation in the area that can lead to bowel issues. Up to 37 percent of women with endometriosis also have bowel endometriosis. In cases where a woman has yet to be diagnosed with endometriosis, these symptoms may appear to be IBS or pelvic inflammatory disease.

When to See a Doctor

So, how can you tell the difference between IBS and endometriosis? And when should you be concerned that bowel issues may actually be endometriosis? Unfortunately, the answer isn’t that simple.

IBS requires a “diagnosis of elimination,” meaning doctors have to rule out other causes before they come to a final determination. Often, we will perform a battery of tests, including blood tests, lactose intolerance tests and a colonoscopy, to first eliminate other health conditions. To be diagnosed with IBS, you must experience discomfort for at least three days during the last three months and you must have bowel symptoms for at least six months before you can get a medical exam.

Though IBS shares similar symptoms to endometriosis (and bowel endometriosis, in particular), the two conditions do differ in some ways.

One study that compared the two conditions found that women with IBS were more likely to alternate between constipation and diarrhea, have nausea, upper abdominal pain, more pressure in their abdomen and pain that worsened after eating or stress. On the other hand, women in the study with endometriosis were more likely than those with IBS to bleed between periods, have vaginal tenderness and more pain right before their period.

However, what complicates the matter is that women with IBS often experience more severe symptoms during their menstrual cycle. If you notice that your symptoms worsen during this time, talk to your gynecologist to express your concerns. If other symptoms are present that may be warning signs of endometriosis, your doctor likely will suggest a laparoscopy, a minimally invasive procedure that allows us to get a closer look inside your abdomen and determine if there are any growth or cysts that may indicate endometriosis.

If you are diagnosed with endometriosis, medication, hormone therapy (contraceptives and injectable drugs) or surgery to remove the endometriosis are all effective treatment options. However, the best treatment approach will depend on your particular case.

IBS and endometriosis are both painful conditions that affect many women. Many of the symptoms overlap, but if you have bleeding between periods, intense pre-menstrual pain and severe bowel symptoms before your period, it’s best to talk to your doctor to determine if the issue is gynecological and not gastrointestinal.

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