Irritable bowel syndrome (IBS)

2020, Responses from: Lara Briden

I have both endometriosis and irritable bowel syndrome (IBS). Is there a connection? 

Yes, there’s a connection between endometriosis and bowel problems.

For one thing, both endo and IBS can present with similar symptoms such as bloating, abdominal cramping, nausea, diarrhoea, and pain with bowel motions. This overlap in symptoms can make it challenging to find the right diagnosis so be sure to alert your doctor to symptoms that are more endo-specific such as pain with sex, pain referred to the back, or a family member with endometriosis.

It is also quite common to have your situation of both endo and IBS. In fact, bowel symptoms are known to occur in up to 90 percent (1) of women with endometriosis and are generally attributed to either the presence of lesions on the bowel or to heightened pain sensitivity in the pelvis and abdomen, which is called visceral hypersensitivity.

There is also the intriguing possibility that gut problems may contribute, at least in part, to the disease process of endometriosis. That’s according to new research which has linked endometriosis to an imbalance of gut bacteria. (2)

The good thing about the link between endo and IBS is that you might be able to reduce endo symptoms simply by treating your gut problems. The best-known treatment for IBS is the low-FODMAP diet, which is the avoidance of fermentable carbohydrates found in dairy, wheat, legumes, and certain fruits and vegetables. Low-FODMAP is widely prescribed for IBS and has also been found to be helpful for endometriosis. (3)

Similar to the low-FODMAP diet is the strategy of avoiding gluten (a protein found in wheat, rye, and barley) and A1 casein (a protein found in normal cow’s milk). Both gluten and A1 casein (4) can cause digestive problems and avoiding them can help to reduce the symptoms of both IBS and endometriosis in some people. (5,6)

There’s no one-size-fits-all nutritional approach to endometriosis but understanding the link between endo and gut problems could help you discover which IBS treatments are also helpful for your endo pain.

In addition to a low-FODMAP diet, other possibles treatments for IBS include:

  • reducing stress
  • exercising regularly
  • eating at regular times
  • avoiding (if possible) stomach acid medication which can worsen IBS (7)
  • Trying a probiotic such as Lactobacillus plantarum 299v or Saccharomyces boulardii

Hopefully, future research will clarify the relationship between endometriosis and IBS and bring new treatments to light.

For more tips about IBS and endo, visit the ENZ nutrition page.


  1. Maroun P et al. Relevance of gastrointestinal symptoms in endometriosis. Aust N Z J Obstet Gynaecol. 2009 Aug;49(4):411-4.
  2. Leonardi M et al. Endometriosis and the microbiome: a systematic review. BJOG. 2020 Jan;127(2):239-249.
  3. Moore JS et al. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205.
  4. Jianqin S et al. Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk. Nutr J. 2016 Apr 2;15:35.
  5. Marziali M et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012 Dec;67(6):499-504.
  6. Marziali M et al. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltrating Endometriosis.  Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S51-S52
  7. Bruno G et al. Proton pump inhibitors and dysbiosis: Current knowledge and aspects to be clarified. World J Gastroenterol. 2019 Jun 14;25(22):2706-2719.
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