What Is Endo Belly?

It can be emotionally and physically painful.

Endometriosis is an inflammatory disease where tissue that is similar to the uterine lining begins growing in other internal places in the body. These other spots can include the ovaries, fallopian tubes, bowels, or bladder—even your lungs in rare cases, per MedlinePlus. The tissue still behaves like it's in the uterus, so the tissue cells bleed when your period comes around. But since they're in the wrong spot, the blood is stuck inside your body, and it's incredibly painful.

Endometriosis is thought to affect 11% of women between 15 and 44, according to the Office on Women's Health (OWH). However, it can affect all individuals assigned female at birth (AFAB), and its symptoms can take a toll on your body.

Specifically, endometriosis bloat (also known as "endo belly") is not the typical bloating symptom that comes when a person's period arrives, as endometriosis does not allow for regular cycles. Learn more about endometriosis bloat and what can be done to get relief from it.

What Is Endo Belly—And What Are Some of the Effects?

Endometriosis bloat is one of the most unpleasant endometriosis symptoms. On any given day, the lower abdomen can swell, setting off physical and mental anguish.

"Women in the general public may get bloating a day or two before their cycle," said Karli Goldstein, DO, consulting surgeon and medical advisory board member for the Endometriosis Foundation of America, "but endometriosis bloat can be more drastic and persist longer." The bloating can stay for days, weeks, or just a few hours.

Endo belly typically gets worse as the day goes on. "Frequently, patients will be fine in the morning, and it will get bigger and bigger until the evening when they can't button their pants," Dr. Goldstein explained. "You can look six months pregnant by the end of the day."

Beyond causing physical discomfort, endo belly is also emotionally troubling. Since endometriosis can make it difficult to conceive, looking like you're in your second trimester can feel like a cruel side effect. Plus, there can be body image ramifications. Individuals with endometriosis are told to eat healthily, exercise frequently, and maintain ideal body weight to help with their symptoms. When an endo belly surges forward, it can feel frustrating, upsetting, and demoralizing.

Why Does Endo Belly Occur?

"We don't know the exact reason why it happens," Dr. Goldstein said. "There have been multiple studies, but there's no good proof. Even though you can see visibly something's happening, if we do a CT scan, there's not really a tangible, finite reason it's happening. It's very frustrating for patients."

Endometriosis is a complex disease that affects each person differently, but there are two theories as to what causes bloating in endometriosis. The first is that endo belly accompanies a menstrual period. When endometrial tissue growing on other organs thinks it's time to menstruate, those with endometriosis begin bleeding internally, and the body gets inflamed.

The second theory is that patients with endometriosis can be more sensitive regarding how their intestines and gut process things, Dr. Goldstein said, adding that endo belly could be a side effect of the intestines working overtime.

This is one reason why anti-inflammatory diets are consistently recommended for people with endometriosis, Dr. Goldstein said. However, there's no one diet for endo, Dr. Goldstein stressed. "You have to see what's best for you and what you react to."

Ways To Reduce the Occurrence of Endo Belly

Since there's no official stance on what causes bloating with endometriosis, there's no official cure. But there are some techniques worth trying that may help soothe your symptoms.

Dr. Goldstein recommended seeing an endometriosis specialist. Make sure your endometriosis is being managed before tackling your bloating. "A lot of our patients, after having quality excision surgery, report that their bloating is better," Dr. Goldstein said.

Getting a referral for a dietician can also be beneficial for handling endo belly. "You need to find someone who will holistically work on the body and your reactions to different things," Dr. Goldstein said. "Find someone open-minded." You can ask your endometriosis specialist for a recommendation if you're unsure where to start.

As noted, starting an anti-inflammatory diet is considered to be helpful for those who have endometriosis. The best way to find your version of an anti-inflammatory diet is to start with an elimination diet, slowly add things back in, and note when endo belly pops up. Eliminate those foods going forward: Your dietitian can help you through this process.

Of note, healthy lifestyle habits are crucial, Dr. Goldstein said, but not always easy when dealing with endometriosis. "It takes a multi-team and system approach to feel your best. You have to work harder at these things than family and friends. Even with surgery, you can't slack on all the other aspects afterward, or you will feel crummy."

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